Universitatea Babeş-Bolyai Facultatea de Psihologie şi Ştiinţele Educaţiei Departamentul Psihologie

Psihologia Religiei

Anul II, semestrul II

Disciplină opțională

Titular curs Prof.univ.dr. Adrian Opre

An universitar 2014-2015

Date de identificare a cursului

Date de contact ale titularului de curs:

Nume: Prof.univ.dr. Opre Adrian Nicolae

Birou: Birou 6 sediul Fac. de Psihologie şi Ştiinţele Educaţiei, str. Republicii 37

Telefon: 0264-590967

Fax: 0264-590967

E-mail: nicolae.opre@ubbcluj.ro

Consultaţii: Miercuri, 12-14

Date de identificare curs şi contact tutori:

Numele disciplinei – Psihologia religiei

Codul disciplinei – PLR1433

Anul, Semestrul – anul 2, sem. 2

Tipul disciplinei – Opțional

Pagina web a cursului- http://psychology.psiedu.ubbcluj.ro

Tutori – Prof. Univ. Dr. Adrian Opre, asist.univ. dr. Ramona Buzgar, drd. Dumulescu Daniela, drd. Ligia Blidaru

Adresa email: religieitutor@psychology.ro

1.2. Condiţionări şi cunoştinţe prerechizite

Cursul de faţă se bazează pe cunoștințele dobândite la o serie de discipline din cadrul specializării Psihologie, precum Introducere în psihologie și Psihologie Experimentală, Psihologie Cognitivă și Limba engleză. De asemenea, cunoştinţele dobândite în cadrul celorlalte cursuri din anul I sporesc considerabil accesibilitatea temelor pe care vi le propunem. În totalitatea lor, aceste prerechizite vor fi foarte utile în rezolvarea lucrărilor de evaluare ce încheie fiecare modul şi, respectiv, în promovarea examenului de evaluare finală.

1.3. Descrierea cursului

Disciplina Psihologia religiei face parte din pachetul de materii opționale ale specializării psihologie, nivel licenţă, din cadrul Facultăţii de Psihologie şi Ştiinţe ale Educaţiei a Universităţii „Babeş-Bolyai” din Cluj-Napoca. Prin tematica sa, această disciplină constituie punctul de pornire în familiarizarea studenţilor cu problematica psihologiei religiei, și completează cunoştinţele aferente cursurilor de Psihologia sănătății, Psihologia Familiei, Psihologia personalităţii, Psihologia dezvoltării, respectiv Psihologie clinică. Tematica tuturor acestor discipline se completează reciproc.

1.4. Organizarea temelor în cadrul cursului

Tematica ce corespunde acestei discipline opționale este structurată sub forma unui reader ce conține doisprezece teme de învăţare. În afara primelor două teme, care corespund

unei introduceri generale în problematica psihologiei religiei, abordând comparativ religia și psihologia, celelalte conținuturi propuse abordează teme mult mai specifice, care acoperă o parte importantă din preocupările cercetărilor și cercetătorilor din acest domeniu. Nivelul de înţelegere şi, implicit, utilitatea informaţiilor pe care le regăsiţi în fiecare modul vor fi sensibil optimizate dacă, în timpul parcurgerii suportului de curs, veţi consulta sursele bibliografice recomandate. De altfel, rezolvarea tuturor lucrărilor de verificare impune, cel puţin parcurgerea referinţelor obligatorii menţionate (reader-ul). În situaţia în care aveţi nelămuriri legate de modulele de învăţare, de realizarea sarcinilor facultative sau a proiectului, sunteti invitaţi să contactaţi tutorii disciplinei la adresa de email specificată.

1.5. Formatul şi tipul activităţilor implicate de curs

Aşa cum am menţionat mai sus, prezentul suport de curs este structurat pe doisprezece module. Parcurgerea acestora va presupune atât întâlniri faţă în faţă (consultaţii), cât şi muncă individuală. Consultaţiile, pentru care prezenţa este facultativă, reprezintă un sprijin direct acordat dumneavoastră din partea titularului şi a tutorilor. Pe durata acestora vom recurge la prezentări contrase a informaţiilor nucleare aferente fiecărui modul, dar mai cu seamă vă vom oferi, folosind mijloace auditive şi vizuale, explicaţii alternative, răspunsuri directe la întrebările pe care ni le veţi adresa. În ceea ce priveşte activitatea individuală, aceasta o veţi gestiona dumneavoastră şi se va concretiza în parcurgera tuturor materialelor bibliografice obligatorii, rezolvarea lucrărilor de evaluare şi a proiectului de semestru. Reperele de timp şi implicit perioadele în care veţi rezolva fiecare activitate (lucrări de verificare, proiect etc) sunt monitorizate de către noi prin intermediul calendarului disciplinei. Modalitatea de notare şi, respectiv, ponderea acestor activităţi obligatorii, în nota finala vă sunt precizate în secţiunea „Politică de evaluare şi notare”.

Pe scurt, având în vedere particularităţile învăţământului la distanţă dar şi reglementările interne ale CFCID al UBB, parcurgerea şi promovarea acestei discipline presupune antrenarea studenţilor în următoarele tipuri de activităţi:

a. consultaţii – pe parcursul semestrului vor fi organizate două întâlniri de consultaţii faţă în faţă; prezenţa la aceste întâlniri este facultativă;

b. realizarea unui reaction paper și a unui proiect de semestru, menţionate în suportul de curs

c. discuţii legate de conţinutul modulelor, prin intermediul adresei de tutoriat religieitutor@psychology.ro.

1.6. Materiale bibliografice obligatorii

În suportul de curs, sunt precizate atât referinţele biblografice obligatorii, cât şi cele facultative. Sursele bibliografice au fost astfel stabilte încât să ofere posibilitatea adâncirii nivelului de analiză şi, implicit, comprehensiunea fiecărei teme.

Dintre materialele recomandate ca bibliografie pentru acest curs atragem atenţia asupra volumelor citate în cele ce urmează, care constituie principalele resurse bibliografice:

Hood, R.W., Hill, P.C., Spilka, B., (2009) The Psychology of Religion, An Empirical Approach Fourth Edition, THE GUILFORD PRESS, New York

Jonte-Pace, D., Parsons, W., (2001), Religion and Psychology. Mapping the terrain, Routledge, London and New York Dincolo de aceste două surse, pentru fiecare modul există o bibliografie minimală pe care

studenţii o pot parcurge pentru a-şi completa cunoştinţele şi care este utilă în realizarea temelor.

1.7. Materiale şi instrumente necesare pentru curs

Optimizarea secvenţelor de formare reclamă accesul studenţilor la următoarele resurse:

calculator conectat la internet (pentru a putea accesa bazele de date şi resursele electronice suplimentare dar şi pentru a putea participa la secvenţele de formare interactivă on line)

imprimantă (pentru tiparirea materialelor suport sau a temelor redactate) acces la resursele bibliografice (ex: abonament la Biblioteca Centrală „Lucian Blaga”) acces la echipamente de fotocopiere

1.8. Calendarul cursului

Pe parcursul semestrului al II-lea, în care se studiază disciplina de faţă, sunt programate 2 întâlniri faţă în faţă (consultaţii) cu toţi studenţii; acestea sunt destinate soluţionării, nemediate, a oricăror nelămuriri legate de conţinut sau a celor privind sarcinile individuale. Pentru prima întâlnire se recomandă lectura atentă a primelor șase module; la cea de a doua întâlnire se discută ultimele module şi se realizează o secvenţă recapitulativă pentru pregătirea examenului final. De asemenea, în cadrul celor două întâlniri, studenţii au posibilitatea de a solicita titularului şi/sau tutorilor sprijin pentru rezolvarea temei de semestru sau a proiectului de semestru, în cazul în care nu au reuşit singuri. Pentru a valorifica maximal timpul alocat celor două întâlniri, studenţii sunt atenţionaţi asupra necesităţii suplimentării lecturii din suportul de curs cu parcurgerea obligatorie a cel putin uneia dintre sursele bibliografice de referinţă. Datele celor două întâlniri vor fi anunţate în timp util pe site-ul facultăţii: www.psychology.ro. De asemenea, în calendarul disciplinei se regăseşte data limită pentru trimiterea temei de semestru (reaction paper).

Pentru acest an universitar, consultațiile sunt programate după cum urmează:

- luna martie 2014 (zilele pentru consultații vor fi afișate pe site-ul facultății)

- luna mai 2014 (zilele pentru consultații vor fi afișate pe site-ul facultății)

1.9. Politica de evaluare şi notare. Evaluarea finală se va realiza pe baza unui colocviu desfăşurat în sesiunea de la finele semestrului I. Nota finală se compune din:

(a) punctajul obţinut la colocviu în proporţie de 60% (6 puncte);

(b) evaluarea reaction paper-ului 30% ( 3 puncte),

(c) punctul acordat din oficiu 10% (1 punct)

Pentru predarea și evaluarea reaction paper-ului se vor respecta cu stricteţe cerinţele tutorilor. Orice abatere de la acestea aduce după sine penalizări sau pierderea punctajului corespunzător temei. În cazul în care studentul consideră că activitatea sa a fost subapreciată de către evaluatori, atunci poate solicita feedback suplimentar prin contactarea prin email a tutorilor sau a titularului de curs (în această ordine).

1.10. Elemente de deontologie academică

Se vor avea în vedere următoarele detalii de natură organizatorică:

Orice material elaborat de către studenţi pe parcursul activităţilor va face dovada originalităţii. Studenţii ale căror lucrări se dovedesc a fi plagiate nu vor fi acceptaţi la examinarea finală.

Orice tentativă de fraudă sau fraudă depistată va fi sancţionată prin acordrea notei minime sau, în anumite condiţii, prin exmatriculare.

Rezultatele finale vor fi puse la dispoziţia studenţilor prin afişaj electronic. Contestaţiile pot fi adresate în maxim 24 de ore de la afişarea rezultatelor iar soluţionarea

lor nu va depăşi 48 de ore (zile lucrătoare) de la momentul depunerii.

1.11. Studenţii cu nevoi speciale:

Titularul cursului şi echipa de tutori îşi exprimă disponibilitatea, în limita constrângerilor tehnice şi de timp, de a adapta conţinutul şi metodele de transmitere a informaţiilor, precum şi modalităţile de evaluare (examen oral, examen on line etc) în funcţie de tipul dizabilităţii cursantului. Altfel spus, avem în vedere, ca o prioritate, facilitarea accesului egal al tuturor cursanţilor la activităţile didactice si de evaluare.

1.12. Strategii de studiu recomandate:

Date fiind caracteristicile învăţământului la distanţă, se recomandă studenţilor o planificare foarte riguroasă a secvenţelor de studiu individual, coroborată cu secvenţe de dialog, mediate de reţeaua de internet, cu tutorii si respectiv titularul de disciplină. Lectura fiecărui modul şi rezolvarea lucrărilor de evaluare facultative garantează nivele înalte de înţelegere a conţinutului tematic şi totodată sporesc şansele promovării cu succes a acestei discipline.

Calendarul sintetic al disciplinei

Modalităţi de evaluare Termen de

predare

Punctaj

Tema de semestru (reaction paper)*.

Alegeti un articol de specialitate din domeniul psihologiei religiei (din cele oferite de noi sau din alta sursa stiintifica) si realizati o analiza critica a acestuia.

Tema nu trebuie să depășească 2 pagini.

3 p

Colocviu (proiect de semestru) In sesiune 7 puncte

*Informații suplimentare despre teme vor fi postate pe site-ul Departamentului de Psihologie, pe grupurile de discuții ale studenților din an, dar vor fi discutate și la consultații.

Consultaţii față în față

Data Ora Sala

Vor fi anunțate la o dată ulterioară pe site-ul

Departamentului de Psihologie

Vor fi anunțate la o dată ulterioară pe site-ul

Departamentului de Psihologie

22.05.2014

CUPRINS* THE HISTORIOGRAPHY OF SCIENCE AND RELIGION David B.Wilson……………………………………………………………………..………………………. 8

THE CONFLICT OF SCIENCE AND RELIGION Colin A.Russell …………………………………………………………………………………………….14

THE DEMARCATION OF SCIENCE AND RELIGION Stephen C.Meyer …………………………………………………………………………………… ……17

GOD, NATURE, AND SCIENCE Stanley L.Jaki ……………………………………………………………………………………………..23

GENESIS AND SCIENCE John Stenhouse …………………………………………………………………...………………………..28

Metodologia de cercetare in psihologia religiei ………………………...……………………….30

Psihoterapia cu clienti religiosi ………………………………………………………………….43

Interventii spirituale in psihoterapie ……………………………………….……………………51

The role of religion in therapy …………………………………………………………………..68

Rolul religiei si spiritualitatii asupra sanatatii fizice si mentale …………...……………………93

A prospective study of religion/spirituality and depressive symptoms among adolescent psychiatric patients ………………..……………………………………………………………101

Religion and anxiety: A critical review of the literature……………………………………..…110

Psychotherapy as a Religious Value……………………………………………………………129

Percepţiile despre smerenie: studiu preliminar …………………..…………………………….133

Evenimente negative de viață, tipuri de coping religios pozitiv și negative și funcționare mental ………. …………………………………….156

Contextualizing models of humility and forgiveness:a reply to gassin ………………………..170 Depresie si spiritualitate ............................................................................................................181

*Unele dintre articolele din acest reader au fost traduse de studentii care au fost inscrisi la

acest curs optional.

THE HISTORIOGRAPHY OF SCIENCE AND RELIGION David B.Wilson

The history of science and religion has been a contentious subject. In addition to the usual scholarly

disputes present in any academic area, this historical subject has been enmeshed in more general historiographical debates and influenced by the religious or antireligious beliefs of some historians. After considering some basic issues, this essay discusses several works written during the previous century and a half, while focusing on the last fifty years. Recent decades have seen a radical shift in point of view among historians of science. Although historians have espoused various approaches to the past, it will make our subject more manageable if we concentrate on the polar opposites around which views have tended to cluster. One approach has been to examine past ideas as much as possible in their own context, without either judging their long-term validity or making the discussion directly relevant to present issues. Another approach has been to study past ideas from the perspective of the present, taking full advantage of the hindsight provided by later knowledge to judge which ideas have proven to be valid. The second approach has apparent advantages. It does not exclude current knowledge that can assist us in the historical task. It also keeps present issues to the fore by insisting that historians draw lessons from the past that are relevant to current issues. However, historians have tended to regard the second approach as precariously likely to lead to distortion of the past in the service of present concerns. Dismissing this as ―presentism,‖ therefore, historians of science have come to favor the first, or contextualist, approach. Whichever method historians use, they might reach one of several possible conclusions about the historical relationship between science and religion. Conflict, mutual support, and total separation are three obvious candidates. One of these models might long have predominated, or the relationship might have changed from time to time and place to place. The discovery of conflict might raise the further questions of which side emerged victorious and which side ought to have done so. The discovery of mutual support might lead to the question of whether either science or religion contributed to the other‘s continued validity or even to its origin.

The Conflict Thesis

The most prominent view among both historians and scientists in the twentieth century has been a presentist conflict thesis that argues as follows. To engage in the history of science, one must first know what science is. It is certainly not religion, and, indeed, it is quite separate from religion, as can clearly be seen in science as practiced in the modern world. The historian of science, then, should properly examine the internal development of the scientific ideas that made modern science possible (that is, to the exclusion of such external factors as religion). The proponents of some ideas in the past were closer to the right track in this process than others. Those who expanded the realm of religion too far were on the wrong track, so that religion improperly intruded on the realm of science. In such instances, conflict ensued between science and religion, with scientific advances eventually making the truth clear to all and invariably (and rightly) emerging victorious. The historical process need not have occurred in this way, but it so often did that conflict has been the primary relationship between science and religion. Sciences best-known victories were those of Copernicanism and Darwinism. Presentism, internalism, and the conflict thesis coalesced into a de facto alliance, with the result that the conflict model is still widely accepted by academics (historians and scientists alike), though generally no longer by historians of science. A gulf in point of view thus marks the immediate setting of any scholarly treatment of the subject for a popular audience. That this alliance was not a necessary one can be seen in the work of William Whewell (1794–1866), the most prominent historian of science during the first half of the nineteenth century. Known today primarily as a historian and philosopher of science, Whewell was, first of all, a mathematical physicist, but also an Anglican clergyman and a moral theorist. His philosophy of science featured a series of what he called ―fundamental ideas‖ (like the idea of space) that, as part of man‘s mind created in the image of God, figured crucially in scientific knowledge of God‘s other creation, nature. Moral knowledge was structured similarly.

Both moral and scientific knowledge were progressive. Scientists, for example, gradually became aware of the existence and implications of fundamental ideas. The study of history, that is, disclosed (a sometimes lurching) progress toward the present or, at any rate, Whewell‘s particular version of the present. Great scientists, such as Isaac Newton (1642–1727), were both intellectually strong and morally good. Whewell did not think that conflict between science and religion had been especially significant historically, nor, indeed, was it in Whewell‘s own day. From his vantage point, he could give medieval science the uncomplimentary epithet ―stationary‖ for several reasons that did not particularly include religious repression. The Roman Catholic Church had acted against Galileo (1564–1642), to be sure, but, for Whewell, that episode was an aberration. A tightly knit, biblical-historical-philosophical-moralscientific- theological unity was manifested in Whewell‘s major, mutually reinforcing, books:

History of the Inductive Sciences (1837), Foundation of Morals (1837), Philosophy of the Inductive Sciences (1840), and Elements of Morality (1845). John William Draper (1811–82), author of History of the Conflict Between Religion and Science (1874), and Andrew Dickson White (1832–1918), author of The Warfare of Science (1876) and A History of the Warfare of Science with Theology in Christendom (1896), lived in an age that was different from Whewell‘s. While the Darwinian debates of the 1860s preceded Draper‘s book, what really alarmed him during that decade was the formulation of the doctrine of papal infallibility and the Roman Catholic Church‘s pronouncement that public institutions teaching science were not exempt from its authority. In his History, Draper depicted these developments as merely the latest phase in a long history of ―the expansive force of the human intellect,‖ in conflict not with religion generally, but with that ―compression‖ inflicted by Catholicism. White developed and first published his views at about the same time as Draper. White‘s insights stemmed from his presidency of the new Cornell University, which was founded as a secular institution that stood in sharp contrast to the traditional religious sponsorship of colleges and universities.

The withering criticism and innuendo directed at him personally by some religious figures led eventually to the writing of his books. Like those of Draper, White‘s books did not condemn all religion. They attacked what White called ―that same old mistaken conception of rigid Scriptural interpretation‖ (White 1876, 75). White proclaimed that whenever such religion sought to constrain science, science eventually won but with harm to both religion and science in the process. Science and ―true religion,‖ however, were not at odds. Had Whewell still been alive, White and Draper might have told him how their circumstances had helped them improve on his writing of history. Unlike Whewell, they believed that they had stood in the shoes, as it were, of those who had been persecuted. White seemed especially to identify with Galileo. Their improved awareness had, they thought, enabled them to observe factors that he had overlooked. In any case, their books were highly influential. Moreover, it was not their whispered qualifications but their screaming titles that were to thunder through the decades, remaining audible more than a century later. Differences of opinion did not seem to alter what was to become the widely current views of Draper and White. In Metaphysical Foundations of Modern Physical Science (1924), E.A.Burtt argued that the foun dations of science were often theological. Galileo‘s God, for example, labored as a geometrician in creating the world, with the result that man, who knew some mathematics as well as God did, was capable of grasping nature‘s essential mathematical logic. In Science and the Modern World (1926), Alfred North Whitehead maintained that the origin of modern science depended upon medieval theology, which had long insisted on God‘s rationality and hence also the rationality of his creation. Yet, in the 1930s, when his research suggested that seventeenth-century English Puritanism had fostered science, Robert K.Merton found that prevailing scholarly opinion, which had been shaped by the books of Draper and White, held that science and religion were inherently opposed and necessarily in conflict. Of course, the 1920s were the decade not only of Burtt and Whitehead, but also of the Scopes trial, which was generally interpreted as yet another in a long series of confrontations between science and religion. Also, during the 1920s and 1930s(and for some time afterward), the still undeveloped discipline of the history of science was pursued mainly by men trained in the sciences, who found presentist internalism a natural point of view.

Reaction to the Conflict Thesis

The Whig Interpretation of History (1931), written by the young general historian Herbert Butterfield, was eventually to influence the history of science deeply. Butterfield argued that historians had tended to be Protestant in religion and Whig in politics. They liked to divide the world into friends and enemies of progress—progress, that is, toward their own point of view. History was thus peopled by progressives and reactionaries, Whigs and Tories, Protestants and Catholics. Whig historians made the mistake of seeing Martin Luther, for example, as similar to modern Protestants rather than, as was actually the case, closer to sixteenth-century Catholics. By reading the present into the past in this way, Whig historians ratified the present, but only by misshaping the past. A better way was to assume that the sixteenth century was quite different from the twentieth and to explore the sixteenth century on its own terms, letting any similarities emerge from historical research rather than from prior assumption. Butterfield‘s Origins of Modern Science (1949) applied this methodology to the history of science, including the relationship between science and religion, during the scientific revolution. By not viewing scientists of the past as necessarily similar to modern scientists, it was possible to reach historical insights quite different from those of, say, Whewell or White. Overall, the scientific revolution resulted not from accumulating new observations or experimental results, but from looking at the same evidence in a new way: It was a ―transposition‖ in the minds of the scientists.

The alleged revolutionary Copernicus (1473– 1543) could now be understood as a ―conservative,‖ much akin to the Greek astronomers with whom he disagreed. Religion was not necessarily either opposed to or separate

from science in the modern sense but could, in principle, be viewed in any relationship, depending on the historical evidence. Reading the evidence in a non-Whiggish way, Butterfield saw variety. There was, to be sure, theological opposition to the Copernican system, but it would not have been very important if there had not also been considerable scientific opposition. Even Galileo did not actually prove the earth‘s motion, and his favorite argument in favor of it, that of the tides, was a ―great mistake.‖ Christianity favored the new mechanical worldview because it allowed a precise definition of miracles as events contrary to the usual mechanical regularity. Newton‘s gravitational theory required God‘s continued intervention in the universe he created, and one of Newton‘s possible explanations of gravity ―made the existence of God logically necessary‖ (Butterfield 1949, 157). Butterfield‘s Christianity and History (1949) made his own Christian faith explicit, but his religious views did not make Origins of Modern Science into a Christian tract, though they guaranteed that Christian factors received a fair hearing. Whatever the exact influence of Butterfield on them, three books published during the 1950s revealed the progress of non-Whiggish studies of science and religion during the scientific revolution. Alexandre Koyré, influenced by Burtt, had already published studies like ―Galileo and Plato‖ (1943) a few years before Butterfield‘s Origins of Modern Science. In From the Closed World to the Infinite Universe (1957), Koyré argued that the revolution involved philosophy and theology as well as science and that all three dimensions of thought usually existed in ―the very same men,‖ such as Johannes Kepler (1571–1630), René Descartes (1596–1650), Isaac Newton, and Gottfried Wilhelm Leibniz (1646–1716). Koyré thus portrayed the conflict between Newton and Leibniz, one that involved Leibniz‘s stiff opposition to Newton‘s gravitational theory, as primarily a theological conflict. He contrasted Newton‘s ―work-day God‖ (who caringly involved himself in the operation of his universe) with Leibniz‘s ―God of the sabbath‖ (who created the world skillfully enough for it to run by itself). In his The Copernican Revolution (1957), Thomas Kuhn adopted the ―unusual‖ approach of treating astronomers‘ philosophical and religious views as ―equally fundamental‖ to their scientific ones. For the early Copernicans, at the center of the universe resided the sun, ―the Neoplatonic symbol of the Deity‖ (Kuhn 1957, 231). Unlike Koyré‘s and Kuhn‘s books, Richard Westfall‘s Science and Religion in Seventeenth-Century England (1958) examined a variety of better- and lesserknown men of science (virtuosi) in a particular national context. In general, the virtuosi regarded their scientific discoveries as confirmation of their religious views, thus answering charges that studying nature both led man to value reason over revelation and made it difficult to know the nonmaterial side of existence. While there existed in the seventeenth century a multiplicity of ways to dovetail science and religion, there was a general movement from revealed religion to a natural theology that prepared the way for the deism of the next century.

The 1950s witnessed non-Whiggish studies of science and religion, not only in the century of Galileo and Newton, but in Darwin‘s century, too. In his ―second look‖ in Isis at Charles Gillispie‘s Genesis and Geology (1951), Nicolaas Rupke credited Gillispie with transforming the historiography of geology by going beyond the great ideas of great men as defined by modern geology to the actual religious-politicalscientific context of British geology in the decades before Darwin‘s Origin of Species (1859). Explicitly rejecting the conflict thesis of Draper and White, Gillispie saw ―the difficulty between science and Protestant Christianity…to be one of religion (in a crude sense) in science rather than one of religion versus science‖ (Gillispie 1951, ix). Writing about a period in which geologists were often themselves clergymen, Gillispie thought ―that the issues discussed arose from a quasi-theological frame of mind within science‖ (Gillispie 1951, x). At the end of the decade, John Greene published The Death of Adam (1959), an examination of the shift from the ―static creationism‖ of Newton‘s day to the evolutionary views of Darwin‘s. Without making any particular point of rejecting the Draper-White conflict thesis, Greene nevertheless did so implicitly, calling attention ―to the religious aspect of scientific thought‖ (Greene 1959, vi) and infusing his book with examples of a variety of connections between religion and science. Thus, Georges Louis Leclerc, Comte de Buffon (1707–88), was forced to fit his science to the religious views of the day but found evolution contrary to Scripture, reason, and experience. William Whiston (1667–1752) employed science to explain scriptural events, rejecting alternative biblical views that were either too literal or too allegorical. Charles Darwin (1809–82) jousted with fellow scientists Charles Lyell (1797–1875) and Asa Gray (1810–88) about the sufficiency of natural selection as opposed to God‘s guidance and design in evolutionary processes.

Christian Foundations of Modern Science

If these notable books of the 1950s rejected the conflict thesis in various ways, two books from the early 1970s went even further, turning the thesis on its head to declare (echoing Whitehead) that Christianity had made science possible. The first was Reijer Hooykaas‘s Religion and the Rise of Modern Science (1972). The Protestant historian Hooykaas (1906–94) had explored the relations between science and religion for several years. His Natural Law and Divine Miracle (1959), for example, showed the compatibility of what he called ―a Biblical concept of nature‖ with nineteenth-century biology and geology. In 1972, he went further by arguing for a Christian, especially

Calvinistic, origin of science itself. After discussing Greek concepts of nature, Hooykaas concluded that, in the Bible, ―in total contradiction to pagan religion, nature is not a deity to be feared and worshipped, but a work of God to be admired, studied and managed‖ (Hooykaas 1972, 9). Not only did the Bible ―de-deify‖ nature, Calvinism encouraged science through such principles as voluntaristic theology, a ―positive appreciation‖ of manual work, and an ―accommodation‖ theory of the Bible. Voluntarism emphasized that God could choose to create nature in any way he wanted and that man, therefore, had to experience nature to discover God‘s choice. This stimulus to experimental science was reinforced by the high value that Christianity placed on manual labor. The view that, in biblical revelation, God had accommodated himself to ordinary human understanding in matters of science meant that Calvinists generally did not employ biblical literalism to reject scientific findings, particularly Copernican astronomy. Stanley L.Jaki‘s Science and Creation (1974) also expanded themes that were present in his earlier chapter ―Physics and Theology‖ in his The Relevance of Physics (1966). Jaki was a Benedictine priest with doctorates in both theology and physics. His Science and Creation, a book of breathtaking scope, examined several non-Western cultures before focusing on the origin of science within the Judeo-Christian framework. Jaki argued that two barriers to science pervaded other cultures: a cyclic view of history and an organic view of nature. Endless cycles of human history made men too apathetic to study nature. Even when they did, their concept of a living, willful nature precluded discovery of those unvarying patterns that science labels natural laws. The Judeo-Christian view, in contrast, historically regarded nature as the nonliving creation of a rational God, not cyclic but with a definite beginning and end. In this conceptual context (and only in this context), modern science emerged, from the thirteenth through the seventeenth centuries. Earlier adumbrations of science were pale, short-lived imitations, doomed by hostile environments. Unfortunately, Jaki thought, amidst attacks on Christianity in the twentieth century, there had arisen the theory of an oscillating universe, which was another unwarranted, unscientific, cyclic view of nature. Hence, consideration of both past and present disclosed the same truth: ―the indispensability of a firm faith in the only lasting source of rationality and confidence, the Maker of heaven and earth, of all things visible and invisible‖ (Jaki 1974, 357).

The Continuing Influence of the Conflict Thesis

Despite the growing number of scholarly modifications and rejections of the conflict model from the 1950s on, the Draper-White thesis proved to be tenacious, though it is probably true that it had been more successfully dispelled for the seventeenth century than for the nineteenth. At any rate, in the 1970s leading historians of the nineteenth century still felt required to attack it. In the second volume of his The Victorian Church (1970), Owen Chadwick viewed the conflict thesis as a misconception that many Victorians had about themselves. His The Secularization of the European Mind (1975) presented Draper‘s antithesis as the view to attack by way of explaining one aspect of nineteenth-century secularization. Writing about Charles Lyell in 1975, Martin Rudwick also deplored distortions produced by Draper and White, arguing that abandoning their outdated historiography would solve puzzles surrounding Lyell‘s time at King‘s College, London. Examining nineteenth-century European thought in History, Man, and Reason (1971), the philosopher-historian Maurice Mandelbaum rejected what he called ―the conventional view of the place of religion in the thought of the nineteenth century,‖ which ―holds that science and religion were ranged in open hostility, and that unremitting warfare was conducted between them‖ (Mandelbaum 1971, 28). Why did these historians believe that the conflict thesis was sufficiently alive and well to require refutation? For one thing, even those historians who were most significant in undermining the conflict thesis did not reject it entirely. Moreover, they made statements that could be construed as more supportive of the thesis than perhaps they intended. ―Conflict with science‖ was the only subheading under ―Religion‖ in the index to Gillispie‘s The Edge of Objectivity (1960), and it directed the reader to statements that seemed to support the conflict model. What geology in the 1830s ―needed to become a science was to retrieve its soul from the grasp of theology‖ (Gillispie 1960, 299). ―There was never a more unnecessary battle than that between science and theology in the nineteenth century‖ (Gillispie 1960, 347). Even Gillispie‘s Genesis and Geology was criticized by Rudwick in 1975 as only a more sophisticated variety of the ―positivist‖ historiography of Draper and White. Westfall, in a preface to the 1973 paperback edition of his book, wrote: ―In 1600, Western civilization found its focus in the Christian religion; by 1700, modern natural science had displaced religion from its central position‖ (Westfall 1973, ix). Greene introduced the subjects of the four chapters in his Darwin and the Modern World View (1961) as four stages in ―the modern conflict between science and religion‖ (Greene 1961, 12). Surely, the most widely known book written by a historian of science, Kuhn‘s Structure of Scientific Revolutions (1962), excluded those philosophical and religious views that Kuhn had earlier (in his Copernican Revolution [1957]) labeled ―equally fundamental‖ aspects of astronomy. This exclusion undoubtedly aided the view that a conflict existed, a view that was the ally of internalism. The 1970s were a period in which past scientists‘ religious statements could still be dismissed as

―ornamental or ceremonial flourishes‖ or as ―political gestures.‖ The ―orthodoxy‖ of internalism among historians of science in the 1960s and early 1970s was the target of the fascinating autobiographical account of life as a student and teacher at Cambridge University by Robert Young in his contribution to Changing Perspectives in the History of Science (1973). And even Young, whose own pathbreaking nonconflictive articles from around 1970 were later reprinted in Darwin’s Metaphor (1985), wrote in his 1973 piece that ―the famous controversy in the nineteenth century between science and theology was very heated indeed‖ (Young 1973, 376).

A second factor was the prevailing view among scientists themselves, which influenced historians of science, who either had their own early training in science or maintained regular contact with scientists, or both. In this regard, we might consider the work of the scientist-historian Stephen Jay Gould, one of the most successful popularizers of both science and the history of science. A collection of his popular essays appeared in 1977 as Ever Since Darwin. Gould stoutly rejected the ―simplistic but common view of the relationship between science and religion—they are natural antagonists‖ (Gould 1977, 141). However, the book‘s specific instances came preponderantly from the conflict theorist‘s familiar bag of examples: the Church‘s disagreeing with Galileo; T.H. Huxley‘s ―creaming‖ Bishop ―Soapy Sam‖ Wilberforce; natural selection s displacing of divine creation; and, as Freud said, man‘s losing his status as a divinely created rational being at the center of the universe because of the science of Copernicus, Darwin, and Freud himself. Gould‘s most sympathetic chapter was his discussion of Thomas Burnet‘s late-seventeenth-century geological explanations of biblical events like Noah‘s flood. Even here, however, Gould regarded the views of Burnet‘s opponents as dogmatic and antirationalist, reflecting the same unhappy spirit that, wrote Gould, later possessed Samuel Wilberforce, William Jennings Bryan, and modern creationists. ―The Yahoos never rest‖ (Gould 1977, 146). Whatever the reasons for the continued survival of the conflict thesis, two other books on the nineteenth century that were published in the 1970s hastened its final demise among historians of science. In 1974, Frank Turner carved out new conceptual territory in Between Science and Religion. He studied six late Victorians (including Alfred Russel Wallace, the co-inventor of the theory of evolution by natural selection) who rejected both Christianity and the agnostic ―scientific naturalism‖ of the time. In their various ways, they used different methods, including the empiricism of science (but not the Bible), to support two traditionally religious ideas: the existence of a God and the reality of human immortality. Even more decisive was the penetrating critique ―Historians and Historiography‖ that James Moore placed at the beginning of his Post-Darwinian Controversies (1979). In what would have been a small book in itself, Moore‘s analysis adroitly explored the historical origins of Draper and White‘s ―military metaphor‖ and went on to show how the metaphor promulgated false dichotomies: between science and religion, between scientists and theologians, between scientific and religious institutions. The metaphor simply could not handle, for example, a case of two scientist-clergymen who disagreed about a scientific conclusion partly because of their religious differences. Finally, Moore called for historians to write ―non-violent‖ history, of which the remainder of his book was a prodigious example. Examining Protestant responses to Darwin‘s ideas, he concluded that it was an ―orthodox‖ version of Protestantism that ―came to terms‖ with Darwin more easily than did either a more liberal or a more conservative version and, in addition, that much anguish would have been spared had this orthodoxy prevailed.

The Complexity Thesis

By the 1980s and 1990s, there had been nearly a complete revolution in historical methodology and interpretation. Setting aside his own views of science and religion, the historian was expected to write non- Whiggish history to avoid what Maurice Mandelbaum called the ―retrospective fallacy.‖ This fallacy consisted of holding an asymmetrical view of the past and the future, in which the past was seen as like a solid, with all of its parts irrevocably fixed in place, while the future was viewed as fluid, unformed, and unforeseen. The problem for the historian was to transpose his mind to such an extent that a historical figure‘s future (which was part of the historian‘s own past) lost the fixity and inevitability that the historian perceived in it and, instead, took on the uncertainty that it had for the historical figure. The concern for what led to the present, and the extent to which it was right or wrong by present standards, thus dissipated. A good test for the historian was whether he could write a wholly sympathetic account of a historical figure with whom he totally disagreed or whose ideas he found repugnant. Would the historical figure, if by some magic given the chance to read the historian‘s reconstruction, say that, indeed, it explained what he thought and his reasons for doing so? To be valid, any broader historical generalization had to be based on specific, non-Whiggish studies that accurately represented past thought. This radically different methodology yielded a very different overall conclusion about the historical relationship of science and religion. If ―conflict‖ expressed the gist of an earlier view, ―complexity‖ embodied that of the new. The new approach exposed internalism as incomplete and conflict as distortion. Past thought turned out to be terribly

complex, manifesting numerous combinations of scientific and religious ideas, which, to be fully understood, often required delineation of their social and political settings.

From this mainstream perspective, moreover, historians could deem other approaches unacceptable. Zeal for the triumph of either science or religion in the present could lure historians into Whiggish history. The works not only of Draper and White, but also of Hooykaas and Jaki fell into that category. Kenneth Thibodeau‘s review in Isis of Jaki‘s Science and Creation, for example, declared it ―a lopsided picture of the history of science‖ that ―minimizes‖ the accomplishments of non-Christian cultures and ―exaggerates‖ those of Christian ones (Thibodeau 1976, 112). In a review in Archives Internationale d’Histoire des Sciences, William Wallace found Hooykaas‘s Religion and the Rise of Modern Science to be ―a case of special pleading.‖ In their historiographical introduction to the book they edited, God and Nature (1986), David Lindberg and Ronald Numbers judged that Hooykaas and Jaki had ―sacrificed careful history for scarcely concealed apologetics‖ (Lindberg and Numbers 1986, 5). Likewise, some historians found Moore‘s nonviolent history unacceptable: He ―sometimes seems to be writing like an apologist for some view of Christianity‖ (La Vergata 1985, 950), criticized Antonella La Vergata in his contribution to The Darwinian Heritage (1985). Among the multitude of articles and books that argued for a relatively new, non-Whiggish complexity thesis, two exemplars were Lindberg and Numbers‘s God and Nature and John Brooke s Science and Religion (1991). Though similar in outlook, they differed in format. The first was a collection of eighteen studies by leading scholars in their own areas of specialty, while the second was a single scholar‘s synthesis of a staggering amount of scholarship, an appreciable portion of which was his own specialized research. Turning in their introduction to the contents of their own volume, Lindberg and Numbers rightly observed that ―almost every chapter portrays a complex and diverse interaction that defies reduction to simple ‗conflict‘ or ‗harmony‘‖ (Lindberg and Numbers 1986, 10). Medieval science, for example, was a ―handmaiden‖ to theology (but not suppressed), while the close interlocking of science and religion that developed by the seventeenth century began to unravel in the eighteenth. To examine briefly the complexity of only one chapter, consider James Moore‘s (nonapologetic) discussion of ―Geologists and Interpreters of Genesis in the Nineteenth Century.‖ Moore focused on British intellectual debates occurring in a variegated context of geographical, social, generational, institutional, and professional differences. Around 1830, professional geologists (that is, those with specialist expertise) tended to ―harmonize‖ Genesis and geology by using geology to explain the sense in which the natural history of Genesis was true. They were opposed by nonprofessional ―Scriptural geologists,‖ who used Genesis to determine geological truths. By the 1860s, a new generation of professional geologists did their geology independently of Genesis. They were in agreement with a new generation of professional biblical scholars in Britain, who believed that Genesis and geology should be understood separately. Meanwhile, the earlier conflicting traditions of harmonization and scriptural geology were kept going by amateurs.

Hence, while debate over how to meld Genesis and geology was a social reality in late-Victorian Britain, it did not perturb the elite level of the professionals. Numbers expanded his own chapter in God and Nature into The Creationists (1992), an outstanding treatment of such issues at the nonelite level in the twentieth century. Brooke‘s volume targeted general readers in a way that Lindberg and Numbers‘s did not. In his historiographical remarks, Brooke considered the very meanings of the words ―science‖ and ―religion,‖ resisting specific definitions for them. The problem, Brooke explained, was that the words had so many meanings. It could even be misleading to refer to Isaac Newton‘s ―science,‖ when Newton called what he was doing ―natural philosophy,‖ a phrase connoting quite different issues in the seventeenth century than did ―science‖ in the twentieth. As did Lindberg and Numbers, Brooke found complexity: ―The principal aim of this book,‖ he wrote, ―has been to reveal something of the complexity of the relationship between science and religion as they have interacted in the past‖ (Brooke 1991, 321). As for Lindberg and Numbers, so also for Brooke, complexity did not preclude general theses. He concluded, for example, that science went from being ― subordinate‖ to religion in the Middle Ages to a position of relative equality in the seventeenth century, not separate from religion but ―differentiated‖ from it.

Conclusion

This essay, in rejecting presentist histories of science and religion, may itself seem somewhat presentist. Though it tries fairly to present the opposite point of view, it favors the recent historiographical revolution in advocating a contextualist approach, with all its attendant complexities. Though the new point of view has decided advantages over the old, it has the potential of leading historians astray. Pursuit of complexity could produce ever narrower studies that are void of generalization. Moreover, awareness of the great variation of views in different times and places could lead to the mistaken conclusion that those ideas were nothing but reflections of their own ―cultures.‖ Instead, in thinking about science and religion, as in most human endeavors, there have always been the relatively few who have done their work better than the rest. Existence of differences among them does not mean that they have not thought through and justified their own positions. In fact, that they have done so is an example of

a contextualist generalization—one that is not only in harmony with the evidence of the past, but also relevant to present discussions. Indeed, the whole non-Whiggish enterprise might inform the present in other ways, too, though scholars are understandably wary of drawing very specific lessons from history for the present. Consider, however, a few general points. Study of past ideas on their own terms might provide a kind of practice for working out one‘s own ideas or for nourishing tolerance for the ideas of others. There have been and, no doubt, always will be disagreements among our strongest thinkers, as well as questions of the relationship between their ideas and those of the population at large. Moreover, things always change, though not predictably or necessarily completely. Indeed, the most influential thinkers seem fated to have followers who disagree with them, even while invoking their names. Even the most well-founded, well-argued, and well-intentioned ideas about science and religion are liable to later change or eventual rejection. The same is true for historiographical positions, including, of course, the complexity thesis itself.

THE CONFLICT OF SCIENCE AND RELIGION Colin A.Russell

The Conflict Thesis

The history of science has often been regarded as a series of conflicts between science and religion (usually Christianity), of which the cases of Galileo Galilei (1564–1642) and Charles Darwin (1809–82) are merely the most celebrated examples. Some would go further and argue that such conflict is endemic in the historical process, seeing these and other confrontations as occasional eruptions of a deep-seated inclination that is always present, if not always quite so spectacularly visible. There is usually the additional assumption, implicit or explicit, that the outcome of such conflict will always and inevitably be the victory of science, even if only in the long term. Such a view of the relations between science and religion has been variously described as a ―conflict thesis,‖ a ―military metaphor,‖ or simply a ―warfare model.‖ The considerable literature on this subject began with two famous works of the nineteenth century: John William Draper‘s History of the Conflict Between Religion and Science (1874) and Andrew Dickson White‘s A History of the Warfare of Science with Theology in Christendom (1896). A more mature work of the twentieth century, J.Y.Simpson‘s Landmarks in the Struggle Between Science and Religion (1925), adds to the vocabulary of metaphors by positing a struggle between science and religion. The first two books achieved a wide circulation and have been repeatedly reprinted. They were written at a time when science seemed triumphant at home and abroad, and each author had his particular reasons for settling old scores with organized religion. Draper, a professor of chemistry and physics in a medical school in New York, feared the power wielded by the Roman Catholic Church and was worried by the promulgation of the dogma of papal infallibility of 1870. White, professor of history at the University of Michigan and later president of Cornell (the first private nonsectarian university in the United States), was not surprisingly opposed by the advocates of sectarian theology. White‘s book thus became a manifesto directed (in the last version) not so much against religion as against dogmatic theology. For nearly a century, the notion of mutual hostility (the Draper-White thesis) has been routinely employed in popular-science writing, by the media, and in a few older histories of science. Deeply embedded in the culture of the West, it has proven extremely hard to dislodge. Only in the last thirty years of the twentieth century have historians of science mounted a sustained attack on the thesis and only gradually has a wider public begun to recognize its deficiencies.

Issues of Contention

First, it may be helpful to spell out briefly the chief issues of contention around which the real or imagined conflict revolves. Initially these issues were in the area of epistemology: Could what we know about the world through science be integrated with what we learn about it from religion? If not, a situation of permanent conflict seemed probable. Such epistemological issues were first raised on a large scale by the Copernican displacement of the earth from the center of the solar system, which was clearly incompatible with what seemed to be the biblical world picture of a geocentric universe. The question, though posed by Copernicus (1473–1543) himself, caused little public stir until the apparent conflict became inextricably intertwined with other clerico-political disagreements at the time of Galileo. With hindsight, it is truly remarkable that, as early as the sixteenth century, Copernicus and his disciple Georg Joachim Rheticus (1514–74) resolved the issue to their satisfaction by invoking the patristic distinction between the Bible‘s teaching on spiritual and eternal realities and its descriptions of the natural world in

the language of ordinary people. Rheticus specifically appealed to Augustine‘s doctrine of ―accommodation,‖

asserting that the Holy Spirit accommodated himself on the pages of Scripture to the everyday language and terminology of appearances. What began to emerge was what later became the distinction between world picture and worldview, the former being mechanistic, tentative, and expendable, while the latter concerned values and principles that were likely to endure. This same principle imbued the work both of Galileo and his followers and of Johannes Kepler (1571–1630) and effectively defused the issue for a majority of Christian believers. If they were right, there was an absence of conflict not only over the specific case of cosmology but, in principle, over anything else in which scientific and biblical statements appeared to be in contradiction. A ―conflict thesis‖ would have seemed untenable because there was nothing to fight about. However, the historical realities were such that these lessons were not quickly learned. Despite the advent in the late eighteenth century of evidence for a much older Earth than had been imagined on the basis of the Mosaic account in Genesis, little opposition arose until the emergence in early- Victorian England of a disparate but vocal group of ―scriptural geologists.‖ They were not, as is often claimed, a group of naive scientific incompetents, but, indeed, were often rather able men who saw a distinction between biblical descriptions of the present natural world and of events in the past, respectively corresponding to their understandings of physical science and history. While for the most part happy to accept ―accommodation‖ over biblical references to the sun and Earth, they were not prepared to extend it to what appeared to be descriptions of history, including chronology. The potential for conflict was greatest where science had a historical content (as in geology or biology).

The war cries of the ―scriptural geologists‖ were echoed by those who, in due course, assailed Darwinian evolution on the same grounds. A second, and related, area of contention has been in the realm of methodology. Here we find the age-old polarization between a science based on ―facts‖ and a theology derived from ―faith,‖ or between a naturalistic and a religious worldview. Naturalism has had a long history, going back to the early Middle Ages and beyond, with a spectacular revival in nineteenth-century England that was dignified by the title of ―scientific naturalism.‖ It was a view that denied the right of the church to ―interfere‖ in the progress of science by introducing theological considerations into scientific debates. By the same token, any appeal to divine purpose as an explanation of otherwise inexplicable phenomena has been a famous hostage to fortune. This philosophy of ―God of the gaps‖ has generated special heat when one of the ―gaps‖ has later been filled naturalistically. In these cases, conflict has certainly appeared, though whether it is really about methodological issues may be doubted. It has also been argued in a veritable torrent of informed and scholarly works that the methodologies of science and of religion are complementary rather than contradictory, and local instances of dispute have been assigned to other causes. Yet, this confusion still penetrates popular thinking, and the conflict thesis has been thereby sustained. The third potential for conflict has been in the field of ethics. Most recently this has been realized in such questions as genetic engineering, nuclear power, and proliferation of insecticides. Past debates on the propriety of such medical procedures as vaccination and anesthesia have been replaced by impassioned conflict over abortion and the value of fetal life. In Victorian times, one of the more serious reasons for opposing Darwin was the fear that his theories would lead to the law of the jungle, the abandonment of ethical constraints in society. Yet, in nearly all of these cases, it is not so much science as its application (often by nonscientists) that has been under judgment. Fourth, some opposition between science and religion has arisen from issues of social power. In Catholic cultures in continental Europe, the polarity between sacred and secular was often much sharper than in Britain and the United States, with the result that progressive science-based ideologies were more frequently in explicit contention with conservative political and ecclesiastical forces. In early-nineteenth-century Britain, certain high-church Anglicans turned on science for threatening their dominant role in society.

While this debate was formally about the authority of Scripture, in reality it was about the growing spirit of liberalism within the universities. Not surprisingly, the community of science resented such attacks and, in due course, turned the table on the enemy. Their response came in the form of a concerted effort by certain scientific naturalists in Victorian England, most notably those associated with Thomas Henry Huxley (1825–95), to overthrow the hegemony of the English church. The movement, which was accompanied by bitter conflict, generated a flood of articles, lay ―sermons,‖ and verbal attacks on the clergy and included conspiratorial attempts to get the ―right men‖ in to key positions in the scientific establishment. It involved lectures, secular Sunday schools, and even a successful lobby to have Charles Darwin‘s body interred in Westminster Abbey. Yet, it was not a battle between science and religion except in the narrowest sense. Unlike White, who averred that he opposed not religion but dogmatic theology, Huxley sought to undermine organized religion, though his rhetoric frequently sought to convey the impression of a disinterested defence of truth. One recent writer identifies the driving force behind at least the Victorian struggles as ―the effort by scientists to improve the position of science. They wanted nothing less than to move science from the periphery to the centre of English life‖ (Heyck 1982, 87). It was at this time that science became professionalized, with the world‘s first professional institute for science, the Institute of Chemistry,

established in 1877. In Europe, it was also the period when scientific leadership began to slip from Britain to Germany, generating a fierce rearguard reaction by some British scientists against anything that could diminish their public standing. If the Church was seen to be in their way, it must be opposed by all means, including the fostering of a conflict myth, in which religion routinely suffered defeat at the hands of triumphalist science.

The Weaknesses of the Conflict Thesis

The conflict thesis, at least in its simple form, is now widely perceived as a wholly inadequate intellectual framework within which to construct a sensitive and realistic historiography of Western science. Nor was it merely a case of British controversy. Ronald L.Numbers has suggested that ―the war between science and theology in colonial America has existed primarily in the cliché-bound minds of historians.‖ He regards the polemically attractive warfare thesis as ―historically bankrupt‖ (Numbers 1985, 64, 80). In the composite volume God and Nature: Historical Essays on the Encounter between Christianity and Science (1986), edited by Numbers and his colleague at the University of Wisconsin, David C.Lindberg, an effort is made to correct the stereotypical view of conflict between Christianity and science. The shortcomings of the conflict thesis arise from a multiplicity of reasons, some of which may be briefly summarized as follows.

First, the conflict thesis hinders the recognition of other relationships between science and religion. At different phases of their history, they were not so much at war as largely independent, mutually encouraging, or even symbiotic. Certainly there are well-documented cases, such as those of Galileo and Darwin, in which science and religion seemed to wage open war with each other. But recent scholarship has demonstrated the complexity of the issues at stake in even these cases, with ecclesiastical politics, social change, and personal circumstances as relevant as questions of science and religion. Quite apart from those considerations, such cases have been too often taken as typical, and, consequently, a generalized conflict thesis has been erected on insubstantial foundations. As a historical tool, the conflict thesis is so blunt that it is more damaging than serviceable. One has only to consider the ―two books‖ of Francis Bacon (1561–1626) —nature and Scripture—each of which had a role complementary to that of the other. They were held not to be at odds with each other, because they dealt with different subjects. Again, for many major scientific figures in the seventeenth and eighteenth centuries, Christianity played a central role in fostering and even shaping their scientific endeavors: The instances of Kepler, Robert Boyle (1627–91), Isaac Newton (1642– 1727), and René Descartes (1596–1650) are the most conspicuous. The historical relations between religion and science are certainly more rich and complex than a simple conflict thesis suggests.

Second, and more specific, the conflict thesis ignores the many documented examples of science and religion operating in close alliance. This was most obviously true of the seventeenth and eighteenth centuries, as evidenced by the names of Boyle, Newton, Blaise Pascal (1623–62), Marin Mersenne (1588–1648), Pierre Gassendi (1592– 1655), and Isaac Beeckman (1588–1637). Since then, a continuous history of noted individuals making strenuous efforts to integrate their science and religion has testified to the poverty of a conflict model. This was particularly true in Britain, where representatives in the nineteenth century included most famously Michael Faraday (1791–1867), James Joule (1818–89), James Clerk Maxwell (1831–79), William Thomson (Lord Kelvin [1824–1907]), and George Gabriel Stokes (1819–1903). In the next century, a number of distinguished scientists of religious persuasion were ready to join societies like the Victoria Institute in London or its successors in Britain and the United States, which were dedicated to bringing together religious and scientific ideas. The English-speaking world was not unique in this quest for integration but has certainly been the most subject to historical scrutiny.

Third, the conflict thesis enshrines a flawed view of history in which ―progress‖ or (in this case) ―victory‖ has been portrayed as inevitable. There appears to be no inherent reason why this should be so, though it is readily understandable why some should wish it to be the case. This approach represents and embraces a long demolished tradition of positivist, Whiggish historiography.

Fourth, the conflict thesis obscures the rich diversity of ideas in both science and religion. Neither of these has ever been monolithic, and there was seldom a unified reaction from either. Thus, in the case of Galileo, it was the Roman Catholic, not the Protestant, wing of Christianity that appeared to be at odds with science. In the Darwinian controversy, a uniform response was lacking even within one branch of Protestantism, for Anglicans of low-, high-, or broad-church persuasion tended to respond to Darwin‘s theories in different ways. Moreover, the scientific community was deeply divided over religion in Victorian England, the mathematical physicists being far more sympathetic than the scientific naturalists. The conflict thesis fails to recognize such variety.

Fifth, the conflict thesis engenders a distorted view of disputes resulting from other causes than those of religion versus science. Given this expectation, conflict is not difficult to find in every circumstance, whether or not justified by the available historical evidence. A classic case is that of the alleged opposition to James Young Simpson (1811–70) for his introduction of chloroform anesthesia in midwifery. Despite repeated claims of clerical

harassment, the evidence is almost nonexistent. Insofar as there was any conflict, it was between the London and Edinburgh medical establishments or between obstetricians and surgeons. The origins of that myth may be located in an inadequately documented footnote in White (1896, 2.63). Finally, the conflict thesis exalts minor squabbles, or even differences of opinion, to the status of major conflicts. The confrontation between Samuel Wilberforce (1805–73) and Huxley in 1860 has been so frequently paraded as a one-sided battle on a vast scale that one is liable to forget that, in fact, it was nothing of the kind. Such exaggeration is an almost inevitable accompaniment to the exposition of a conflict theory. It is excellent drama but impoverished history, made credible only by a prior belief that such conflict is inevitable. Of such material are legends made, and it has been well observed that ―the dependence of the conflict thesis on legends that, on closer examination, prove misleading is a more general defect than isolated examples might suggest‖ (Brooke 1991, 40).

Reasons for Its Endurance

Given, then, that the warfare model is so inaccurate, one may wonder why it has lasted so long. This is, indeed, a major question for historians. The explanation may lie at least partly in the celebrated controversy of Huxley and his friends with the Anglican and Roman Catholic churches. In addition to the strategies mentioned above, they had another tactic, more subtle and yet more bold than anything else they accomplished. By establishing the conflict thesis, they could perpetuate a myth as part of their strategy to enhance the public appreciation of science. Thus, Huxley could write, with a fine disregard for what history records: Extinguished theologians lie about the cradle of every science as the strangled snakes beside that of Hercules; and history records that wherever science and orthodoxy have been fairly opposed, the latter have been forced to retire from the lists, bleeding and crushed if not annihilated; scotched if not slain. The Huxleyite warriors were outstandingly successful in this respect, and their ideals were enshrined in the works of Draper and White, best understood as polemical tracts that advanced the same cause. Yet, Draper takes such liberty with history, perpetuating legends as fact, that he is rightly avoided today in serious historical study. The same is nearly as true of White, though his prominent apparatus of prolific footnotes may create a misleading impression of meticulous scholarship. With an astonishing breadth of canvas, his writing exudes confidence in his thesis and conveys a sense of truly comprehensive analysis. Yet, with his personal polemic agenda, selectivity was inevitable.

As such, it exposed him to the criticism that he was trapped by his own presuppositions of an inherent antagonism between the theological and the scientific views of the universe. His book, which he commenced writing in the 1870s, is no longer regarded as even a reliable secondary source for historical study. It is, however, an accurate reflection of how certain liberalminded men of his day perceived the relationship between religion and science and of how ―history‖ (or a version of it) was pressed into service for their cause. The remarkable thing about the whole conflict thesis is how readily the Victorian propaganda in all of its varied forms has become unconsciously assimilated as part of the received wisdom of our own day. However, it is salutary to note that serious historical scholarship has revealed the conflict thesis as, at best, an oversimplification and, at worst, a deception. As a rare example of the interface between contemporary public opinion and historical scholarship, it is high time for a robust exposure of its true character.

THE DEMARCATION OF SCIENCE AND RELIGION Stephen C.Meyer

Introduction

What is science? What is religion? How do the two intersect? Historians of science address these questions by analyzing how the scientific and religious beliefs of particular scientists or cultures have interacted at specific times. Philosophers of science and religion, however, have sought to characterize the relationship between them in more general terms. Their endeavor has required defining science and religion in order to distinguish or ―demarcate‖

them from each other by clear and objective criteria. During modern times, theologians and philosophers of science have attempted to make categorical demarcations between science and religion on various definitional grounds.

Defining Differences: Some Philosophical Context

The neo-orthodox theologian Karl Earth (1886–1968), for example, asserted that science and religion have different objects of interest. Religion and theology focus on God‘s self-revelation through Christ; science studies the

natural world. Earth maintained that science and religion use different methods of obtaining knowledge. Scientists can know the external world through rational and empirical investigation. Yet, because of human sin, man cannot know God from the visible testimony of the creation, that is, ―from the things that are made‖ (Romans 1:20), as Saint Paul put it. Instead, human knowledge of God comes only if God reveals himself directly to man in a mystical or an a-rational way. Existentialist philosophers such as Søren Kierkegaard (1813–55) and Martin Buber (1878–1965) also accepted a fundamental epistemological distinction between science and religion. According to both, scientific knowledge is impersonal and objective, whereas religious knowledge is personal and subjective. Since science concerns itself with material things and their functions, objective knowledge is possible, at least as an ideal. Religion, however, involves a personal relationship with the object known (God) and a personal or moral response to him. Therefore, radical subjectivity characterizes religious endeavor. Or, to use Buber‘s well-known terminology, science fosters an ―I-it‖ relationship between the knower and the known; religion, an ―I-Thou‖ relationship.

A group of early-twentieth-century philosophers known as logical positivists also insisted that science and religion occupy separate and nonoverlapping domains, but for different reasons. According to the positivists, only empirically verifiable (or logically undeniable) statements are meaningful. Since science makes statements about observable material entities, its statements have meaning. Religious or metaphysical beliefs, however, refer to unobservable entities such as God, morality, salvation, free will, and love. Hence, by positivistic definition, they lack meaning. As Frederick Coppleston has explained, the principal tenet of positivism was that, since experience alone provides the basis for knowledge, ―the scientific method was the only means of acquiring anything that could be called knowledge‖ (Coppleston 1985, 117–18). Hence, positivism not only distinguishes between science and religion, but it does so on grounds that deny objective warrant to religious belief.

Models of Interaction: Defining the Issues

Contemporary philosophers of science and religion generally recognize that science and religion do represent two distinct types of human activity or endeavor. Most acknowledge that they require different activities of their practitioners, have different goals, and ultimately have different objects of interest, study, or worship. For these reasons, some have suggested that science and religion occupy either completely separate ―compartments‖ or ―complementary‖ but nonoverlapping domains of discourse and concern. These perspectives have been formalized as two models of science-religion interaction known, respectively, as compartmentalism and complementarity. Compartmentalism (associated with Barth, Kierkegaard, and positivists) asserts that science and religion inevitably offer different types of descriptions of different types of realities. Complementarity (as articulated principally by neuroscientist Donald M.Mackay in the 1970s) allows that science and religion may sometimes speak about the same realities but insists that the two always describe reality in categorically different but complementary ways (that is, with so-called ―incommensurable‖ languages). Both of these models deny the possibility of either conflict or specific agreement between science and religion. Science, properly understood, can neither support nor undermine religion since the two represent distinct and nonintersecting planes of experience and knowledge. Both complementarity and compartmentalism thus presuppose the metaphysical or religious neutrality of all scientific theories.

Contemporary philosophers such as Alvin Plantinga, Roy Clouser, and J.P.Moreland have questioned the strict separation of science and religion. They point out that it does not follow from the real differences between them that science and religion must differ qualitatively in every respect. Thus, philosophers have noted that religions as well as sciences make truth claims. Moreover, science and religion often seem, at least, to make claims about the same subject in clear prepositional language. For example, both make claims about the origin and nature of the cosmos, the origin of life, and the origin of man; both make claims about the nature of human beings, the history of certain human cultures, and the nature of religious experience. Religions, like sciences, may be right or wrong about these subjects, but few contemporary philosophers of science (though not necessarily theologians or scientists) now agree that science and religion never make intersecting truth claims. Historical religions in particular (such as Judaism, Christianity, and Islam) make specific claims about events in time and space that may either contradict or agree with particular scientific theories. Indeed, as Plantinga has argued, many (though not all) scientific theories have metaphysical and religious implications. Plantinga cites several examples of scientific theories, which, if taken as claims about truth rather than merely as instrumental devices for ordering experience or generating hypotheses, have clear metaphysical import. He notes that various cosmological explanations for the fine-tuning of the physical constants (the so-called ―anthropic‖ coincidences) either support or deny a theistic conclusion; that sociobiology and theism give radically different accounts of human altruism; and that neo-Darwinian evolutionary theory, contra theism, denies any detectable design or purpose in creation. On this latter score, many evolutionary biologists agree with Plantinga‘s assessment. Francisco Ayala, Stephen Jay Gould, William Provine, Douglas Futuyma, Richard

Dawkins, Richard Lewontin, and the late G.G. Simpson, for example, all agree that neo-Darwinism (taken as a realistic portrayal of the history of life) postulates an exclusively naturalistic mechanism of creation, one that allows no role for a directing intelligence. As Simpson put it: ―man is the result of a purposeless and natural process that did not have him in mind‖ (Simpson 1967, 344–5). In any case, these theories deny, contra classical theism, any discernable evidence of divine purpose, direction, or design in the biological realm. From a Darwinian point of view, any appearance of design in biology is illusory, not real. Thus, even if God exists, his existence is not manifest in the products of nature. As Francisco Ayala has explained: ―The functional design of organisms and their features would…seem to argue for the existence of a designer. It was Darwin‘s greatest accomplishment to show [however] that the directive organization of living beings can be explained as the result of a natural process, natural selection, without any need to resort to a Creator or other external agent‖ (Ayala 1994, 4–5). As Richard Lewontin and many other leading neo-Darwinists have noted, organisms only ―appear‖ to have been designed. Statements such as these clearly illustrate why attempts to impose a strict separation between science and metaphysics or science and religion have been increasingly questioned.

Where scientific theories and religious doctrines are taken as truth claims (as both scientists and religious believers usually require), some sci entific theories may be taken as either supporting or contradicting religious doctrines. Indeed, many would argue that there is no reason to exclude the possibility that some truth claims of religion may be evaluated rationally on the basis of public evidences. Several of the examples cited above suggest that scientific discoveries or theories may well contradict religious doctrines. Other examples suggest the possibility that science may also provide support for the truth claims of religion. Archaeological evidence may support biblical assertions about the history of Israel or early Christianity; cosmological or biological evidence may support various theological conceptions of creation; and neurophysiological or psychological evidence may support religiously derived understandings of consciousness and human nature. While many religious practitioners would acknowledge with Earth and Buber that religious commitment requires more than intellectual assent to doctrinal propositions, it does not follow that the prepositional truth claims of religion may not have an evidential or rational basis. Hence, recent work on the relationship between science and religion has suggested limits to the complementarity and compartmentalism models. While most philosophers of science and religion would agree that compartmentalism and complementarity model some aspects of the relationship between science and religion accurately, many now assert that these models do not capture the whole of the complex relationship between science and religion. Real conflict and real agreement between scientific and religious truth claims has occurred and is possible. Theories of science may not always be religiously or metaphysically neutral. Yet, contemporary defenders of the complementary model contend that the alleged metaphysical implications of scientific theories represent illicit or unsupported extensions of scientific theory, not the science itself. They assert that statements such as those cited above about the meaning of Darwinism, for example, do not represent science per se, but ―para-scientific‖ reflection about science or a pseudoscientific ―apologetic‖ for philosophical naturalism. Such reflection may reveal the metaphysical predilections of scientists (for example, Gould or Simpson), but it does not demonstrate any real metaphysical implications of science.

Those critical of compleme tarity agree that Ayala‘s and Simpson‘s statements do reflect metaphysical biases and that these statements may lack empirical support. Yet, for them it does not follow that either Gould‘s or Simpson‘s articulation of Darwinism is inaccurate. Nor does it follow that Darwinism does not constitute a scientific theory. Many scientific theories reflect the biases of scientific theorists. Some are inadequately supported or fallible. Does that mean that they are necessarily unscientific? This discussion begs a more fundamental question. Can scientific theories have metaphysical implications? If not, why not? Could Darwin, for example, formulate a scientific theory specifying that life arose as a result of exclusively naturalistic forces such as natural selection and random variation? Could he, as a scientist, deny that divine guidance played a causal role in the process by which new species are created? Many historians of science now agree that Darwin meant to exclude a causal role for God in his theory of evolution. They also agree that competing theories implied just the opposite. Is Darwinism, then, unscientific? Indeed, was all nineteenth-century biology prior to Darwin unscientific? If so, on what grounds? What exactly is science?

History of the Demarcation Issue

Such questions lead inevitably to the center of one of the most vexing issues in the philosophy of science, namely, the demarcation issue. Identifying scientific theories or truth claims and distinguishing them from religious or metaphysical truth claims (as opposed to religious practices or rituals) seems to require a set of criteria for defining science. But what exactly makes a theory scientific? And how can scientific theories be distinguished or demarcated from pseudoscientific theories, metaphysical theories, or religious beliefs? Indeed, should they be? In a

seminal essay, ―The Demise of the Demarcation Problem‖ (Laudan 1988a, 337–50), Larry Laudan explains that contemporary philosophers of science have generally lost patience with attempts to distinguish scientific theories from nonscientific theories. Demarcation criteria (criteria that purport to distinguish true science from pseudoscience, metaphysics, and religion) have inevitably fallen prey to death by a thousand counter-examples. Many theories that have been repudiated on evidentiary grounds express the very epistemic and methodological virtues (for example, testability, falsifiability, repeatability, and observability) that have been alleged to characterize true science. By contrast, some highly esteemed theories lack one or more of the allegedly necessary features of science. Laudan notes that, following Aristotle, science was first distinguished from nonscience by the degree of certainty associated with scientific knowledge. Science, it was thought, could be distinguished from nonscience because science produced certain knowledge (episteme), whereas other types of inquiry, such as philosophy or theology, produced opinion (doxa). Yet, this approach to demarcation ran into difficulties. Unlike mathematicians, scientists rarely provided strict logical demonstrations (deductive proofs) to justify their theories. Instead, scientific arguments often utilized inductive inference and predictive testing, neither of which produced certainty. Moreover, these limitations were clearly understood by philosophers and scientists by the late Middle Ages. For example, William of Ockham (c. 1280–c. 1349) and Duns Scotus (c. 1265–c. 1308) specifically refined Aristotelian inductive logic in order to diminish (but not eliminate) the fallibility known to be associated with induction. Further, as Owen Gingerich has argued, some of the reason for Galileo‘s conflict with the Roman Catholic Church stemmed from his inability to meet scholastic standards of deductive certainty, standards that he regarded as neither relevant to, nor attainable by, scientific reasoning.

By the late Middle Ages, and certainly during the scientific revolution, scientists and philosophers understood that scientific knowledge, like other knowledge, is subject to uncertainty. Hence, attempts to distinguish science from nonscience began to change. No longer did demarcationists attempt to characterize science on the basis of the superior epistemic status of scientific theories; rather they attempted to do so on the basis of the superior methods science employed to produce theories. Science came to be defined by reference to its method, not its certainty or its content. This approach also encountered difficulties, not the least of which was the consistent presence of disagreement about what the method of science actually entails. During the seventeenth century, the socalled mechanical philosophers insisted, contrary to Aristotelians, that scientific theories must provide mechanistic explanations. Yet, Isaac Newton (1642–1727) formulated a theory that provided no such mechanistic explanation. Instead, his theory of universal gravitation described mathematically, but did not explain, the gravitational motion of the planetary bodies. Despite provocation from Gottfried Wilhelm Leibniz (1646–1716), who defended the mechanistic ideal, Newton expressly refused to give any explanation for the mysterious ―action at a distance‖ associated with his theory of gravitational attraction. Similar debates about scientific method occurred during the nineteenth century. Some scientists and philosophers regarded the inductive procedures of John Stuart Mill (1806–73) and William Herschel (1738– 1822) as representative of the true scientific method. Others articulated the so-called vera causa ideal, which limited science to previously known or observable causes. Still others, such as C.S.Peirce (1839– 1914) and William Whewell (1794–1866), insisted that predictive success constituted the most important hallmark of true science, whether or not theoretical entities could be observed directly. Yet, Peirce and Whewell also acknowledged that explanatory power, as opposed to predictive success, characterized scientific theorizing in some contexts. Such lack of agreement brought havoc upon the demarcationist enterprise. If scientists and philosophers cannot agree about what the scientific method is, how can they distinguish science from disciplines that fail to use it? In any case, there may well be more than one scientific method. Historical sciences, for example, use distinctive types of explanations, inferences, and modes of testing. If more than one scientific method exists, then attempts to mark off science from nonscience by using a single set of methodological criteria will almost inevitably fail. As problems with using methodological considerations grew, the demarcationist enterprise again shifted ground. Beginning in the 1920s, philosophy of science took a linguistic, or semantic, turn.

The logicalpositivist tradition held that scientific theories could be distinguished from nonscientific theories not because scientific theories had been produced via unique or superior methods, but because such theories were more meaningful. Logical positivists asserted that all meaningful statements are either empirically verifiable or logically undeniable. According to this ―verificationist criterion of meaning,‖ scientific theories were more meaningful than philosophical or religious ideas because scientific theories referred to observable entities, whereas philosophy and religion referred to unobservable entities. This approach also subtly implied the inferior status of metaphysical beliefs. Yet, positivism eventually self-destructed. Philosophers came to realize that positivism could not meet its own verificationist criterion of meaning: The verificationist criterion turned out to be neither empirically veri fiable nor logically undeniable. Furthermore, positivism misrepresented much actual scientific practice. Scientific theories refer to unverifiable and unobservable entities such as forces, fields, atoms, quarks, and universal

laws. Meanwhile, many disreputable theories (for example, the flat-Earth theory) appeal only to ―common sense‖ observations. Clearly, positivism‘s verifiability criterion would not achieve the demarcation for which philosophers of science had hoped. With the demise of positivism, demarcationists took a different tack. Karl Popper (1902–94) proposed falsifiability as a demarcation criterion. According to Popper, scientific theories can be distinguished from metaphysical theories because scientific theories can be falsified (as opposed to verified) by prediction and observation, whereas metaphysical theories cannot. Yet, this, too, proved to be a problematic criterion. First, falsification turns out to be difficult to achieve. Rarely are the core commitments of scientific theories directly tested via prediction. Instead, predictions occur when core theoretical commitments are conjoined with auxiliary hypotheses (hence, always leaving open the possibility that auxiliary hypotheses, not core commitments, are responsible for failed predictions). Newtonian mechanics, for example, assumed as its core three laws of motion and the theory of universal gravitation. On the basis of these assumptions, Newton made a number of predictions about the positions of planets in the solar system. When observations failed to corroborate Newton‘s predictions, he did not reject his core assumptions. Rather, he altered some of his auxiliary hypotheses to explain the discrepancies between theory and observation. For example, he force. As Imre Lakatosh has shown, Newton‘s refusal to repudiate the core of his theory even in the face of anomalies enabled him to refine his theory and eventually led to its tremendous success (Lakatosh 1970, 189–95). The explanatory flexibility of Newton‘s theory did not function to confirm its ―nonscientific status,‖ as the Popperian demarcation criterion would imply.

Studies in the history of science have shown the falsificationist ideal to be simplistic. The role of auxiliary hypotheses makes many scientific theories, including those in the so-called hard sciences, difficult, if not impossible, to falsify conclusively on the basis of one failed prediction or anomaly. Yet, some theories (for example, of flat Earth, phlogiston, and heliocentrism) have been eventually falsified in practice by the judgment of the scientific community regarding the preponderance of data. This fact raises a difficult question for demarcationists. Since the theories of phlogiston and a flat Earth have been overwhelmingly falsified, they must be falsifiable and, therefore, scientific. Are such falsified theories more scientific than currently successful theories that have the flexibility to avoid falsification by a single anomaly? Is a demonstrably false theory more scientific than one that has wide explanatory power and may well be true? Further, Laudan shows that it is absurdly easy to specify some prediction, any prediction, that, if false, would count as a conclusive test against a theory (Laudan 1988b, 354). Astrologers and phrenologists can do it as easily as, indeed, astronomers and physiologists. Such contradictions have plagued the demarcationist enterprise from its inception. As a result, most contemporary philosophers of science regard the question, ―What methods distinguish science from nonscience?‖ as both intractable and uninteresting. What, after all, is in a name? Certainly not automatic epistemic warrant or authority. Increasingly, then, philosophers of science have realized that the real issue is not whether a theory is scientific, but whether a theory is true or warranted by the evidence. Hence, as philosopher Martin Eger has summarized it: ―[d]emarcation arguments have collapsed. Philosophers of science don‘t hold them anymore. They may still enjoy acceptance in the popular world, but that‘s a different world.‖ Or, as Laudan expresses it: ―If we could stand up on the side of reason, we ought to drop terms like ‗pseudo-science‘…they do only emotive work for us‖ (Laudan 1988a, 349).

Demarcation Arguments in the Creation-Evolution Debate

Despite the rejection of demarcation criteria by philosophers of science, these criteria continue to be employed in various ideologically charged scientific debates. Perhaps the most dramatic example has occurred in the so-called creation-evolution debate. Both sides have asserted that theories espoused by the other depart from established canons of the scientific method. Creationists such as Duane Gish and no less a personage than Karl Popper himself have referred to Darwinian evolutionary theory as an unscientific ―metaphysical research program‖ (Popper 1988, 145). For their part, defenders of evolution have employed these same tactics to discredit any possibility of a scientific theory of creation and to exclude the teaching of creationist interpretations of biological evidence in U.S. public high schools. In 1981–82, during the Arkansas trial over the legitimacy of teaching ―creation science,‖ the Darwinist philosopher of science Michael Ruse cited five demarcation criteria as the basis for excluding any creationist theory from public education. According to Ruse, for a theory to be scientific it must be (1) guided by natural law, (2) explanatory by natural law, (3) testable against the empirical world, (4) tentative, and (5) falsifiable. Ruse testified that creationism, with its willingness to invoke divine action as a cause of certain events in the history of life, could never meet these criteria. He concluded that creationism might be true but that it could never qualify as science. Presiding Judge William Overton agreed, ruling in favor of the American Civil Liberties Union (ACLU), at whose behest Ruse had testified, and citing Ruse‘s five demarcation criteria in his ruling.

After the trial, some philosophers of science, including Larry Laudan and Philip Quinn (neither of whom supported creationism‘s empirical claims), repudiated Ruse‘s testimony as either ill-informed about the status of the demarcation problem or disingenuous. Both argued that Ruse‘s criteria could not distinguish the a priori scientific status of creationist and evolutionary theory. They insisted that only specific empirical, as opposed to methodological, arguments could accomplish this. Indeed, upon further examination, Ruse‘s demarcation criteria have proven problematic, especially as applied to the debate about biological origins. For example, insofar as both creationist and evolutionary theories constitute historical theories about past causal events, neither explains exclusively by reference to natural law. The theory of common descent, arguably the central thesis of Darwin‘s Origin of Species (1859), does not explain by natural law. Common descent does so by postulating a hypothetical pattern of historical events that, if actual, would account for a variety of currently observed data. In the fifth chapter of the Origin, Darwin (1809–82) himself refers to common descent as the vera causa (the actual cause or explanation) of a diverse set of biological observations. In Darwin‘s theory of common descent, as in historical theories generally, postulated causal events (or patterns thereof) do the explanatory work. Laws do not. Hence, Ruse‘s second demarcation criterion, if applied consistently, would require classifying both creationist theory and the Darwinian theory of common descent as unscientific. Similar problems have afflicted Ruse‘s remaining demarcation criteria. Theories about the past rarely employ the exclusively predictive methods of testing required by Popper‘s falsifiability criterion. Theories of origins generally make assertions about what happened in the past to cause present features of the universe to arise. Such theories necessarily attempt to reconstruct unobservable past causal events from present clues or evidences. Methods of testing that depend upon the prediction of novel or future events have minimal relevance to historical theories of whatever type. Those who insist that testing must involve prediction, rather than compare the explanatory power of competing theories, will find little that is scientific in any origins theory, evolutionary or otherwise. Analyses of the other demarcation criteria articulated by Ruse have shown them similarly incapable of discriminating the a priori scientific status of creationist and evolutionary theories. Accordingly, during a talk before the American Association for the Advancement of Science (AAAS) in 1993, Ruse repudiated his previous support for the demarcation principle by admitting that Darwinism (like creationism) ―depends upon certain unprovable metaphysical assumptions.‖

The Future of the Demarcation Issue

The demarcationist arguments employed in the origins controversy almost inevitably presuppose a positivistic or neopositivistic (that is, Popperian) conception of science. Some have wondered, therefore, whether new developments in the philosophy of science might make demarcation tenable on other grounds. Yet, recent non-positivistic accounts of scientific rationality seem to offer little hope for a renewed program of demarcation. Philosophers of science Paul Thagard and Peter Lipton have shown, for example, that a type of reasoning known as ―inference to the best explanation‖ is widely employed not only in science, but also in historical, philosophical, and religious discourse. Such work seems to imply that knowledge is not as easily classified on methodological or epistemological grounds as compart-mentalists and demarcationists once assumed. Empirical data may have metaphysical implications, while unob servable (even metaphysical) entities may serve to explain observable data or their origins. More recent work on the methods of the historical sciences has suggested that the methodological and logical similarity between various origins theories (in particular) runs quite deep. Philosopher of biology Elliot Sober has argued that both classical creationistic design arguments and the Darwinian argument for descent with modification constitute attempts to make retrodictive inferences to the best explanation. Other work in the philosophy of science has shown that both creationist and evolutionary programs of research attempt to answer characteristically historical questions; both may have metaphysical implications or overtones; both employ characteristically historical forms of inference, explanation, and testing; and, finally, both are subject to similar epistemological limitations. Hence, theories of creation or ―intelligent design‖ and naturalistic evolutionary theories appear to be what one author has termed ―methodologically equivalent.‖ Both prove equally scientific or equally unscientific provided the same criteria are used to adjudicate their scientific status (provided that metaphysically neutral criteria are used to make such assessments). These two theories may not, of course, be equivalent in their ability to explain particular empirical data, but that is an issue that must be explored elsewhere.

GOD, NATURE, AND SCIENCE Stanley L.Jaki

Science deals with an external reality, usually taken for nature, writ large, that is equivalent to the totality

of material things or the physical universe. Such a nature, or universe, has been taken either for an entity not to be reduced to something else or for something essentially dependent for its existence on a supernatural factor, usually called God. Viewing nature as a self-explaining entity can translate itself into either a materialistic or a pantheistic ideology. In the former, spiritual experiences are taken to be the result of the processes of matter. In pantheistic theology, both nature and mind (spirit) are considered to be manifestations of some divine principle, which pervades all nature but is ultimately not different from it. The view that nature depends on God can be either theistic or deistic. In theism (essentially Christian theism in the Western world), God is not only the Creator, but also the Sustainer, who can interfere with nature by, say, working miracles in support of an information (revelation), which is superadded to what man can deduce about God from a philosophical reflection on nature. In deism, God is thought to have removed himself from nature‘s workings and from human affairs after the moment of creation.

All of these ideological trends have one thing in common: They assume that nature is ordered and that the human mind is capable of tracing out that order. One could, therefore, try to unfold on an analytical basis the respective impacts of those various religious ideologies on the scientific enterprise. However, such an approach would, at almost every step, imply historical considerations about science, and all the more so as science has only gradually revealed itself as a strictly quantitative study of things in motion. It may, therefore, seem more logical to specify, from the start, those impacts in their historical context, because pantheism, theism, deism, and materialism represent also a historical sequence. This sequence is not essentially affected by the fact that the Greeks, who are usually credited with the dawn of scientific thinking in the West, showed markedly materialistic tendencies. Although among the statements attributed to the Ionians, who stood at the beginning of Greek philosophical and scientific speculation, one finds remarks about nature as being full of gods, they usually put the emphasis on the exclusive role of matter and motion. That trend was even more marked in the case of Anaxagoras (fifth century B.C.) and the atomists.

It was in reaction to that dehumanizing trend that Socrates (469–399 B.C.) proposed the animation of all matter so that a defense of the existence of an immortal human soul (anima) could be argued. According to Socrates, all parts of matter move in order to achieve what is ―best‖ for them, in strict analogy to man‘s striving for what is best for him. Such was Socrates‘s way of ―saving the purpose,‖ no matter what was the object of inquiry. In the concluding sections of his Phaedo, Plato (c. 427–347 B.C.) gives some glimpses of that new physics. Plato goes into details in the third part of his Timaeus, in which the living human body serves as the explanation of the physical world. This third part, largely neglected by Plato‘s interpreters, stands in marked contrast with the first part, in which Plato sets up a geometrical explanation of matter in terms of the five perfect geometrical bodies. The contrast is between two principles. One is called by Plato the principle of ―saving the phenomena,‖ or a science that is confined to the task of correlating purely quantitative data about things. The other is the Socratic program, which is left unnamed but which best deserves the label ―saving the purpose.‖

Greek Pantheism

The full articulation of a new program for science, within which the concept of organism was the chief explanatory device, is contained in Aristotle‘s (384–322 B.C.) On the Heavens and Meteorologica, of which the first deals with celestial, and the second with atmospheric and terrestrial, physics. They do not contain, to recall a remark of E.T.Whittaker, a single acceptable page from the modern scientific viewpoint. This ―scientific‖ debacle is the result of Aristotle‘s assumption of the radical animation of all nonliving matter, as initiated by Socrates, who claimed that man‘s soul (anima) is best manifested by his purposeful actions aiming at what is best for him. It was, however, in the writings of Aristotle that this trend of attributing a ―soul‖ to everything was given a sweeping theological twist in a pantheistic sense. Since Aristotle deified the universe in that sense, he had to deny that the universe could have been created out of nothing. Consistent with this denial, he also rejected the view that the actual universe was only one of the infinitely many possibilities for physical existence. The Prime Mover of Aristotle is a part, however subtly, of the sphere of the fixed stars, which obtains its motion through an emotive contact with the Prime Mover and directly shares, therefore, in its ―divine‖ nature. This sharing is the source of all other motions in the Aristotelian universe, in both its superlunary and its sublunary parts. In both parts, things are animated to move naturally in order to achieve their purpose by reaching their natural places. This animation of nature, in a more or less pantheistic sense, which discouraged a quantitative (or geometrical) approach

to nature, is everywhere noticeable in the discourse of post-Aristotelian Greek thinkers, especially when their extant writings are sufficiently extensive. It should seem significant that not even the non-Aristotelians among the ancients took issue with Aristotle‘s patently wrong statement (On the Heavens 1.6) that the rate of fall is proportional to the mass of the body, a statement that logically follows from his ―animation‖ of nature. The scientifically valuable (that is, quantitatively correct) achievements in Greek science seem to have been worked out mostly in isolation from broader views of nature. Among them are Eratosthenes‘s (c. 275– 194 B.C.) geometrical method to ascertain the size of the earth and a similarly geometrical method by Aristarchus of Samos (c. 215–c. 145 B.C.) to deduce the dimensions of the earth-moon-sun system. These achievements form an indispensable basis on which all subsequent science rests. They made possible the Ptolemaic system as the culmination of Greek efforts, at the instigation of Plato, ―to save the phenomena.‖ This phrase expressed the methodological conviction that the complex and variable planetary motions could be reduced to, and explained by, a simple and harmonious geometrical model. Still, when the extant corpus is fairly large, one cannot help noticing the intrusion of traces of the Aristotelian, and at times worse, forms of animization into scientific discourse. There are traces of it even in the Almagest of Ptolemy of Alexandria (second century A.D.). His astrological compendium, Tetrabiblos, remains the ―Bible‖ of that animistic preoccupation. In his ―physical‖ astronomy, a work on planetary hypotheses, Ptolemy considers the coordination of planets in terms of human beings. Only Archimedes‘s (c. 287–212 B.C.) writings do not show any trace of this animization of nature.

The ancient Greeks certainly recognized something of the nonideological character of quantitative considerations about nature, but, owing to the pervasive presence of pantheistic considerations, they failed o make the most of that character. The pantheistic conviction that the superlunary matter is divine prompted opposition to Anaxagoras‘s idea that a large meteor, which hit Aegospotami in 421 B.C., could come from above the moon‘s orbit. The pantheistic animation of the world also lurked behind the opposition to the heliocentric system proposed by Aristarchus of Samos. In pantheism, the human mind is in particular a sharer in the divine principle. Therefore, pantheism encourages the idea that the human mind has some innate insights into the overall structure and workings of nature. This idea fosters an a priori approach, as opposed to an a posteriori, or partly experimental and observational, approach. This is particularly clear in the case of Aristotle‘s dicta on the physical world. This aprioristic influence could be harmless when the subject matter of investigation was rather restricted. There is no trace of pantheism in Aristotle‘s valuable observational researches in biology. Of course, there the subject matter consisted of living organisms that, in all appearance, acted for a purpose, and, therefore, there was no special need to fall back on the broader perspective of a pantheistically colored animation of nature. The animation of nature exerted its unscientific impact with particular force in respect to the study of motion. First, it was asserted that since only the superlunary region was totally divine, matter in that realm obeyed laws of motion different from those of ordinary, or sublunary, matter. Moreover, this dichotomy between superlunary and sublunary matter implied that the latter was not truly ordered in its motions and interactions. Again, it was one thing to predict planetary positions; it was another to work out a physics of the motion of planets together with the motion of bodies on the earth. Here pantheism, as codified by Aristotle, blocked any meaningful advance. For, in Aristotle‘s system, the motion of planets (and even of things on the earth) was but a derivative of the motion of the sphere of the fixed stars, which, in turn, had its source in a continuous contact, however refined, with the Prime Mover. And since the source of all motion was thought to reside in that kind of contact between the Mover and the moved, the logic of that starting point demanded that all motion be explained as a continuous contact between the Mover and the moved. This, however, meant a rejection of the idea of inertial motion, which, as will be seen, proved to be indispensable for the eventual birth of a science that could deal with that most universal aspect of inanimate material things, which is their being in motion. Greek science, with its major achievements and stunning failures, represents a tantalizing case of the most crucial, and most neglected, aspect of the history of premodern science. That aspect consists of the invariable failure of all major ancient cultures to make a breakthrough toward the science of motion. The ultimate root of that systematic failure is theological, a point that will stand out sharply when we turn to the impact that theism had on science. That theism was Christian theism.

Christian Theism

The possibilities that a theistic conviction could hold for science first appeared in the writings of Athanasius (c. A.D. 296–373), a resolute defender of the strict divinity of the Logos (Christ), through whom God the Father created all. If, however, the Logos was divine, its work had to be fully logical or ordered and harmonious. This theological insistence on full rationality in the created realm inspired Augustine of Hippo (354–430) to lay down the principle that, if conclusions that science safely established about the physical world contradicted certain biblical passages, the latter should be reinterpreted accordingly. This is not to say that this principle quickly or

invariably found a praiseworthy implementation among Christian thinkers. But it acted as part of a broader perception within Christian theism wherever serious attention was paid to Paul‘s insistence that Christians should offer a well-reasoned worship (Romans 12:1). Hence, the rights of scientific reasoning were protected whenever the rationality of faith was defended against various champions of fideism or against the claim that faith in a supernatural mystery is the condition for the understanding of this or that plainly philosophical proposition. More generic, though very powerful and still to be fully aired, was the impact that the Christian doctrine of the Incarnation had. According to that doctrine, a real human being, Jesus Christ, was the ―only begotten‖ Son of God, in the sense of possessing a truly divine status. For those adhering to that doctrine, it was impossible to embrace the tenet, popular among Greek as well as Roman authors, that the universe was the ―only begotten‖ emanation from the divine principle. Hence, Christian theism contained a built-in antidote against the ever-present lure of nature worship or pantheism. Apart from these general principles, Christian theism also showed its potential usefulness for science in some particular matters, as can be seen in the writings of John Philoponus (d. c. 570). He was the first to argue that, since stars shine in different colors, they should be composed of ordinary matter. The argument had for its target the divine status ascribed throughout pagan antiquity to the heavens, a status that introduced a dichotomy in the physical universe and thereby set a limit to considering scientific laws as being truly universal.

The crucial impact of Christian theism on science came during the intellectual ferment brought about by the introduction of Aristotle‘s works to the medieval educational system during the latter part of the thirteenth century. Whatever the medieval enthusiasm for Aristotle, his pantheistic doctrine of the eternity and uncreated character of the world was uniformly opposed from the start as irreconcilable with the basic tenets of Christian theism. With John Buridan (c. 1295–c. 1358), the opposition took on a scientific aspect as well. For if it was true that the world, with its motions, had a beginning, then one could logically search for the manner—the how?—in which that beginning could be conceptualized. Buridan explained that how? was an eminently scientific question by saying that, in the first moment of creation, God imparted a certain quantity of impetus (or momentum, as it was called later) to all celestial bodies, which quantity they keep undiminished because they move in an area where there is no friction. Such a motion, insofar as it implied a physical separation between the Mover and the things moved, is the very core of the idea of inertial motion, to employ a term to be used later. In the context of his commentaries on Aristotle‘s On the Heavens, Buridan carefully notes that ―inertial‖ motion, insofar as it is a physical reality, does not mean absolute independence of things from the Creator. Anything, once created, remains in existence only through the Creator‘s general support, which is, however, distinct from the act of creation. In other words, Buridan is not a forerunner of deism. In deism, there is no room for such a support. Buridan‘s notion of a created world implies, in a genuinely Christian vein, the world‘s utter, continuous dependence on the Creator. The depth of createdness reveals, in turn, a Creator so superior to his creation that he can give his creation a measure of autonomy without any loss to his absolute and infinite supremacy. Similar is the theological background of Oresme (c. 1320–82), Buridan‘s successor at the Sorbonne, who looked at the world as a clockwork. While the world had already in ancient times been referred to as a clockwork, Oresme used that concept with an important theological surplus. This is why Oresme‘s clockwork universe is not an anticipation of Voltaire‘s and other eighteenth-century deists‘ celebration of the idea of a clockwork universe. Buridan‘s step can be seen rather as an anticipation of the Cartesian or Newtonian idea of inertial motion as long as one focuses on that step‘s very essence. It lies deeper than the difference between a circular and a rectilinear motion.

There is no question that Buridan retained the Aristotelian idea of a naturally circular motion for the celestial bodies. But he broke with Aristotle on the truly essential point—namely, that celestial motions were not caused by those bodies remaining in a quasi-physical contact with the divine power. This represented the crucial breakthrough toward the Cartesian formulation of linear inertia and of its incorporation into Newton‘s laws of motion. That Buridan‘s and Oresme‘s teaching about motion was a genuine product of their Christian theistic thinking is shown by the eagerness with which it was espoused in the fast-growing late-medieval and early- Renaissance university system. Buridan‘s and Oresme‘s doctrine was carried by their many students at the Sorbonne to the far corners of Europe. Among the many universities with copies of Buridan‘s commentaries was Cracow in Poland. It was there that Copernicus (1473–1543) learned a doctrine that sustained him in his efforts to cope with the dynamic problems created by the earth‘s motion in his system. With his vast articulation of the heliocentric system, Copernicus forced the physics of motion to the center of scientific attention. There was, of course, plenty of room to improve on the medieval doctrine of impetus, but only because that doctrine opened the way for meaningful advances toward a fully developed science of motion, which came only with Isaac Newton‘s Principia. One cannot overestimate the support that Christian theism afforded Copernicus and the major early Copernicans, especially Johannes Kepler (1571–1630). It was becoming increasingly clear that data of measurements were to have the last word concerning the structure and measure of the physical world. While the rhapsodically pantheistic Giordano

Bruno (1548–1600) merely promoted confusion, Baruch Spinoza (1632–77) was so consistent with his pantheism as to be unable to explain why there had to be finite things, if everything was part of the infinite God.

Separating Science and Religion

Nothing showed so much the methodological independence of a fully fledged science from theology as the complete absence of any reference to God in the first edition of Newton‘s Principia (1687). Newton (1642– 1727) contradicted that independence when he invoked, in the General Scholium that he added to the second edition of the Principia (1713), the Pantokrator as the all-powerful, infinitely dynamic Creator described in the Bible. Moreover, that Pantokrator is pictured as intervening periodically in the workings of the solar system so that it may stay in equilibrium. The opposition of Gottfried Wilhelm Leibniz (1646– 1716), a convinced Christian, to belief in God‘s periodic interventions in nature created a celebrated dispute that distracted from the influence of the Principia in respect to the relation of religion (be it pantheism, deism, or theism) to science. While a theist may take comfort from the fact that the author of the Principia was a genuine theist, there is nothing in that work that could not be equally useful and valid within any religious or nonreligious framework. This is so because the Principia, to quote its full title, is an exposition of the ―mathematical principles of natural philosophy‖ (emphasis added). This means that, as long as exact science is a quantitative study of the quantitative aspects of things in motion, it enjoys a full independence from all ideological, religious, and theological perspectives. And this holds true in respect both to the formulation of a major scientific theory and to its subsequent interpretation. Hence, the relation of pantheism, theism, and deism to science is a matter that is essentially different in its status before and after Newton‘s Principia.

Before the appearance of that work, which preceded the robust emergence of deism in the Western world, pantheism and theism could play their respectively inhibitory and creative roles in science. After the Principia, exact science had a broadly articulated mathematical, or quantitative, structure that safely operated within its own set of methodical canons and retained a very large measure of independence from participating scientists‘ religious or antireligious motivations.

This was not fully understood during the eighteenth century, and certainly not by deists, who claimed to have a better perspective on science because of their freedom from the fetters of Christian dogma. No deist of the eighteenth century is known to have spurred a major advance in the physical sciences. Voltaire (1694– 1778) was at best a popularizer of Newtonianism. Nor could he live easily with the proverbial piety of Leonhard Euler (1707–83), to whom goes the credit of unfolding a great many consequences of Newton‘s physics. Whatever Pierre Laplace‘s (1749–1827) personal philosophies (he changed them as a weathervane turns with the prevailing political winds), his claim that his cosmogonic theory did not need God as a hypothesis expressed concisely the true character of the mathematical investigation of matter in motion. It was enough for the physicist to assume, as a matter of commonsense truth, that matter and motion existed and were measurable. Hence, after the Principia, the religious or antireligious interpretations of science could touch only on the philosophies spun around an essentially quantitative, or mathematical, core. That core rested on Newton‘s three laws of motion, a point that is true regardless of the extent to which science increasingly dealt with mere energy transfers, as was especially the case with modern atomic and subatomic physics. Whether in classical or quantum mechanics, energy, it is well to recall, is but the work done by force over a given amount of distance.

In other branches of empirical science, one can observe an ever stronger tendency to achieve a degree of exactness comparable to that obtained in physics. This tendency has almost completely triumphed in chemistry, at least in the sense that only the complexity of many processes sets practical limits to it. The rise and flourishing of biophysics and biochemistry witness the same trend in biology, whatever the merits of the claim that the art of classification remains indispensable. It should, however, be noted that, even in that art, quantitative considerations have remained implicit. Such a classification is still of paramount importance in evolutionary theory, Darwinian or other. In Charles Darwin‘s (1809–82) case, materialistic motivations came to play a major part in his having worked with dogged resolve, over thirty years, on what became Origin of Species (1859) and The Descent of Man (1871). It should be noted that Alfred R.Wallace (1823–1913), who was a theist, could formulate the same theory but that he rejected, in terms of the theory, Darwin‘s derivation of the human mind as a mere random product of biological processes. For it still contradicts Darwinian logic to ascribe the growth of the brain to the needs of a mind that is still to manifest itself through language.

Darwin‘s theory owed its success to two factors, very different from each other. One was a unified picture of material nature (nonliving and living), which prompted a vast amount of research with, at times, spectacular results. This is a point to be genuinely appreciated by many theists, who might find in their very belief in a rational Creator the chief motivation in espousing evolutionary theory. Theists have, of course, some excuse for dragging their feet in the other factor that assured so much popularity to Darwin‘s theory. That factor was materialism, within

which man is not subject to any transcendental reality, not even to a set of invariably valid ethical norms. This materialistic interpretation of evolution has, however, no connection with any major advance in biology insofar as the latter is carefully distinguished from the materialistic proclivities of the discoverers themselves. A case in point is the unabashed materialism of Francis Crick (b. 1916) and James Watson (b. 1928), codiscoverers of the double-helix structure of DNA molecules. The more a scientific proposition or a branch of science is embedded in mathematics, the clearer becomes its ideological independence and neutrality. This facet of science is the standard against which one can make a reliable appraisal of its interrelation with various forms of religious views and of the perceived impact of these views on science. In light of this fact, generalizations such as that nineteenth-century science was materialistic seem quite unfounded. While some of it was, of course, the majority of scientists during that century still adhered to theism and, in fact, to Christian theism.

Integrating Science and Religion

The only meeting ground of science and religion (whether theism, deism, pantheism, or materialism) depends on a methodically realist epistemology. A firm espousal of the mind‘s ability to know the external world is indispensable to giving rational respectability to one‘s religious views. By the same token, a scientist must formulate similar epistemological views in order to relate his or her quantitative data to physical reality. The working out of an epistemology that assures reality to the theologian as well as to the scientist, though for different purposes, is the basis of a meaningful discourse about the relation between theology and science. An epistemology (or its lack) is evident in all methodologies of science. It can, indeed, be shown that most great creative advances in science have been made in the context of an epistemology that occupies a middle ground between idealism and empiricism. The former invariably leads to solipsism, whereas the latter proves incapable of coping with generalizations, inferences, and induction. The epistemological middle ground is, moreover, the one that has always been used in philosophical reasoning that allows an inference to the existence of that transcendental factor, which, at the very start of this essay, was called God, or the Creator. It can also be shown that, whenever a scientist or a philosopher worked out a scientific methodology that made impossible the foregoing inference, the results were potentially disastrous for science. René Descartes (1596–1650), Baruch Spinoza (1632–77), Immanuel Kant (1724– 1804), and Georg Hegel (1770–1831) represent the major instances from the idealist (rationalist) side, whereas Francis Bacon (1561–1626), John Locke (1632–1704), Étienne Condillac (1715–80), and Ernst Mach (1838–1916) illustrate the same from the empiricist (sensationist) side. During the twentieth century, paradigmists threw a red herring, by turning the philosophy of science into the psychology and the sociology of science, within which any objective difference among theism, deism, pantheism, and materialism or plain agnosticism had to appear irrelevant. Again, there is no point in talking about the relation of science to theism (or even to deism) if the latter merely stand for a religiously colored aestheticism (which was the kind of religion articulated in great detail by Alfred North Whitehead [1861– 1947] and espoused in usually inarticulate phrases by many scientists who did not want to appear to be materialists). The eternity of matter has, as its basic dogma, the uncreatedness of the universe. Hence, materialist scientists must either outline a scientific touchstone for this dogma or demonstrate, through scientific observation or experiment, that matter is, in fact, eternal, that is, without the possibility of a beginning or an end.

In this age of science, in which the acceptability and credibility of any proposition so heavily depends on its true or alleged connection with science, theists should be wary of resting their stance on vague philosophical discourses just because they have been used by prominent scientists. One such discourse is the philosophy of complementarity as popularized by Niels Bohr. The fact that, in atomic, nuclear, and fundamental-particle physics, wave and particle concepts, though quantitatively irreducible to one another, are equally indispensable does not legitimize the acceptance in philosophy of mutually exclusive basic starting points. Precisely because a theist (or a deist or an atheist) takes an essentially philosophical position, that position can integrate only what is of genuinely philosophical content in a scientific proposition. But, as argued above, the content is independent of that mathematical, or quantitative, structure that is the very core of a scientific theory. Thus, for instance, James Clerk Maxwell‘s (1831–79) theory will forever remain only the system of his equations (to recall a famous remark of Heinrich Hertz [1857–94], the first to demonstrate experimentally results that are best interpreted as electromagnetic waves). For such theories never exist in a one-to-one correspondence to the physical reality that is tied to them more or less philosophically. Failure to recognize this fact has vitiated many fashionable programs of integrating science and theology. Science and theology work with mutually irreducible sets of concepts. This does not mean that they are in opposition, but only that they are different. This is the gist of a memorable remark made by a prominent British physicist, Sir William Bragg (1862–1942), a Nobel laureate. He likened the relation of the two to the cooperation of the thumb and the fingers, whereby one can grasp things. Their cooperation is also a spatial and functional opposition: Only by remaining different are they helpful for grasping a large variety of propositions.

GENESIS AND SCIENCE

John Stenhouse

Genesis, the first book of the Bible, the authorship of which has been traditionally ascribed to the Hebrew prophet Moses (who is variously dated to the fifteenth or the thirteenth century B.C.), constitutes the foundation text of those biblical religions (Judaism and Christianity) that have deeply shaped Western culture. The relationship between the first two chapters of Genesis, which describe God‘s creation of the world and the first human beings (Adam and Eve) in six days, and scientific knowledge has constituted one of the most important and controversial sites of intersection between science and religion throughout the ages. Of particular concern has been the question of how literally the account should be taken by those who accept its authority as divine revelation. Some of the church Fathers christianized Greek natural philosophy, especially that of Plato (c. 427–347 B.C.), in their attempts to interpret the Genesis account of Creation. The fourth-century A.D. theologian Augustine of Hippo (354–430), for example, attempted to reconcile the Genesis notion that God created everything in the beginning with the observation that living things grow and develop. Borrowing the Stoic idea that nature contains seedlike principles, Augustine argued that God created many living things potentially rather than actually, in the form of seminal principles that determined their subsequent development. Some theologians in the early church saw layers of meaning in Genesis, which provided a space for scientific theory, an interpretive tradition that continued during the Middle Ages. Commentators on the Hexameron (six days of creation), such as Thierry of Chartres (c. 1100– c. 1156), restricted God‘s supernatural intervention to the initial act of Creation. Everything else, including Adam and Eve, appeared naturally, as the gradual unfolding of the developmental principles that God had implanted in nature. The Dominican theologian Thomas Aquinas (c. 1225–74) argued that Genesis might be compatible with a variety of scientific theories. The firmament created on the second day in Genesis 1:6–9, for example, might refer either to the sphere of the fixed stars or to that part of the atmosphere in which clouds condense. Wary of tying the authority of Scripture too closely to changing scientific knowledge, Aquinas left the options open. Protestants emphasized the plain meaning of Scripture during the turbulent years following the Reformation, without reading Genesis as a scientific text. John Calvin (1509–64), for example, argued that Moses wrote Genesis in a popular style for ordinary people, and he warned against treating it as an authoritative source of astronomical (as opposed to religious) knowledge.

Until late in the seventeenth century, few scholars saw any compelling evidence against the view that creation had occurred within the last six thousand years. In the mid-seventeenth century, the learned biblical scholar James Ussher (1581–1656), archbishop of Armagh, calculated an exact date, 4004 B.C., which began to appear in the margins of the Authorized or King James Version of the Bible beside Genesis 1:1. The view that the cosmos, Earth, and Adam had been created almost simultaneously was challenged only by the occ sional freethinker, such as Isaac de la Peyrère (1596–1676), a French Calvinist, who argued that humans had existed on Earth before Adam, who was the first Jew, not the first man. Toward the end of the seventeenth century, scholars began to stretch the initial creation back into the past. Thomas Burnet (c. 1635–1715), an English clergyman, argued in Sacred Theory of the Earth (1680–9) that the cosmos had been created long before the earth and its inhabitants. During the eighteenth century, a growing number of thinkers began to suspect that the earth, too, had a history long predating the appearance of humans and that its origin might be explained scientifically. Georges Leclerc, Comte de Buffon (1707– 88), was perhaps the first seriously to challenge the view that Earth‘s history and human history were coextensive. The French astronomer Pierre Laplace (1749–1827) argued in 1796 that a rotating nebula left behind rings that, cooling and condensing, became the planets of our solar system. When asked by Napoleon about the role of God in his theory, Laplace replied: ―Sire, I have no need of that hypothesis.‖ Some naturalists began to doubt whether the Deluge accounted for the entire fossil record. In the work of the French zoologist Georges Cuvier (1769– 1832), the Flood became simply one of a series of dramatic natural events that periodically entombed living creatures in the rocks. By the early nineteenth century, most naturalists had come to believe that the earth was extremely old and had been inhabited by a succession of creatures, many of them now extinct, ages before Adam and Eve first appeared. Many opted for a local rather than a universal Deluge. Liberal Protestants such as the geologist Charles Lyell (1797– 1875) abandoned the attempt to harmonize Genesis and geology in detail, finding in Genesis religious truths, such as God‘s creation of all things, but no science. Evangelical Christians preferred more conservative interpretations, such as the gap theory of Thomas

Chalmers (1780–1847), the Scottish Free Church scholar, who in 1814 proposed allowing a gap of indefinite duration between the first two verses of Genesis, which provided unlimited time prior to the Creation week for earlier creations and extinctions. Clerical geologists such as Edward Hitchcock (1793–1864) in the United States popularized the gap theory, which influential fundamentalists such as C.I.Scofield (1843–1921), editor of the widely circulated Scofield Reference Bible, disseminated in the twentieth century. A second interpretation popular among evangelicals, the day-age theory, interpreted the days of Genesis not as twenty-four hour periods but as long geological epochs. The Scottish geologist and Free Churchman Hugh Miller (1802–56) popularized this view in the nineteenth century, as did Benjamin Silliman (1779–1864) of Yale University and James Dwight Dana (1813–95) in the United States and Sir John William Dawson (1820–99) in Canada. American fundamentalists such as William Jennings Bryan (1860–1925) transmitted it to the twentieth century.

The theory of evolution raised further problems in the second half of the nineteenth century. How could the Genesis doctrine of the creation of humanity in the image of God be reconciled with the notion that humans had evolved from apelike ancestors? On the left of the spectrum of opinion, a growing band of atheists, freethinkers, and agnostics, such as Charles Darwin (1809– 82) and T.H.Huxley (1825–95), dismissed Genesis as falsehood or primitive religious superstition. This group shaded into a broad category of religious believers, including liberal Protestants, Reform Jews, and a few Catholics, who were prepared to reinterpret Genesis in order to embrace evolution. They argued that Genesis used the language of myth, symbol, or poetry to teach a few simple, profound religious truths, such as God‘s creation of humans in his image. Adam came to symbolize humanity in general, not a real person. Some, such as the American Protestant minister Henry Ward Beecher (1813–87), eagerly abandoned what he regarded as obnoxious traditional doctrines, such as the Fall and Original Sin (Genesis 3), for an optimistic evolutionary anthropology, being confident of theability of humans to build the kingdom of God. Orthodox believers, such as the Princeton Presbyterian theologian Benjamin B.Warfield (1851–1921) and some Roman Catholics, argued that, though the human body might have evolved, the soul remained a supernatural creation. Such thinkers accommodated evolution without drastically reinterpreting Genesis, though not all insisted on a historical Adam. Some sanctified the old preadamite heresy to argue that nearhumans existed before Adam, who was the first full human (that is, the first to be made in the image of God). Further to the right of the religious spectrum, many continued to read Genesis literally. Ellen G.White (1827–1915), for example, the American founder-prophetess of Seventh-day Adventism, declared that God had created Adam and Eve and all earthly life in six days of twenty-four hours between about six and ten thousand years ago. George McCready Price (1870–1963), an Adventist geologist, transmitted this view to the twentieth century and tried to give it scientific standing. The views of Price, which became known as ―creation science,‖ reached a large audience in the pages of The Genesis Flood (1961), a best-seller written by Henry Morris (b. 1918), an engineer, and John C.Whitcomb (b. 1924), a theologian. By the 1980s, millions of evangelical Christians, particularly in the United States, believed that God had created the earth, Adam, and Eve within the last ten thousand years and that Noah‘s Flood accounted for virtually the entire fossil record.

As the creation-science movement indicates, Western thinkers in the twentieth century became more divided than ever in their views of human origins. Atheist and agnostic scientists such as the astronomer Carl Sagan (1934–96), the sociobiologist E.O.Wilson (1929–), and Stephen Hawking (1947–), a physicist, articulated a variety of naturalistic origin myths that owed nothing to Genesis. Protestant neo-orthodox theologians, following Karl Barth (1886–1968), emphasized the radical difference between God the Creator and a radically fallen creation, and neither quarreled with, or cared much about, what science had to say about origins. The Roman Catholic Church officially embraced the evolution of the human body in the papal encyclical Humani Generis (1950). The Swiss Protestant theologian Emil Brunner (1899–1966) read Genesis existentially rather than historically, with Creation signifying the dependence of the creature on the Creator and the Fall representing human rejection of that dependence. Such interpretations signified the decision of more liberal theologians to leave questions of cosmogony and human origins to science, while religious thinkers were free to inject meaning, purpose, and values into the Genesis account of Creation.

Foundations for an Empirical Psychology of Religion The Empirical Study of Religion and Spirituality

Psychology’s status as a science is based largely on its methodology—that is, its use of scientific methods to study the phenomena of interest. The psychology of religion is no different from the psychological study of anything else. The problem is that religion and spirituality are exceedingly complex phenomena—so complex, as we have seen in Chapter 1, that they are difficult even to define. In this chapter, we demonstrate that they are also elusive to capture by standard scientific methods. On top of this, many people see religion and science as opposites that are in some type of conflict, and therefore see the use of one to help investigate the other as somehow problematic or at least inappropriate. Some religious people may even feel threatened by the scientific study of religion, for fear that it may somehow explain away something held as sacred. We attempt to dispel many of these concerns in this chapter. Still, the field is fraught with dangerous mines, and both the scientific investigator and student must be careful as they overturn each rock in their exploration. These are serious and legitimate concerns that deserve special care. The psychologist of religion should not blindly enter the minefield without an understanding of the risks involved. But, as we shall see, there are useful tools to help us in our scientific study, and so we need not be timid. In fact, since its earliest days, psychology has examined religion with confidence. In 1902, William James—a U.S. philosopher and one of the founders of our field—gave his famous Gifford Lectures at the University of Edinburgh. These were soon published in book form as The Varieties of Religious Experience (James, 1902/1985), a book continuously in print for over 100 years—a rare feat indeed.

The success of James’s Varieties lies in several features that guide our discussions in this book, now more than a century later. James explored questions about the nature of religion, already touched upon in Chapter 1, and compared religion to such concepts as psychic phenomena and superstition. James also asked whether religion is a help or a hindrance; that is, does the good it brings outweigh the harm that can be associated with it? In addition, he wanted to know the conditions under which religious conversion was likely to occur and the role that emotions play in religious experience. These questions are as much a part of the scientific study of religion today as they were in 1902, and we explore them throughout this book. Before we get to such substantive issues, however, we need to understand the empirical foundations of the psychological study of religion. Let us first do so by avoiding what is perhaps one of the most dangerous mines in the field—the temptation to reduce the richness and complexity of religious experience to a favorite psychological construct.

By beginning our discussion with the issue of reductionism, we are highlighting an important but sensitive philosophical shift in the psychology of religion—represented by Emmons and Paloutzian’s (2003) call for a new multilevel interdisciplinary paradigm, which we have mentioned in Chapter 1. The new paradigm (which means, for our purposes, a generally accepted perspective among a community of scholars in a given discipline) proposed is one that values multiple methods as legitimate and complementary in providing a more complete understanding of religious and spiritual phenomena. It also emphasizes interdisciplinary approaches, as the boundaries between such disciplines as sociology, psychology, and anthropology are becoming less rigid. As we shall see, in no way does this call for a paradigm shift lessen the discipline’s resolve to be scientific. It does represent, however, an understanding of what constitutes legitimate science that may be somewhat different from the traditionally received view. In any case, part of the call for a new paradigm is to value nonreductive assumptions about the nature of religion and spirituality.

Reductionism in Conceptualizing Religious Issues ―Reductionism‖ is an attempt at explanation. It involves explaining a topic by variables independent

of the topic itself, usually in the form of understanding the nature of complex things by reducing them to simpler, more fundamental phenomena. There are various types of reductionism (methodological, theoretical, ontological), and some may be more appropriate to understanding than others. We wish to avoid getting mired in the details of this philosophical debate, for the issues underlying reductionism are complex. Some defend reductionism as necessary to science, while others suggest that such a view involves a flawed understanding of science. It is safe to say, however, that as we attempt to scientifically explain broader and more complex issues (such as religious experience), we should greet reductionism with greater reservation. So, for example, when we utilize the need for meaning and purpose as a general framework for the study of religion, we should not assume that religion is only a useful device for finding meaning. Religion is much more than a meaning-making device.

Reducing a complex concept may sometimes be appropriate, such as reducing a preschool child’s church attendance to parental religiousness, and at times it may even be necessary for conceptualization purposes. In general, however, we caution against reductionistic tendencies in the psychology of religion. Examples of Reductionism in the Psychology of Religion

Three traditions in the psychology of religion are selected here to illustrate reductionism: those of Sigmund Freud, Raymond B. Cattell, and William James. In each of these traditions, many of the reasons people give for being religious—primarily, beliefs—are ignored. The beliefs themselves are assumed only to reflect some psychological issue. Freud assumed that religion is false, in the sense that its primary object (i.e., God) is not real. He was intrigued as to why people are religious when it is irrational to be so; since they believe in nothing that is real, there must be other foundations for these beliefs. In the introduction to The Future of an Illusion, Freud (1927/1961b) stated: . . . in past ages in spite of their incontrovertible lack of authenticity, religious ideas have exercised the strongest possible influence on mankind. This is a fresh psychological problem. We must ask where the inner force of those doctrines lies and to what they owe their efficacy, independent as it is, of the acknowledgement of reason. (p. 51) Freud maintained that the inner force to which religion is reduced is infantile projection of the parental figure, a form of neuroticism. Other psychologists endorsed variants of this theme (e.g., Faber, 1972; Suttie, 1952; Symonds, 1946). In this view, the substance of religion—what a person believes, or the reasons behind certain religious behavior and practices— does not matter. If this is so, there can be nothing of importance to religious beliefs, so why measure them?

Raymond Cattell (1938, 1950) represents another tradition of reductionistic research. It started with the fact that Cattell himself was a behaviorist who literally could not think in terms of beliefs. His stance ended with his personal view of religion as just ―silly superstition‖ (Gorsuch, 2002). Like Freud, Cattell did give credit to religion for being a powerful force in people’s lives. Given this beginning, Cattell posited motivational bases for being religious. Cattell and Child (1975) reported that religion is a function of strong needs to avoid fear, to be nurtured, and to nurture others. Others working in this tradition explained religion as a result of being deprived and therefore turning to a belief in life after death to meet currently unmet needs (Dewey, 1929). People thus create religious beliefs to resolve various problems. Again, since there can be nothing of importance to religious beliefs per se, why measure them? William James (1902/1985), a founder of the psychology of religion, treated religion with much greater respect than did Freud or Cattell. Why people hold religious beliefs to be true was not an issue for James, since he approached religion pragmatically: Does it help people live? To this he resoundingly answered, ―Yes.‖ Others have continued in this mode, and a major part of the increased attention given to spirituality (see below) stems from religion’s having been shown to be beneficial (e.g., Gorsuch, 1976, 1988; Larson et al., 1989; Pargament, 1997). James’s form of reductionism is more subtle than that of Freud or Cattell since James did not clearly take an atheistic position. In his view, nothing religionists claim in and of themselves as a basis for their religious faith needs to be examined; such beliefs are relevant only to the extent that they are functionally important—that they are of some benefit to the persons who hold them. For James, religious beliefs are reduced to their pragmatic value.

Religion as “Nothing but” Superstition One common form of reductionism applied to religious experience is that such experience is ―nothing

but‖ some related concept. So, for example, one might believe that religion is nothing but superstition, and that if one can understand the basis of this superstition, then religious experience is explained. Let’s consider this example in more detail. A ―superstition‖ has been defined as ―any belief or attitude, based on fear or ignorance, that is inconsistent with the known laws of science or with what is generally considered in the particular society as true and rational; esp., such a belief in charms, omens, the supernatural, etc.‖ (Guralnik, 1986, p. 1430). A superstitious person is one who acts on such beliefs. Examples of superstitious actions include walking under a ladder, avoiding the number 13, and tugging on one’s cap before throwing a pitch in a baseball game. These examples of superstition contain nothing that is called religious or spiritual. But can the ―superstition‖ label be properly extended to religion as studied by psychology? The Oxford Universal Dictionary on Historical Principles (Onions, 1955) includes in its definition of superstition: ―esp. in connection with religion‖ (p. 2084). This definition explicitly links the two concepts, but it also distinguishes between superstition and religion, since the two realms are not equated with each other. One basis of superstition can be found in learning research. Though this type of research was originally conducted on animals by the noted psychologist B. F. Skinner (1948, 1969), superstition is obviously present in humans and may occur in one-trial learning, particularly with strong negative reinforcement (Morris & Maisto, 1998). Primarily when threat, pain, or much emotion is present, and is then resolved, irrelevant stimuli present in the situation become meaningful. For example, let us suppose that Joe, an athlete, was wearing a specific pair of socks when a problem was alleviated; hence they become his ―lucky socks,‖ which he wears just in case they might make a difference in future similar circumstances. Joe knows full well that there is no rational basis for the lucky socks to affect the game, but he just feels better when wearing them. Of course, if success occurs, the incident will be cited as proof of the superstition’s truth. It is not surprising that some religious behaviors are also superstitious for a particular person. They meet the twin conditions of being nonrational and of avoiding a major negative outcome (i.e., being based in fear). We must, however, ask whether religion is just superstition. Most religious beliefs and behavior do not meet the conditions of superstition. Religions usually have well-developed theologies that make religious behaviors rational, at least to those who hold them. The threat of avoiding a major negative outcome also seldom enters into daily religious behavior. Furthermore, the promise of hell is unlikely to take hold after one-trial learning. The idea of hell requires much complex social learning, plus both cognitive and motivational inputs. Later we will show that the subculture in which one is raised is a major determinant of religious behavior in general. Although religion includes conditioned responses, it is far more than just these responses; much social learning may be involved, and genetic and evolutionary factors may even play indirect roles.

What do the data say? Can scientific investigation itself help answer whether religion is just superstition? If both religion and superstition involve the same psychological processes, then one should expect either (1) positive correlations between measures of religiousness and measures of superstition (i.e., those who are most superstitious are also the most religious), in that the two are functionally the same; or (2) negative correlations between religion and superstition, in that one serves as a substitute for the other.

Studies are few in this area, and further work is necessary. Using the statistical technique called ―factor analysis,‖ Johnston, de Groot, and Spanos (1995) found separate factors for beliefs involving the paranormal, superstition, extraordinary life forms, and religion; these results counter the ―functionally the same‖ hypothesis. Sparks’s (2001) review of work in this area confirms the distinctiveness noted by Johnston et al. (1995). Goode (2000), however, claims that there may be paranormal elements in certain religious concepts (e.g., creationism, angels, the Devil), and provides data to this effect. We discuss the empirical research relating to paranormal and religious experiences, including mysticism, in Chapters 10 and 11. Contrary to the ―substitution‖ hypothesis is Hynam’s (1970) finding that superstition was correlated positively with a lack of clear social norms or rules, while both religiousness and scientific training were negatively related. The data are not conclusive, but they seem to suggest that religion and superstition should be treated as independent constructs. Thus we can tentatively say that a definition of either religion or superstition is more accurate if it does not include the other. To be sure, most psychologists of religion do not investigate superstition or psychic phenomenon per se. Of course, superstition and psychic reports occur in almost all areas of life and among religious people as well the nonreligious. They are, however, peripheral to the psychology of religion.

Reductionism: Conclusions

The empirical study of religiousness has many great challenges. The first of these challenges considered here is how to maintain the scientific standards of good empirical work, always the goal of science, without sacrificing the richness and depth of the object of study. We have gone to considerable lengths to make the case that religious experience should not be reduced to specific psychological processes. It is tempting to do so when one adopts the naturalistic perspective that underlies scientific investigation, and to ignore the meaning system of the people being studied. What is needed is some nonreductionistic accounting of the phenomena of interest, but without abandoning scientific methodology and thus not reaping the benefits that it provides. Qualitative and Quantitative Research Methods

One way to avoid reductionism is to treat the individual as a holistic entity, instead of the typical psychological research approach of fractionating the individual into traits, attitudes, beliefs, values, habits, responses, and underlying physiology. This holistic–atomistic distinction is not a sharp dichotomy, and many levels exist between these endpoints. However, some researchers maintain that by breaking the individual into such concepts as traits or attitudes and then abstracting these by an ―objective‖ analysis, only a false and incomplete picture of the person is attained—a partial interpretation with a grain of truth to it. Instead, these researchers argue that a holistic, phenomenological, clinical approach is better. The challenge, of course, is whether such an approach can meet standard scientific criteria. Idiothetic and Nomothetic Approaches to Research

This challenge is not unique to the psychology of religion. Indeed, one of the great classical issues in psychology is the distinction between ―idiothetic‖ and ―nomothetic‖ approaches to investigating the issue of interest (Gorsuch, 2008). In essence, the idiothetic approach relies largely on the judgment of an expert, usually (in the psychology of religion) one steeped in clinical or pastoral methods—possibly a cleric, pastoral counselor, or therapist. The bases for expert judgment are covert and not readily available for public analysis or understanding. In contrast, the nomothetic orientation seeks to obtain information that is empirical, public, reproducible, and reliable. It is the main traditional scientific avenue to demonstrating valid knowledge. The major characteristics of these concepts are listed in Table 2.1.

It should be evident that the approach espoused in this text is essentially nomothetic. Harsh as it may sound to advocates of an idiothetic approach, those seeking scientific answers will find validity in the judgment of Paul Meehl (1954): ―Always . . . the shadow of the statistician hovers in the background. Always the actuary will have the final word‖ (p. 138). We do believe that those who utilize holistic, idiothetic techniques have much to offer; their applied contributions cannot be overestimated. However, idiothetic research is not frequently utilized in the psychology of religion for good reason: Its methods do not meet standard scientific criteria. Therefore, idiothetic approaches should best be thought of as supplementary to nomothetic methods—both as sources of hypotheses and as means by which to more fully grasp the richness of the more general nomothetic findings. TABLE 2.1. Two Major Approaches to the Psychological Study of Religion

Idiothetic Nomothetic

Individual-behavioral General-behavioral Qualitative Quantitative Concern with depth Attention to the surface European origin American origin Clinical Experimental Intuitive (subjective) Objective Holistic Atomistic Phenomenological Positivistic Source: Medicine Source: Physical science

The Complementary Nature of Qualitative and Quantitative Research The distinction between ―qualitative‖ and ―quantitative‖ research is somewhat related to the

idiographic–nomothetic difference, but the two distinctions should not be confused. Qualitative data collection ranges from writing the biography of a religious person to chatting with several people about a religious topic, conducting interviews with open-ended questions, or having people tell a story about a picture they are given. Central to this process is how experience is interpreted. In short, it is ―the interpretative study of a specified issue or problem in which the researcher is central to the sense that is made‖ (Banister, Burman, Parker, Taylor, & Tindall, 1994, p. 2), and is thus ―(a) an attempt to capture the sense that lies within, and that structures what we say about what we do; (b) an exploration, elaboration and systematization of the significance of the identified phenomenon; and (c) the illuminative representation of the meaning of a delimited issue or problem‖ (Banister et al., 1994, p. 3). The use of qualitative methods often allows researchers to ―get behind‖ the quantitative data to uncover specific issues of meaning. People may have specific reasons—sometimes common and sometimes uncommon—for responding, for example, with a 4 on a 7-point scale as a statement of moderate agreement on a religious belief statement. Without qualitative methodologies to unpack what a 4 actually means, we have limited understanding of the phenomena of interest. At issue is the fact that many of our quantitative measures involve ―arbitrary metrics‖ (Blanton & Jaccard, 2006), which do not tell us the absolute standing of an individual or group on an underlying psychological construct. For example, a score of 68 on a 100-point measure of depression does not tell us how depressed a person actually is. Such arbitrariness, of course, is not a death sentence for research, in that quantitative measures are used to test ideas and theories; therefore, the relative standing of scores is useful. We can say that a score of 68 on a measure of depression is more than a score of 38, and this difference, for example, may support or not support a hypothesis. However, what the score means in terms of the actual experience of depression is limited. Therefore, several researchers in the psychology of religion have called for a greater role for qualitative methods (e.g., Belzen, 1996; Belzen & Hood, 2006). This call is especially relevant to an understanding of religion as a meaning system—the approach taken in this text.

It also resonates well with the earlier-noted call by Emmons and Paloutzian (2003) for a new multilevel interdisciplinary paradigm that values multiple levels of analysis and nonreductive assumptions regarding the nature of religious and spiritual experience. Qualitative methods are the methods of choice in idiothetic research, but many such methods are used in nomothetic research as well. Therefore, it is an error to equate qualitative methods with idiographic research and quantitative methods with nomothetic research, as is frequently done. For example, determining what religious behaviors people perform in certain specific settings may call for a novel procedure. This could include observing missionary activity in a Third World village undergoing cultural change, or the behavior of congregants during a church service (Wolcott, 1994). In contrast, quantitative data collection techniques might ask people to rate how strongly they agree with a particular statement or to report how often they attend worship services. The major distinction is that quantitative measures give scores directly, but qualitative data must be processed by a rater or by a computer program for information.

A similar distinction can be made between qualitative and quantitative analyses of data. Qualitative treatment can involve a more or less subjective review that enables a scholar to make sense of the information and draw conclusions. A researcher employing quantitative analysis uses statistics such as means, standard deviations, significance levels, and correlations in order to draw conclusions. Although quantitative methods have been typical of data collection and analysis in the sciences as well as in the psychology of religion, there is no doubt that they miss something. A description of a sunset in terms of physics is quantitative, but none would argue that a painting of that sunset is replaced by the physical description. Physics has never claimed to contain the whole of human experience regarding physical phenomena; nor does the psychology of religion claim to contain the whole of human experience regarding religion. Just as a personal experience with a sunset is meaningful in addition to the physics of a sunset, so a personal religious experience cannot be replaced by the psychology of that experience. Similarly, psychology does not directly cover the history of religions, the biographies of religious leaders, or the anthropology of religions, although they may be considered within the new paradigm insofar as interdisciplinary considerations provide a broader context within which to understand psychological findings (Hood & Williamson, 2008a, b). The psychology of religion is an application of scientific methods to enhance our psychological understanding of religion.

Reliability and Validity The acceptability of both quantitative and qualitative methods within the psychology of religion

depends on whether they can be shown to meet the scientific criteria of reliability and validity. For example, when Ponton and Gorsuch (1988) used an instrument called the Quest Scale in Venezuela, its reliability was low, so the authors were hesitant to draw any conclusions from it. Qualitative measures also need to demonstrate reliability. Do different persons or judges agree in their observations and/or interpretations? If they reach different conclusions as to whether a person feels God’s presence during meditation, for example, then there is no reliability in their measure.

Once it has been shown that the qualitative or quantitative method is reliable, validity must then be established. Usually ―content validity‖ is used, as noted earlier. This means that psychologists examining the method agree that the items or interview or rating criteria are appropriate for whatever descriptive term is employed. Since both qualitative and quantitative methods are acceptable if they meet the standards of being reliable and valid, why are quantitative methods so popular? One important problem is that reliable qualitative methods are rather expensive to use. Consider the question of how a victim becomes a forgiving person after major harm has been done to that person. Using an interview-based qualitative approach, a researcher might ask each of 100 people to describe a time when a person harmed them, and then, in their own words, to explain how they forgave that person and how their religious faith was a part of that process. The interviewing would take about 300 hours (including setting up the interviews, doing the interviews, finding new people to reduce the ―no-shows,‖ transcribing the interviews, etc.). Then the interviews would need to be rated by two people trained to use the same language to describe the processes that were reported, and differences would need to be reconciled with the help of a third rater (all this would take another 300 hours). At this point, a total of 600 hours would be needed for collecting and scoring the data. By contrast, in quantitative measurement utilizing a questionnaire, a group of 100 people might take 2 hours to fill out the questionnaire. Scoring these responses would take another 4 hours. The quantitative approach would thus take an estimated 6 hours, versus 600 hours for the qualitative approach. Which procedure would you rather use in a research project? In some cases, qualitative methods are the only ones we currently have to tap into the psychological processes being studied. It is, for example, difficult to understand children’s concepts of God without using their drawings of God, which are then rated. And in models where a person makes a choice, it is also a problem to find out what options spontaneously occur to that person without utilizing at least somewhat qualitative methods. Throughout this text, we report many studies that use qualitative research methods, provided that those methods demonstrate sufficient reliability and validity. When they do meet adequate psychometric criteria, we can be just as confident in reporting the results of qualitative research as those of quantitative research. An Example of a Qualitative Approach

There is no single qualitative method. Though a common element of virtually all qualitative methods is that they take an interpretive approach to their subject matter, the methods vary considerably in terms of their goals and aims. Some methods, such as discourse analysis or participant observation, may only produce descriptive information. Other techniques, such as interviewing and ethnography, may likewise be descriptive, but may also involve an explanatory interpretation by the coinvestigators (the researcher and the person being studied). Here we provide a single brief example of the use of qualitative techniques that is particularly relevant and applicable to the overall theoretical framework of religion as a meaning system used in this text. ―Narrative analysis‖ is a qualitative technique used to investigate the means by which individuals utilize the language of their culture to construct a story of their experience. Hood and Belzen (2005) suggest that this is a particularly useful technique to test ideas drawn from psychoanalytic theory. They recommend using archives of taped interviews, and point to effective uses of this technique in studying a serpent-handling sect in Appalachia (Hood, 1998, 2005a) and the Word of Life congregation in Turku, Finland (Hovi, 2004). Let us consider the serpent-handling example. Williamson and Pollio (1999) analyzed the narrative form of serpent-handling sermons, while Hood (2005a) utilized an oral narrative of a handler. This team of researchers (Williamson, Pollio, & Hood, 2000) has also creatively used ―phenomenological‖ methods to identify, from the snake handlers’ perspective, the actual experience of handling a snake, especially in the context of religious commitment. Sixteen open-ended interviews (Williamson, 2000) were then subjected to interpretations based upon a ―hermeneutical methodology‖ developed by Pollio, Henley, and Thompson (1997) involving a group interaction by researchers trained in dialogical procedures (see Hood & Williamson, 2008a, for a more

complete description). From this analysis, four fundamental beliefs of serpent handlers were identified: (1) Handling serpents is a biblical mandate based on Mark 16:17–18; (2) handling serpents is a sign of enablement or power bestowed by God in response to obedience; (3) handling serpents is a sign of God’s protection (handlers thereby acknowledge the danger of handling); and (4) the experience of handling serpents is a confirmation of God’s power and blessing (Hood, Hill, & Williamson, 2005). The point here is that what seems to outsiders a bizarre and pointless activity that is dangerous and even life-threatening (11 of the 16 interviewees had been bitten, and all knew of someone who had died from snake bite) carries great meaning for the serpent handlers through its Biblical justification. Understanding the richness of serpent handling as a religious meaning system could not have been attained through quantitative techniques only. Rather, what is necessary is the use of multiple techniques (including historical methodologies). Although qualitative techniques are fraught with potential bias and possible misuse and should therefore be used only according to strict guidelines, they serve as a useful complement that will greatly profit the psychology of religion. Measurement in the Psychology of Religion

To illustrate the importance of good measurement, we borrow an example from Hill, Kopp, and Bollinger (2007) involving Chicago’s Lakeshore Marathon in 2005. This race was not one for the record books. In fact, the runners were perplexed by their unusually slow times and perhaps woke up the next morning to find themselves more sore than usual. The problem? It was discovered afterward that the course had been wrongly charted and they had actually run 27.2 miles—a full mile further than the usual grueling distance for a marathon. Indeed, accurate measurement is very much a relevant issue. Imagine that after you had already run 26.2 miles and your body was excruciatingly telling you that you should be finished, you had yet another full mile to run! Without good measurement in research, the data that are collected in the process of doing a research study are of little if any value. Most measures in the psychology of religion are self-report scales. Participants completing such measures are asked to respond to multiple items designed to assess the many varieties of religious and spiritual experience. Fortunately, psychologists of religion have long recognized the importance of good measurement and have placed a high priority on it. As early as 1984, Gorsuch pronounced measurement to be the current ―paradigm‖ (i.e., the dominant perspective or concern of psychologists of religion). By the end of the 1990s, Hill and Hood (1999a) identified over 125 measurement scales available to psychologists of religion, and many more have been developed in the past decade (Hill, 2005; Hill et al., 2007). To be sure, there is a well-developed measurement literature in the psychology of religion. But what makes one scale better than another? Both theoretical and technical issues must be considered in determining the best measure. Theoretical Considerations

Any attempt to measure a concept such as religiousness or spirituality requires that the concept be specified in measurable terms. Such an ―operational definition‖ is especially important when applied to religiousness and spirituality, because, as we have seen in Chapter 1, there is considerable variety in how these terms are conceptualized. The importance of theoretical clarity extends beyond how the constructs are conceptualized; good theory is necessary in providing a framework for testable hypotheses as well. Furthermore, researchers must consider the various dimensions of religious and spiritual experience (a topic that we consider shortly) to help determine the appropriateness of potential measures. Technical Considerations

A scale’s reliability and validity are the two most important technical issues to consider. The more reliable and valid a measure is, the more useful it is for conducting scientific research. Though brief scales (sometimes just one-item scales) may be appealing because they are time-saving and convenient, they also tend to be less reliable and perhaps less valid. ―Reliability‖ refers to the consistency of a measure and is usually assessed in terms of either (1) ―consistency across time‖ or (2) ―internal consistency.‖ When assessing consistency of a measure over time, better known as ―test–retest reliability,‖ the reliability coefficient is a correlation between the test scores of a group of individuals who are administered the scale on two different occasions (usually at least 2 weeks apart). More common is the use of internal consistency as a reliability indicator. The better multiple scale items fit together (as determined statistically by factor analysis), the higher

the internal consistency. Internal consistency is most often measured by a statistic called Cronbach’s alpha, which ranges from 0 to 1.00, with a higher value indicating greater consistency. Alpha levels of religious and spiritual constructs are preferably above .80, but frequently are acceptable at about .70. Consideration of the scale’s ―validity,‖ or the extent to which a test measures what it purports to measure, is also essential to good measurement. There are many different ways to think of and measure validity. For example, though it may be tempting to do so, we cannot rely simply on our subjective sense of whether or not the scale appears to measure what it is supposed to be measuring, referred to as ―face validity.‖ Face validity is subject to all sorts of human bias and is therefore not scientifically useful. ―Content validity‖ refers to whether or not a representative sample of the domain is being covered. For example, perhaps you are working with a measure of spiritual disciplines. If your measure inquires about prayer, fasting, and tithing, but does not address reading sacred texts or service, content validity is sacrificed—because the entire behavioral domain has not been included in your measure.

―Construct validity‖ examines the agreement between a specific theoretical construct and a measurement device, and may rely heavily on what is already known about a construct. ―Convergent validity‖

and ―discriminant validity‖ are both subdomains of construct validity and can be considered together. Convergent validity asks, ―How well does this measure correspond to similar measures of the same or similar constructs?‖; discriminant validity asks, ―How is this test unrelated to measures of different constructs?‖ Those who develop scales try to demonstrate as much reliability and validity as possible, though it is highly unlikely that any single measure will be perfectly reliable or score high on all types of validity just discussed. Sample Representativeness

There are many measurement scales in the psychology of religion that adequately meet these technical criteria, but care must still be taken in their use. Why? Because these scales were developed on a rather limited sample that may not reflect the population of interest under investigation. The most common form of such limitation is that many of the scales were initially developed for a Christian population, but now many researchers wish to investigate religious and spiritual experience outside the confines of Christianity, or perhaps even outside the context of any formal religious tradition (Hill, 2005). Even more problematic is that many of the scales were initially developed among white, young, middle-class, American (and, to a lesser extent, British) college students (Hill & Pargament, 2003). Four variables known to be strongly correlated with religious experience are age, socioeconomic status, race, and educational level (Hill, 2005); therefore, caution is necessary if one should choose to use such a scale for a population with a different demographic profile or outside the Judeo-Christian context.

Scales created on the basis of either unrepresentative samples or samples representing a narrow population (e.g., a single denomination) are usually insensitive or inapplicable to broader groups (Chatters, Taylor, & Lincoln, 2002). For example, Protestant African Americans— among the most religious of all ethnic groups in the United States—emphasize community service (Ellison & Taylor, 1996), as well as the notion of reciprocal blessings with God (Black, 1999). Both of these characteristics are ignored in virtually all measures of religiousness or spirituality, in favor of other issues that may be irrelevant to African Americans. Hill and Dwiwardani (in press) provided a fascinating example of how difficult it is to transport the study of religious experience to other world religions when they attempted to apply Allport’s I-E distinction to Indonesian Muslims. In order to make the scale that measures both I and E religious orientations applicable to the Muslim context, more than just the language of the scale needed to be changed (e.g., changing the word ―church‖ to ―mosque‖). Because Islam is such a strong pillar of the overall collectivistic culture in Indonesia, the concept of the social basis of the E religious orientation as a form of immature religion is simply not as applicable to Muslims as it is to Christians. Fortunately, however, another group of researchers has provided the Muslim–Christian Religious Orientation Scale (Ghorbani, Watson, Ghramaleki, Morris, & Hood, 2002), which takes into account a social dimension in relation to the broader community and culture rather than to the mosque. It is important that we recognize the limits of our measures and seek to improve them for more diverse settings.

Measurement Domains Because religiousness is a highly complex and varied human experience, good measurement must

reflect this complexity. This does not mean that any single measure must reflect all of this complexity, for many times the topic of interest is but a piece of the religion pie— for example, religious beliefs or specific religious behaviors. Psychologists, especially social psychologists, frequently discuss the totality of human experience in three domains: ―cognition,‖ or how the ideological aspect of (in our case) religion is conceptualized; ―affect,‖ or the emotional, ―like–dislike‖ facet of belief or behavior (which frequently includes attitudes and values); and ―behavior,‖ or what people do and how they act. It is important that measures reflect these individual domains. Mixing these domains often leads to confusing research. So, for example, of about 125 measures identified by Hill and Hood (1999a), there was a cluster of measures stressing religious beliefs, another cluster emphasizing religious attitudes, and so forth. Sometimes it is desirable to have a single multidimensional measure, but even then there will usually be subscales (often determined by factor analysis) tapping more specific domains. Table 2.4, adapted from Hill (2005), provides a summary of 12 common categories of measures that have been developed, with examples of measures from the literature that fit each category. One might be surprised by the number of measures available, especially since the measures and their respective categories in the table are not exhaustive. In fact, the table includes only a small percentage of measures, though Hill (2005) maintains that they represent some of the better measures in the psychology of religion. Notice that the first four categories cover what Tsang and McCullough (2003) refer to as ―Level I‖ measures, which represent ―higher levels of organization reflecting broad individual differences among persons in highly abstracted, trait-like qualities‖ (p. 349). Level I measures may help assess how religious or spiritual a person is, and here we refer to this as ―dispositional religiousness.‖ The final eight categories of measures represent ―Level II‖ measures, which get at how religion or spirituality functions in a person’s life, referred to here as ―functional religiousness.‖ For example, highly religious people may use their religion in different ways to help cope with life’s stressful agents. More scales and more detailed discussions of scales can be found in a number of resources: Hill (2005), Hill and Hood (1999a), MacDonald (2000), and MacDonald, LeClair, Holland, Alter, and Friedman (1995).

Gorsuch’s (1984) claim that the psychology of religion had been dominated by issues of measurement up to that time led him to conclude that measurement scales were ―reasonably effective‖ and ―available in sufficient varieties for most any task in the psychology of religion‖ (p. 234). Now, a quarter of a century later, we can say that Gorsuch was both correct and incorrect. Within the psychology of religion proper, and especially at Level I dispositional measurement, Gorsuch was clearly correct. Researchers have a sufficient arsenal of measurement instruments at hand to adequately assess a person’s level of religiousness or spirituality, even given the complexities of what it means to be religious or spiritual. The one caveat, however, is that measures within the psychology of religion will need to become increasingly pluralistic, to better represent (1) religious traditions other than Christianity and (2) those forms of spirituality that do not conform to any formal religious tradition. However, Gorsuch (or anyone else, for that matter) was, quite understandably, unable in 1984 to envision the direction the field would take, particularly the move toward examining the many functional varieties of religiousness (Level II measurement) that would require further scale development. So, for example, in reviewing the significant association between religion and both mental and physical health (to be discussed in considerable detail in Chapter 13), Hill and Pargament (2003) have highlighted ongoing advances in measurement (e.g., measuring perceived closeness to God, religious struggle) that help delineate why religiousness and spirituality seems to contribute (mostly positively, but sometimes negatively) to health and well-being. It is safe to say that measurement issues, particularly of the Level II functional variety, will continue to be of great interest and concern to psychologists of religion (vezi anexa). Implicit Measures

The final measurement issue we wish to discuss is an issue that plagues all of psychology—the field’s overreliance on self-report measures. Every measure (including qualitative measures) discussed thus far in this section relies on self-reports, which of course may be biased for a number of reasons: intentional deception, impression management, personal bias, and many more. The accuracy of self-reports is especially suspect

when the topic being investigated is personal and sensitive in nature (Dovidio & Fazio, 1992), which religion and spirituality often are. As a result, there has been an increasing interest in developing other measurement techniques (such as physiological measures, better behavioral measures, etc.), including the use of ―implicit‖ measures, particularly as measures of attitudes. Greenwald and colleagues (Greenwald & Banaji, 1995; Greenwald, McGhee, & Schwartz, 1998) have defined implicit attitudes as unconscious, automatic evaluations that influence thoughts, feelings, and behaviors. Probably the most common implicit measure is the Implicit Association Test (IAT; Greenwald et al., 1998) which uses response latency as a marker of one’s unconscious and automatic attitudes. The IAT was first developed as an implicit measure of racial attitudes, whereby an associative strength between two concepts (e.g., objects and evaluative adjec tives) is measured by the amount of time (measured in milliseconds) it takes to determine whether the concepts go together. Thus it may be easier for a racially prejudiced white person to categorize two objects that are congruent (and hence take less time to determine that the two concepts go together) in his or her thinking (e.g., white and good; black and bad) than objects that are incongruent (e.g., white and bad; black and good). Though there are many assumptions underlying the IAT (and the notion of implicit measurement in general), social- psychological research has shown it to be psychometrically adequate in terms of its internal consistency, temporal reliability, and validity (Rowatt & Franklin, 2004). Only recently has research in the psychology of religion utilized implicit measures. Some of these studies have investigated explicit (i.e., self-report) measures of religiousness or spirituality in relation to some implicit measure, such as race attitudes (Rowatt & Franklin, 2004), humility (Powers, Nam, Rowatt, & Hill, 2007; Rowatt, Powers, et al., 2006), attitudes toward homosexuals (Rowatt, Tsang, et al., 2006; Tsang & Rowatt, 2007), or attitudes toward other religious groups (Rowatt, Franklin, & Cotton, 2005). The results of much of this research are covered later in this book, particularly in Chapter 12. Others (e.g., Hill, 1994; Wenger, 2004), however, have made the case that religion itself may be a topic that can be implicitly measured, and several notable attempts have now been made (Bassett et al., 2004; Cohen, Shariff, & Hill, 2008; Gibson, 2006; Wenger, 2004). This research is still in its earliest stages, with the implicit measures themselves needing more frequent testing before any judgment of their utility can be made. These attempts do represent, however, important efforts at getting beyond reliance on self-report measures. Individual Differences Many people perhaps do not recognize that much of the psychology of religion falls primarily within social psychology (though other subdisciplines, particularly clinical and developmental psychology, are well represented) in general, and within the domain of individual differences in particular (Dittes, 1969). Social psychology studies the person in the social context. Because religiousness varies from one person to another, the psychology of religion stresses the individual-variability aspect of social psychology. Most research (and hence most measures used in the research) in the psychology of religion stresses individual differences. That is, the person’s own attitudes and behavior are studied as dependent and independent variables. Social psychology further examines how independent variables, such as religiousness, affect people and their relationships with others. Much of this research is devoted to social-cognitive processes. As noted earlier, individual differences in social psychology are typically accounted for in three domains that are easily applied to religious experience: cognition, affect, and behavior. To these three, we perhaps should add habit, since there are important habitual components in religious experience. Cognition is primarily concerned with beliefs and how they are learned—in other words, how the ideological aspect of religion is conceptualized. The affective realm emphasizes feelings and attitudes—the emotional, ―like–dislike‖ facet of belief or behavior. The attitude concept is especially important to the psychology of religion, since attitudes are often important predictors of behavior. Behavior, of course, consists of what people do, how they act. Finally, habit involves what people do regularly, consistently, and often automatically. The psychology of religion looks at individual religious differences within each of these areas. For our current purposes, the important point to note is that because each domain has a separate purpose, these domains should be kept distinct in measurement. Items representing these domains are exemplified in Table 2.5. The first and third illustrations in the cognitive area use a response format that emphasizes the definition of the domain, mostly here belief. The second and fourth illustrations use a common response format that emphasizes belief but includes an element of affect—namely, value. This distinction is not made for the other domains. Because each domain has a different purpose, it is important to keep them distinct.

Research can then identify the conditions under which they relate to each other. For example, Allport (1959) as interested in total religiousness, based on both the I and E scores of religious orientation (Allport & Ross, 1967). He stressed affect or motivation in these orientations, and he ignored cognition. The original scale, however, included behavioral items, which created conceptual confusion. Later versions of the I and E scales dropped the behavioral items, and the measure of I and E became clearer. The research reported throughout this text cuts across these different domains. It is important to keep in mind whether we are talking about beliefs, values, motivations, and so forth. Because each of the areas functions differently, it is often important to distinguish among them. Still, at other times we may wish to investigate some overriding concern, and to do so we measure across several of these areas. As noted throughout this book, religiousness and spirituality are complex, multidimensional phenomena, and this includes the fact that they incorporate each of these domains as part of the complete experience. TABLE 2.5. Illustrations of Items Assessing Aspects of Cognition,

Affect, Habit, and Behavior

Cognition Belief 1. Rate what you feel are the ―odds‖ (%) that God exists. There is no God 0 25 50 75 100 God definitely exists Value 2. God exists. Strongly disagree 1 2 3 4 5 Strongly agree Belief 3. Rate how important attending church weekly is. Unimportant 1 2 3 4 5 Important Value 4. Everyone should attend church each week. Strongly disagree 1 2 3 4 5 Strongly agree

Affect (attitudes) 5. Rate how much you enjoy worship services. Not at all 1 2 3 4 5 Very much 6. I enjoy worship services. Strongly disagree 1 2 3 4 5 Strongly agree

Habit 7. How long have you had your current pattern of church attendance? a. 1 year or less b. 1–2 years c. 3–4 years d. 5 years or more

Behavior 8. How often do you attend church? a. Never b. A couple of times a year c. Once a month d. Several times a month e. Once a week f. More than once a week

Anexa 1 TABLE 2.4. Specific Measures of Religion and Spirituality in 12 Categories

Level I: Measures of Dispositional Religiousness or Spirituality General Religiousness or Spirituality

Mysticism Scale (Hood, 1975) Religiosity Measure (Rohrbaugh & Jessor, 1975) Spiritual Transcendence Scale (Piedmont, 1999) Spiritual Well-Being Scale (Paloutzian & Ellison, 1982)

Religious or Spiritual Commitment Dimensions of Religious Commitment Scale (Glock & Stark, 1966) Religious Commitment Scale (Pfeifer & Waelty, 1995) Religious Commitment Inventory—10 (Worthington et al., 2003) Santa Clara Strength of Religious Faith Questionnaire (Plante, Vallaeys, Sherman, & Wallston, 2002)

Religious or Spiritual Development Faith Development Interview Guide (Fowler, 1981) Faith Development Scale (Leak, Loucks, & Bowlin, 1999) Faith Maturity Scale (Benson, Donahue, & Erickson, 1993) Religious Maturity Scale (Leak & Fish, 1999) Spiritual Assessment Inventory (Hall & Edwards, 1996)

Religious or Spiritual History The SPIRITual History (Maugans, 1996) Spiritual History Scale (Hayes, Meador, Branch, & George, 2001)

Level II: Measures of Functional Religiousness or Spirituality Religious or Spiritual Social Participation

Attitude Toward the Church Scale (Thurstone & Chave, 1929) Attitude Toward Church and Religious Practices (Dynes, 1955) Religious Involvement Inventory (Hilty & Morgan, 1985)

Religious or Spiritual Private Practices Buddhist Beliefs and Practices Scale (Emavardhana & Tori, 1997) Religious Background and Behavior (Connors, Tonigan, & Miller, 1996) Types of Prayer Scale (Poloma & Pendleton, 1989)

Religious or Spiritual Support Religious Pressures Scale (Altemeyer, 1988) Religious Support (Krause, 1999) Religious Support Scale (Fiala, Bjorck, & Gorsuch, 2002)

Religious or Spiritual Coping Religious Coping Scale (Pargament, Koenig, & Perez, 2000) Religious Coping Activities Scale (Pargament et al., 1990) Religious Problem-Solving Scale (Pargament et al., 1988)

Religious or Spiritual Beliefs and Values Christian Orthodoxy Scale (Fullerton & Hunsberger, 1982) Love and Guilt Oriented Dimensions of Christian Belief (McConahay & Hough, 1973) Loving and Controlling God Scale (Benson & Spilka, 1973) Religious Fundamentalism Scale (Altemeyer & Hunsberger, 1992) Spiritual Belief Inventory (Holland et al., 1998) Spiritual Belief Scale (Schaler, 1996)

Religion or Spirituality as Motivating Forces Intrinsic–Extrinsic Scale—Revised (Gorsuch & McPherson, 1989) Quest Scale (Batson, Schoenrade, & Ventis, 1993) Religious Orientation Scale (Allport & Ross, 1967) Religious Internalization Scale (Ryan, Rigby, & King, 1993) Religious/Spiritual Techniques for Regulating and Reconciling Relationships Forgiveness Scale (S. W. Brown, Gorsuch, Rosik, & Ridley, 2001) Tendency to Forgive Measure (Brown, 2003) Transgression-Related Interpersonal Motivations Inventory (McCullough et al., 1998)

Religious or Spiritual Experiences Daily Spiritual Experiences Scale (Underwood, 1999) Index of Core Spiritual Experiences (Kass, Friedman, Leserman, Zuttermeister, & Benson, 1991) Religious Experiences Episode Measure (Hood, 1970) Religious Strain (Exline, Yali, & Sanderson, 2000) Spiritual Experience Index—Revised (Genia, 1997) Spiritual Orientation Inventory (Elkins, Hedstrom, Hughes, Leaf, & Saunders, 1988)

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Psihoterapia cu clienţi religioşi/spirituali: o introducere Everett L. Worthington,Jr.

Virginia Commonwealth University Jamie D. Aten

The University of Southern Mississippi Journal of Clinical Psychology: In Session, vol. 65(2), 123-130 (2009)

Acest număr al Jurnalului de Psihologie Clinica este dedicat psihoterapiei cu clienţi religioşi/spirituali. După ce vor oferi definiţii ale religiei şi ale spiritualităţii, relevând potenţiale zone de convergenţă şi diferenţiind nuanţele, autorii vor scoate în evidenţă prevalenţa şi tipurile de spiritualitate, atât ale clienţilor, cât şi ale psihologilor/specialiştilor în sănătate mentală. Aceştia descriu contextul istoric, dar şi cel actual, în care se examinează abordările psihoterapeutice cu clienţi cu angajament religios, care experienţiază spiritualitate în cadrul propriei religii, sau care se definesc ca fiind spirituali, fără să fie neapărat religioşi. Apoi, vor sumariza următoarele articole care vor apărea în acest număr, articole care oferă ghidaj practic pentru profesioniştii în sănătate mentală şi clinicieni.

Introducere

În acest număr, ne vom concentra pe psihoterapia cu clienţi religioşi şi spirituali. Oferim un context în care să se discute modalităţile din trecut, prezent şi viitor, în care psihoterapeuţii lucrează cu clienţi religioşi şi spirituali. Începem prin a defini termenii de bază şi prin examinarea estimărilor prevalenţei practicilor psihoterapeutice care înglobează elemente religioase şi spirituale. Vom analiza două modele teoretice, care adresează problema religiei şi a spiritualităţii in terapie. După ce vom oferi o imagine de ansamblu a statutului religiei şi spiritualităţii în psihoterapie, vom sumariza cele şapte articole şi cazuri prezente în acest număr al revistei.

Definiţii ale religiei şi spiritualităţii

Religia este considerată ca fiind o aderenţă la un sistem de credinţe şi la un set de practici asociate cu o dogmă, în cadrul unei comunităţi în care există un consens asupra a ceea ce este acceptat/urmat (believed) şi practicat (Hill et al., 2000). Religia se ocupă cu probleme/ideile şi obiectele ce sunt considerate a fi sacre, adică acele obiecte ce au scopuri divine.

Spiritualitatea este definită ca sentimentul de apropiere şi conexiune cu sacrul. Aceasta presupune un simţământ de intimitate şi generează sentimente ca evlavia şi admiraţia. Deşi nu există un consens asupra definiţiei spiritualităţii (Aten & Leach, 2009), Worthington a sugerat 4 tipuri de spiritualitate, care au la bază obiectele pe care oamenii le consideră sacre:

• Spiritualitatea religioasă poate fi conceptualizată ca un sentiment de apropiere şi conexiune cu sacrul, asa cum e el definit de o religie anume. În cele mai multe cazuri, spiritualitatea religioasă reiese dintr-o apropiere cu un dumnezeu sau cu o entitate/putere superioară.

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• Spiritualitatea umanistă este un sentiment de conexiune cu omenirea. Este un sentiment de a fi relaţionat cu sau de a face parte dintr-un grup general de oameni, sentiment de multe ori susţinut de iubire, altruism şi reflectare (de ex. contemplarea sensului şi împlinirii unei relaţii).

• Spiritualitatea naturalistă este definită ca un sentiment de apropiere cu mediul înconjurător sau cu natura. De exemplu, o persoană poate simţi un sentiment de admiraţie şi mirare evocat de un peisaj natural foarte frumos, de vederea unui apus de soare splendid, sau de experienţierea unei minuni naturale.

• Spiritualitatea cosmică este un sentiment de conexiune cu Creaţia. Acest sentiment poate fi stimulat de contemplarea limitelor aparent nesfârşite ale creaţiei sau de admirarea cerului noaptea, vederea miliardelor de stele şi contemplarea naturii cosmosului. Astfel, o persoană se poate simţi insignifiantă ca individ, dar unită cu restul cosmosului (care poate părea magnific, de dimensiuni inestimabile şi foarte frumos).

Prevalenţa religiei şi spiritualităţii

În Statele Unite, aproape 95% din populaţie raportează credinţa în Dumnezeu şi

mai mult de jumătate cred în viaţa de apoi (Gallup,2002). Mai mult, în concordanţă cu un eşantion de subiecţi reprezentativi pentru populaţiile lumii, majoritatea se consideră religioşi (adică aderă la o religie anume; Berger et al.,1999). Specialiştii, inclusiv cei din sănătate mentală, sunt adesea mai puţin religiosi decât marea majoritate a populaţiei. De multe ori, ei tind să creadă că, asemenea lor, majoritatea oamenilor dau dovadă de o spiritualitate nonreligioasă. Din cauză că interacţionează cu specialişti similari din toată lumea, devin convinşi că spiritualitatea nonreligioasă este o normă universală. Chiar şi aşa, dovezile spun altceva. Majoritatea oamenilor şi majoritatea clienţilor chiar aderă la o religie anume. De exemplu, în Statele Unite, un procent semnificativ din populaţie aderă la creştinism, dar procentul scade din cauza aderării la alte religii mari, precum islamismul, hinduismul, buddhismul şi iudaismul, ca urmare a valului de imigrare recent. Chestionarele de opinie aplicate psihoterapeuţilor au concluzionat că, deşi psihoterapeuţii respectă diversitatea religioasă, o mare majoritate dintre ei nu sunt religioşi (Bergin & Jensen, 1990). În acelaşi timp, cercetătorii au descoperit că terapeuţii consideră că e important să vorbească despre subiectul religiei cu clienţii care au un angajament religios explicit. De exemplu, un număr semnificativ de terapueuţi încearcă să introducă termeni religioşi în cadrul psihoterapiei, pentru a putea să abordeze problema clientului dintr-un cadru de referinţă religios. De asemenea, psihoterapeuţii îi întreabă pe clienţi despre credinţa şi angajamentul religios în cadrul interviurilor iniţiale, pentru a înţelege cât de importantă este religia pentru client (de ex. pun întrebarea cu răspuns deschis: “Cât de importantă este religia pentru tine?”). Cu toate acestea, procentul clinicienilor care abordează mai în profunzime acest domeniu, de exemplu prin evaluarea formală a religiei şi spiritualităţii, este destul de mic (Delaney, Miller & Bisono, 2007).

Relaţia istorică dintre psihoterapie şi religie

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Unii clienţi resimt o tensiune când merg la şedintele de psihoterapie. Mulţi consideră terapia ca pe un domeniu de activitate secular (Kurtz,1999). În acest fel, clienţii religioşi pot să conchidă că nu trebuie să aducă în discuţie probleme religioase cu terapeuţi nonreligioşi. Această ezitare poate izvorî din frica de a nu se considera că au tulburări patologice, tocmai din cauza credinţelor lor. Mulţi clienţi religioşi nu vorbesc niciodată despre religia lor în cadrul psihoterapiei, decât dacă religia este problema centrală sau dacă se leagă serios de problema cu care se prezintă la psihoterapie. Pe de altă parte, mulţi clienţi religioşi, în special cei cu credinţe teologice conservatoare (Thurston, 2000), au căutat şi chiar au cerut o terapie construită în aşa fel încât să includă concepte religioase (de ex. păcat, suflet, karma, dharma, cei 5 piloni ai Islamului, salvare, reîncarnare, legile lui Moise), teme religioase (de ex. iertare, milostenie), şi chiar practici religioase (de ex. rugăciunea sau folosirea textelor religioase). Astfel de clienţi caută o abordare psihoterapeutică construită special pentru setul lor de credinţe şi valori. Înainte de anii ’80, clerul era cel care se ocupa în cea mai mare parte de consilierea religioasă (Kurtz, 1999). În timp ce o astfel de consiliere presupune o compatibilitate din punct de vedere telogic între client şi terapeut, o serie de probleme de natură practică reies din această situaţie. În primul rând, preotul/pastorul/autoritatea religioasă nu are o formare în psihoterapie. În al doilea rând, din cauza multiplelor roluri şi îndatoriri pe care le au, autorităţile religioase nu pot face faţă la întreaga congregaţie care are nevoie de terapie şi consiliere. În al treilea rând, preoţii s-ar putea să nu se poată întâlni cu clienţii atât de des precum ar vrea aceştia. În aceeaşi perioadă din anii ’80, mulţi clienţi conservatori din punct de vedere teologic au devenit mai asertivi în căutarea explicită a psihoterapeuţilor religioşi care îşi construiau abordarea incluzând elemente din religia de care aparţineau (Miller & Lovinger, 2000; Thurston, 2000; Wylie, 2000). De exemplu, Asociaţia Americană a Consilierilor Creştini (AACC) are peste 50.000 de membri, majoritatea dintre ei fiind terapeuţi la nivel de master. Alţi consilieri se descriu în mod explicit ca fiind psihoterapeuţi evrei, musulmani, buddhişti sau hinduşi. Un terapeut religios poate să lucreze într-o organizaţie şi să lucreze cu toţi clienţii lui de aceeaşi confesiune. Totuşi, în ultimele două decenii mai ales, psihoterapeuţii din toate sectoarele de angajare (employment site) au declarat că oferă terapie care înglobează elemente ale unor religii specifice. De obicei, astfel de terapeuţi oferă (de exemplu) atât psihoterapie bazată pe religia iudaică, cât şi psihoterapie seculară. Clienţii lor sunt de obicei informaţi de la început despre aceste opţiuni de psihoterapie. Dacă clientul alege varianta seculară, atunci problemele religioase vor fi adresate numai în cazul în care clientul le aduce în discuţie. Dacă acest lucru nu se întâmplă, psihoterapia va continua ca una seculară. Estimări ale prevalenţei terapiei religioase nu sunt prezente în cercetările reprezentative. Chiar şi aşa, să ne amintim că există peste 50.000 de mii de terapeuţi afiliaţi AACC (Wylie, 2000) – o organizaţie în cadrul unei singure religii. Să ne imaginăm că fiecare din acei terapeuţi are mai mulţi clienţi curenţi. Să luăm în considerare numere proporţionale de terapeuţi religioşi şi pt alte religii, fiecare terapeut având propria clientelă. Astfel, putem deduce că există un număr substanţial de clienţi care parcurg o psihoterapie religioasă, în orice moment dat.

Modele teoretice

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Teoria stres-şi-coping

Poate cel mai recunoscut model al terapiei religioase este cel de stres-şi-coping, propus şi promovat de decenii de către Kenneth Pargament (1997, 2007). Pargament sugerează că, atunci când oamenii experienţiează stresori, ei îi aduc în discuţie în cadrul terapiei, prin accentuarea strategiilor de coping religios existente până atunci sau prin învăţarea unora noi. La început, clienţii folosesc un coping conservator în încercarea lor de a se confrunta cu problema, fără să îşi schimbe credinţele religioase. Ei încearcă să asimileze evenimentele stresante şi reacţiile la eveniment în schema mentală de până atunci.

Dacă copingul tradiţional/conservator nu îi ajută pe clienţi să îşi rezolve dificultăţile emoţionale, clienţii se pot angaja în coping transnormativ. În acest fel, ei îşi modifică schema religioasă de până atunci, pentru a face faţă problemei curente.Un astfel de coping poate fi adaptativ sau maladaptativ (de ex. mâncatul sănătos vs. mâncatul compulsiv). După Pargament şi colegii săi, copingul religios poate, de asemenea, să fie adaptativ sau maladaptativ (de ex. să te simţi protejat de Dumnezeu vs. să te simţi pedepsit de Dumnezeu) şi este evaluat prin scala R-COPE (Pargament, Koenig & Perez, 2000). Perpective religioase în acord şi în dezacord Terapeuţii sensibili la problematica religioasă valorifică diversitatea în religie. Încercând să includă cât mai mult, terapeuţii pot spune, de exemplu, că toate religiile sunt importante şi că sunt dispuşi să abordeze o problemă din punctul de vedere al oricărei religii. Pentru majoritatea clienţilor nonreligioşi sau uşor religioşi, un astfel de enunţ poate să fie dovada acceptării necondiţionate din partea terapeutului. Totuşi, clienţii foarte religioşi s-ar putea să devină circumspecţi şi să-l considere pe terapeut nedemn de încredere – “nu e unul de-al nostru”. Majoritatea clienţilor nu discută de obicei despre astfel de probleme cu psihoterapeutul. Mai degrabă, clientul va deveni din ce în ce mai refractar la tratament şi va termina prematur şedinţele, fără a anunţa în prealabil. Worthington (1988) a propus un model care să îi ajute pe terapeuţi să îi înţeleagă pe clienţii religioşi şi valorile acestora. A sugerat că felul în care clienţii privesc lumea, prin nişte “lentile religioase”, depinde de agajamentul lor religios. Persoanele care se află la extrema “de sus” a angajamentului religios (mai mult de o abatere standard de la medie), vor fi mai predispuşi la a interpreta evenimentele de viaţă prin aceste “lentile religioase”. Cercetări substanţiale stau la baza acestei teoretizări (vezi Wade,Worthington & Vogel, 2007; Worthington, Kurusu, McCullough & Sandage, 1996). Clienţii foarte religioşi au o anumită zonă de toleranţă pentru valorile religioase acceptabile. Dacă clientul consideră că terapeutul aderă la valori prezente în zona lui de toleranţă, atunci poate să lucreze eficient cu terapeutul respectiv. Însă, dacă clientul consideră că terapeutul are valori aflate înafara zonei de toleranţă proprie, atunci acesta va (a) fi refractar la intervenţia terapeutului şi va avea un progres terapeutic redus sau (b) va termina relaţia terapeutică, de obicei fără vreo confruntare prealabilă. Tot din cauză că clienţii foarte religioşi au tendinţa de a privi mereu lumea dintr-o perspectivă religioasă (Worthington, 1988), de cele mai multe ori, se vor interesa în mod direct cu privire la orientarea religioasă a terapeutului, în timpul primei şedinţe de terapie

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sau chiar înainte de a iniţia terapia. Cel mai frecvent, terapeuţii răspund indirect la acest tip de întrebări, întrebând, la rândul lor, “De ce este acest lucru important pentru tine?”. Un client foarte religios poate resimţi această contracarare a întrebării lui ca pe o ofensă şi o poate interpreta ca fiind un răspuns evaziv, deducând faptul că terapeutul nu îi împărtăşeşte credinţele religioase. Chiar dacă terapeutul în cauză face ulterior afirmaţii ce dovedesc acceptare şi toleranţă, clientul nu mai poate fi domolit şi, în mod inevitabil, va termina terapia sau va fi refractar la orice intevenţie a terapeutului (Thurston, 2000). Şi psihoterapeuţii au zonele lor de toleranţă pentru valori religioase, în special dacă sunt, la rândul lor, foarte religioşi. Terapeuţii care nu pot tolera dovezile de intoleranţă din partea altora, e foarte probabil să nu poată lucra bine cu clienţi care afişează credinţe religioase fundamental diferite de ale lor, care au credinţe religioase extremiste sau care sunt rigizi în credinţele lor. În unele cazuri (de ex. diferenţa de credinţe religioase poate duce la o prognoză slabă a tratamentului), terapeuţii ar trebui să comunice clienţilor, în limita posibilului, dacă neconcordanţele în viziunile şi credinţele religioase nu pot fi depăşite (de ex. în şedinţa de terapie, printr-un supervizor al procesului terapeutic sau ca o consultare cu clientul). Alţii ar putea utiliza aceste reacţii negative ce ar putea apărea în timpul terapiei ca pe un proces de confruntare. În cazurile unde nici recomandarea unui alt terapeut, nici confruntarea nu e posibilă, terapeutul trebuie să încerce să dezolte empatie şi acceptare faţă de valorile clientului, să facă compromisuri cu clientul, înspre “a cădea de acord că nu pot fi de acord”, sau să dezolte anumite limite, care să-l ajute să-şi menţină obiectivitatea în procesul terapeutic. Unii terapeuţi seculari se pot simţi confortabil şi într-o situaţie în care trebuie să ofere terapie augmentată religios unor clienţi care nu sunt de acord cu valorile religioase ale lor. De fapt, există un studiu clasic, care a investigat terapia cognitiv-comportamentală creştină (CBT), în cazul unor voluntari cu depresie (Propst, Ostrom, Watkins, Dean & Mashburn, 1992). Terapeuţii care nu erau creştini au utilizat un manual de terapie cognitiv-comportamentală augmentată religios (creştin), iar aceştia au obţinut trezultate mai bune cu clienţii lor, decât au obţinut terapeuţii care într-adevăr erau creştini. Rezultate contradictorii au fost regăsite pe un eşantion clinic (Wade et al., 2007), în contrast cu reculul unor persoane care au avut depresie clinică (Propst et al., 1992). Un terapeut secular care urmează un protocol de augmentare religioasă a terapiei, cu clienţi religioşi, are, într-adevăr, o probabilitate mare de a obţine rezultate favorabile în procesul terapeutic.

Articole din acest număr (al revistei)

În articolul ce urmează celui de faţă, Post şi Wade fac o analiză a cercetării din psihoterapia religioasă, focalizându-se pe terapia religioasă condusă de terapeuţi religioşi, unor clienţi religioşi şi în care se utilizează intervenţii religioase. Cercetările recente arată că terapeuţii sunt încă în mod semnificativ mai puţin religioşi şi spirituali decât clienţii lor (Delaney et al., 2007). Cei mai mulţi dintre psihoterapeuţi privesc în mod pozitiv religiozitatea clienţilor lor, iar nu ca pe o dovadă de maladaptare sau patologie. Cel mai adesea, terapeuţii sunt predispuşi la a face greşeli de judecată atunci când au de-a face cu persoane aparţinând unor religii cu care ei nu sunt familiari. Majoritatea terapeuţilor religioşi oferă clienţilor posibiliatea de a alege între terapia seculară sau cea augmentată religios. Clienţii – chiar şi cei nonreligioşi – sunt deseori deschişi înspre a include

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elementul religios/spiritual în procesul lor terapeutic, vor ca terapeuţii lor să abordeze această problematică şi obţin beneficii din aceasta (chiar dacă terapeutul nu le împărtăşeşte valorile sau credinţele religioase). Per total, numărul proceselor terapeutice clinice care cuprind elemente religioase a crescut în ultimii 10 ani. Mai multe abordări terapeutice augmentate religios beneficiază acum de manuale publicate (de ex. schema spirituală a sinelui) şi de date publicate, care susţin eficienţa sau eficacitatea lor. Studiile de caz din acest număr (al revistei) abordează o gamă largă de orientări teoretice şi formate terapeutice. Shafranske oferă o descriere a terapiei psihodinamice orientate spiritual, accentuând câţiva paşi de bază ce trebuie urmaţi în adresarea sacrului din această perspectivă. Această abordare este apoi exemplificată în cazul impresionant al unui bărbat care experienţia o mare tensiune religioasă. Se fac conexiuni între experienţa acestui client legată de slăbiri ale credinţei lui (catolice) şi alte forme de pierdere suferite de-a lungul vieţii (de ex. moartea tatălui în copilăria timpurie). Pe durata terapiei, clientul îşi revede locurile unde a copilărit şi astfel îşi consolidează insighturile obţinute în dificilul proces al terapiei psihanalitice. Hathaway şi Tan descriu şi ilustrează terapia cognitiv-comportamentală augmentată religios, care include metode legate de mindfulness (înţelegere profundă – n.n.). Autorii încep prin a analiza caracterizarea făcută de Hayes evoluţiei terapiei cognitiv-comportamentale (CBT), în trei etape: terapie comportamentală, terapie cognitivă şi mai noile terapii centrate pe acceptare/mindfulness. Unele forme de terapie din această ultimă etapă abordează tematici religioase inspirate din tradiţiile religioase orientale. Hathaway şi Tan analizează procesul terapeutic al unui client depresiv, conservator din punct de vedere teologic. Terapeutul a utilizat metode ale terapiei cognitiv-comportamentale augmentate de elemente scripturale şi mindfulness. Autorii analizează provocările şi raţiunile presupuse de utilizarea acestui tip de metode religioase orientale cu clienţi creştini sau cu alţi clienţi deişti. În următorul articol, Richards şi colegii descriu forma lor de psihoterapie spirituală deistă, care este integrativă şi universală, în aşa fel încât să poată fi folosită în cazul oricărui tip de spiritualitate deistă. Cu toate acestea, permite şi personalizarea abordării, pentru a include subtilităţi confesionale. Autorii îşi ilustrează metoda terapeutică prin cazul unei femei care suferă de tulburări de alimentaţie. Ei descriu o abordare deistă a tulburărilor alimentare, care susţine că sunt bazate pe pierderea identităţii şi a simţului valorii personale. Hiperfagia devine, în acest fel, un mod de a compensa pierderea identităţii spirituale. Se recomand㸠în acest caz, o restructurare cognitivă, pe premisa că starea de bine psihică a clientei este interconectată cu starea de bine emoţională, relaţională şi cu cea spirituală. Autorii susţin că focalizarea pe spiritualitate poate fi o cale majoră de a pătrunde concepţiile de viaţă ale clientului. Delaney, Forcehimes, Campbell şi Smith prezintă, apoi, un tratament orientat spiritual, pentru dependenţa de alcool. Aceştia descriu rolul pe care spiritualitatea şi religia îl joacă în prevenţia şi tratamentul abuzului de substanţe şi apoi propun câteva mecanisme responsabile de aceste efecte. Ei fac o distincţie importantă între intervenţiile din cadrul confesiunii (within-faith) şi cele dintre confesiuni (between-faith). Sugerează că metodele centrate pe client sunt în mod special eficiente în intervenţiile interconfesionale (between-faith). În experimentul lor clinic recent, i-au învăţat pe terapeuţi să utilizeze o abordare centrată pe client, pentru a-şi ajuta clienţii să exploreze propria spiritualitate şi să folosească cu succes practici spirituale în terapie. Abilitatea

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terapeutului de a-şi angaja clienţii într-o discuţie pe tema spiritualităţii poate depinde de felul în care terapeutul respectiv îşi ponderează rolul de autoritate/expert cu cel de facilitator evocativ. Pe urmă, Dwairy descrie şi ilustrează psihoterapia în cazul musulmanilor. Acesta sugerează că încercarea de a revela procese inconştiente şi de a promova autoactualizarea în cazul clienţilor provenind din culturi colectiviste, poate duce la confruntări puternice între client şi familia acestuia. Autorul recomandă terapia metaforică şi analiza culturală pentru persoanele din asemenea culturi colectiviste. În terapia metaforic㸠clientul poate relaţiona simbolic şi indirect cu conţinutul inconştient şi totodată poate evita ameninţările directe ale conceptelor religioase. În analiza culturală, clienţii îşi pot revela nevoile inconştiente şi pot să restabilească ordinea în sistemul lor de credinţe şi în familie. Dwairy prezintă cele două metode terapeutice utilizate în terapia cu un client arab musulman, suferind de depresie. Printr-un astfel de proces terapeutic ancorat în cultura şi religia lui, clientul şi-a ameliorat credinţele maladaptative, a devenit mai mulţumit de sine şi a găsit căi eficiente de a se adapta în familia sa. Duba şi Watts oferă un exemplu de tratament al cuplurilor religioase, din perspectivă adleriană. Autorii observă că în cupluri există o mare variaţie în felul cum indivizii se bazează pe orientarea religioasă pentru a-şi defini sau restructura relaţia romantică. Confesiunile diferite vor stabili “reguli” specifice sau vor forma modul în care cuplul rezolvă greutăţile la nivel interpersonal şi familial, ca de exemplu sexualitatea, stilul parental sau autoritatea. Aceşia propun o serie de principii ce trebuie respectate atunci când se tratează cupluri religioase, inclusiv discuţii premergătoare terapiei sau consimţământul informat al clienţilor. Ei observă existenţa a numeroase paralele între terapia adleriană şi credinţa religioasă creştină (de ex. orientarea relaţiei, focalizarea pe stilul de viaţă, interesele sociale). Cuplul ilustrat, romano-catolic, a fost tratat de asemenea de un terapeut de confesiune romano-catolică. Partenerii aveau probleme legate de stres, conflicte frecvente şi erodarea intimităţii în cuplu. Terapia a implicat o anamneză a vieţii de cuplu şi a dinamicii iniţiale a relaţiei, precum şi training pe aspecte de management al timpului. În timp, cei doi şi-au corectat percepţiile greşite care afectaseră dinamica relaţiei lor. În final, noi (Aten & Worthington) eaminăm ce s-a învăţat în acest număr (al revistei). Propunem paşi ce vor trebui luaţi în viitor în practicarea terapiilor augmentate spiritual şi religios şi luăm în considerare modalităţi de lucru în cazul clienţilor care iniţiză terapia cerând în mod explicit abordări spirituale sau religioase, dar şi în cazul celor care cer o terapie seculară, dar care e posibil să se confrunte pe durata procesului terapeutic cu probleme ce ţin de spiritualitate sau religiozitate. Sugerăm că ar trebui dezvoltate şi testate noi metode clinice, care să încorporeze practici religioase occidentale şi orientale. De asemenea, recomandăm o mai bună colaborare atât între preoţi (duhovnici) şi psihoterapeuţi, cât şi între psihoterapeuţi şi cercetători. În final, subliniem faptul că formarea clinică are nevoie de îmbunătăţiri în sensul acesta şi propunem câteva direcţii la care s-ar putea interveni. Sperăm că acest număr (al revistei) oferă o ghidare clinică în munca cu clienţii – chiar dacă aceştia caută psihoterapie augmentată religios sau psihoterapie seculară. Integrând practica clinică cu cercetarea, putem să ne raportăm la clienţii religioşi mai precis şi mai eficient. Sperăm că aceste articole îi vor ajuta pe practicieni (dar şî pe

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cercetătorii din domeniul clinic) să depăşească tensiunile istorice dintre psihoterapie şi religie. Bibliografie (...)

ARTICOL TRADUS DE Laura Belean Ramona Monica Rad Cristina Tacaciu

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Intervenţii spirituale în psihoterapie: evaluări făcute de clienţi foarte religioşi

Jennifer S. Martinez, Timothy B. Smith and Sally H. Barlow Brigham Young University

Journal of Clinical Psychology, vol. 63(10), 943-960 (2007)

Intervenţiile spirituale şi religioase din cadrul psihoterapiei se bucură de o atenţie crescândă a cercetătorilor, în special în cazul terapiei cu clienţi foarte religioşi. Acest studiu a examinat experienţele şi opiniile clienţilor despre intervenţiile religioase din cadrul terapiei. Un eşantion de 152 de clienţi ai unui centru de consiliere, din cadrul unei universităţi sponzorizate de Biserica lui Iisus Hristos a Zilei Tuturor Sfinţilor (Church of Jesus Christ of Latter-Day Saints – LDS), au completat un chestionar de evaluare a unor intervenţii specifice, legat de adecvarea, utilitatea şi prevalenţa lor. Intervenţiile din afara şedinţei de terapie au fost considerate de către clienţi ca fiind mai adecvate decât cele din cadrul şedinţei, însă intervenţiile din timpul şedinţei de terapie au fost considerate mai utile. Intervenţiile care au fost considerate atât adecvate, cât şi utile, de către participanţi, au inclus citarea unor pasaje din Scriptură, predarea conceptelor religioase, încurajarea iertării, încurajarea înspre utilizarea comunităţii religioase şi evaluarea spiritualităţii clientului. Unele intervenţii religioase au fost considerate neadecvate sau inutile, iar clienţii au oferit explicaţii pentru motivele care pot face ca o anumită intervenţie să fie eficientă sau ineficientă în psihoterapie. În literatura de specialitate, a fost documentată consistent prevalenţa credinţelor şi afilierii religioase în America de Nord (de ex. Hoge, 1996; Keller, 2000), iar estimările recente indică faptul că peste 80% dintre americani se consideră afiliaţi unei religii şi peste 75% cred în existenţa lui Dumnezeu şi se roagă cel puţin o dată pe săptămână (Baylor University, 2005). În ultimele zeci de ani, psihologii au recunoscut tot mai mult necesitatea de a aborda aspecte spirituale şi religioase în tratamentele privind sănătatea mentală, în special atunci când au de-a face cu clienţi foarte religioşi (Hage, 2006; Richards & Bergin, 2005). În general, psihologii par a fi deschişi către valori şi practici asociate, în mod tradiţional, cu religia (Crook-Lyon, O’Grady, Smith, Jensen & Golighty, 2007; Shafranske, 2000; Walker, Gorsuch & Tan, 2004), iar literatura despre sănătatea mentală documentează tot mai mult modalităţi în care religiozitatea poate fi în mod eficient integrată în intervenţiile psihoterapeutice (Miller, 2003; Pargament, 1997; Shafranske, 1996; Smith, Bartz & Richards, in press; Wade, Worthington & Vogel, 2007). Acest domeniu poate, aşadar, să beneficieze de o înţelegere din ce în ce mai bună a cauzelor pentru care intervenţiile religioase pot să fie eficiente sau ineficiente şi a motivelor pentru care anumite intervenţii sunt cele mai adecvate sau mai utile, pentru clienţii care susţin sau caută să adreseze problematica spirituală şi religioasă în terapie. Religiozitatea a fost deseori definită ca fiind aderarea la un sistem instituţionalizat de credinţe, valori şi activităţi bazate pe crezuri spirituale, în vreme ce spiritualitatea se referă la experienţele transcendente şi la modul de înţelegere a aspectelor legate de Dumnezeu şi/sau de alte caracteristici nevăzute ale vieţii şi ale universului (Kelly, 1995). Un individ poate fi spiritual şi religios, înainte de toate religios, dar nu neapărat spiritual, sau în special spiritual, fără a fi neapărat şi religios. Multe dintre intervenţiile din cadrul psihoterapiei examinate în acest studiu (de ex. rugăciunea, încurajarea iertării) au atât componente spirituale, cât şi religioase. Cu toate acestea, datorită faptului că cele mai

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multe dintre intervenţiile investigate au un fundament religios explicit (de ex. citirea Scripturii), vom folosi termenul religios pe parcursul articolului, cu excepţia situaţiilor în care contextul justifică o formulare mai exactă. În psihoterapie, clienţii se luptă nu doar cu probleme ce ţin de starea de bine personală, ci şi de perspectivele lor în viaţă, relaţiile cu ceilalţi sau valorile lor cele mai adânci. Pentru mulţi clienţi, problematica religioasă se suprapune cu aceste preocupări ale lor (Smith & Richards, 2005). În aceste circumstanţe, clienţii respectivi ar putea obţine beneficii de pe urma abordării explicite a problematicii religioase în cadrul terapiei sau de pe urma augmentării metodelor terapeutice de coping cu resurse religioase. La fel cum ajustarea psihoterapiei în funcţie de experienţele şi valorile culturale ale clientului poate spori eficienţa tratamentului (Griner & Smith, 2006), tot aşa, ajustarea psihoterapiei cu elemente religioase, în cazul clienţilor care valorizează puternic religia, ar putea duce la un tratament mult mai eficient (Richards, Keller & Smith, 2004; Smith et al., in press). Mai mult decât atât, psihologii au obligaţia etică de a oferi servicii care ţin cont de context în cazul fiecărui client, acest lucru incluzând contextele religioase (American Psychological Association [APA], 2002). Psihoterapeuţii trebuie, cu atât mai mult, să ţină cont de experienţele şi credinţele clienţilor care valorizează puternic religia. O înţelegere acurată a concepţiilor religioase ale clienţilor poate avea un impact pozitiv asupra tratamentului, în vreme ce ignorarea credinţelor religioase poate reduce eficienţa terapiei şi poate creşte frecvenţa cu care clienţii pun punct terapiei (Miller, 2003; Propst, 1980; Smith & Richards, 2005). În mod specific, indivizii foarte religioşi consideră de multe ori că psihologii clinicieni s-ar putea să nu aprobe valorile, ideile sau purtarea lor (Worthington, 1986), motiv pentru care vor evita terapia sau vor căuta alţi specialişti în sănătatea mentală, despre care cred că le împărtăşesc credinţele (Worthington, Duport, Berry & Duncan, 1988). Clienţii care sunt foarte religioşi sunt cei mai predispuşi la a-şi dori integrarea intervenţiilor religioase în terapie. Aşadar, studierea încorporării acestui tip de intervenţii în psihoterapie întâlneşte cea mai mare justificare în cadrul populaţiilor care deja raportează puternice valori religioase. După cum a fost documentat pe larg în literatura de specialitate, includerea problematicii religioase în psihoterapie potenţează apariţia unui număr de dileme etice (Richards & Bergin, 2005). Luarea în considerare a consimţământului informat (Hawkins & Bullock, 1995), a dezvoltării identităţii religioase/spirituale (Fowler, 1991; Hulk, Spilka, Hunsberger & Gorsuch, 1996; Poll & Smith, 2003), a relaţiilor biunivoce (Sonne, 1999), a colaborării cu liderii religioşi (Chappelle, 2000), a respectului pentru valorile clienţilor (Haug, 1998; Neusner, 1994), a limitelor impuse de locul de muncă (Chapelle, 2000; Richards & Bergin, 2005) şi a nivelului de competenţă a terapeutului (Barnett & Fiorentino, 2000; Lannert, 1991) este esenţială în a decide dacă să se folosească intervenţii bazate pe religie. Pentru fiecare din aceste arii, au fost făcute recomandări în literatura de specialitate, terapeuţii fiind informaţi despre aceste potenţiale probleme şi sprijiniţi în practicarea psihoterapiei în mod etic. Cu toate acestea, înţelegerea perspectivelor clientului asupra factorilor care reduc eficienţa intervenţiilor religioase în terapie ar oferi informaţii importante pentru practicieni. O largă varietate de intervenţii care pot fi considerate de natură religioasă au fost promovate în literatură, inclusiv rugăciunea împreună cu clienţii, discuţiile pe baza textelor sacre, includerea resurselor disponibile în cadrul comunităţilor religioase,

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angajarea în meditaţie spirituală sau în ritualuri religioase şi încurajarea comportamentelor morale, precum iertarea (Richards & Bergin, 2005). Deşi terapeuţii pot aborda în mod diferit felul cum integrează aceste tipuri de intervenţii în terapie (de ex. Worthington, 1986), ele s-au dovedit a fi eficiente într-o varietate de cadre şi s-au dovedit a augmenta eficienţa terapiei (Smith et al., in press). Intervenţiile religioase au fost integrate cu succes în tratamente tradiţionale seculare, cum ar fi terapia cognitiv-comportamentală (Nielsen, Johnson & Ridley, 2000; Propst, Ostrom, Watkins, Dean & Mashburn, 1992), psihoanaliză (Rizzuto, 1996), terapia transpersonală (Vaughan, Wittine & Walsh, 1996) şi terapia maritală (Sperry & Giblin, 1996). Cu toate acestea, în momentul de faţă avem puţine cunoştinţe legate de care intervenţii sunt cele mai eficiente sau de motivele pentru care acestea sunt eficiente în cazul clienţilor foarte religioşi. Utilizarea intervenţiilor religoase de către psihoterapeuţi, aşa cum a fost raportată de către clienţi, a fost investigată într-o serie de studii de specialitate (Ball & Goodyear, 1991; Jones, Watson & Wolfram, 1992; Moon, Willis, Bailey & Kwashny, 1993; Richards & Potts, 1995; Worthington et al., 1988). Totuşi, cele mai multe cercetări disponibile la ora actuală evaluează utilizarea intervenţiilor religioase din perspectiva clinicienilor. Cu toate că două studii anterioare oferă date privind preocupările de natură religioasă ale clienţilor (Johnson & Hayes, 2003; Rose, Westefeld & Ansley, 2001), iar un alt studiu evaluează opiniile clienţilor privitoare la utilitatea intervenţiilor religioase (Worthington et al., 1988), nu am reuşit să identificăm nici un studiu bazat pe experienţele propriu-zise ale clienţilor şi pe opiniile lor privind adecvarea şi utilitatea acestor intervenţii în tratamentul lor curent. Acest tip de informaţii ar putea fi esenţiale pentru a ajuta terapeuţii să optimizeze felul în care integrează intervenţiile religioase în psihoterapie. Prin urmare, studiul de faţă a încercat să răspundă la următoarele întrebări: Care dintre intervenţiile religioase sunt percepute de către clienţii foarte religioşi ca fiind cele mai adecvate? Care dintre aceste intervenţii sunt percepute ca cele mai utile? Care sunt motivele pentru care clienţii foarte religioşi percep intervenţiile religioase ca eficiente/ineficiente?

Metode Participanţi

Eşantionul pe care s-a desfăşurat acest studiu a fost format din 152 de studenţi, care au utilizat serviciile centrului de consiliere al unei mari universităţi private, sponsorizate de Biserica lui Iisus Hristos a Zilei Tuturor Sfinţilor (Church of Jesus Christ of Latter-Day Saints – LDS). 56 de participanţi (37%) au fost bărbaţi şi 96 (63%) au fost femei, toţi având vârste cuprinse între 18 şi 37 de ani, în felul următor: 62 de participanţi (41%) au avut între 18 şi 21 de ani, 71 dintre ei (47%) au avut între 22 şi 25 de ani, iar 19 participanţi (12%) au avut între 26 şi 37 de ani. Toţi clienţi care au participat la acest studiu, la fel ca toţi terapeuţii de la centrul de consiliere, au fost membri ai Bisericii Zilei Tuturor Sfinţilor (ZTS). Participanţii au raportat rezidenţă permanentă în mai multe state, dar cele mai des declarate au fost Utah (19%), California (12%) şi Idaho (5%); 10 participanţi au fost din afara graniţelor Statelor Unite ale Americii (7%).

Centrul de consiliere oferă servicii proshologice gratuite pentru studenţii la zi ai universităţii. Nu există o limită a numărului de şedinţe de consiliere la care pot lua parte,

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iar în acest studiu, 63 dintre clienţi (41%) au participat la 1-4 şedinţe, 31 de clienţi (20%) au participat la 5-9 şedinţe, iar 58 de clienţi (38%) au participat la 10 sau mai multe şedinţe de consiliere. La centrul de consiliere sunt angajaţi 27 de psihologi licenţiaţi, 2 terapeuţi specilizaţi pe probleme maritale şi de cuplu, 4 psihologi cu studii postdoctorale, 4 psihologi urmând studii predoctorale şi fac practică cu jumătate de normă (part-time) 20 de studenţi la psihologie. Acest centru oferă servicii de sănătate mentală concordante cu cele ale altor centre de consiliere din Statele Unite şi include un program de practică acreditat de APA. Intervenţiile religioase nu se numără printre practicile standard, îns㸠datorită faptului că centrul de consiliere deserveşte preponderent clienţi aparţinând Bisericii ZTS, o parte dintre terapeuţii de aici folosesc ocazional acest tip de intervenţii pe durata tratamentului.

Nu au fost stabilite restricţii cu privire la diagnosticul clienţilor. Problemele pentru care aceştia au iniţiat terapia au variat în eşantionul folosit, în felul următor: 53 de clienţi (35%) au raportat depresie, 20 (13%) au venit la centru pentru probleme de anxietate, alţi 20 (13%) pentru probleme în relaţia de cuplu, iar restul de 59 de clienţi (39%) au raportat o varietate de probleme, printre care se numără disfuncţii alimentare, tulburare compulsiv-obsesivă, schizofrenie, preocupări de natură sexuală şi dificultăţi legate de etapa de vârstă. Antecendente legate de traume sau abuzuri au fost raportate de 9 clienţi (6%). Probleme de natură spirituală sau religioasă nu au fost raportate de nici unul dintre clienţi ca fiind o problemă primară.

Procedură

În zona biroului de recepţie al centrului de consiliere au fost postate afişe invitând

clienţii să participe la un chestionar. Centrul deserveşte aproximativ 570 de clienţi în orice moment, iar datele au fost colectate pe parcursul mai multor săptămâni, în martie 2004 şi în septembrie 2004. Subiectul cercetării nu a fost dezvăluit în afiş, pentru a reduce probabilitatea de biasare a deciziei clienţilor dacă vor sau nu să participe la acest studiu. La cererea clientului, angajaţii biroului de recepţie le-au oferit câte un chestionar, un formular pentru declaraţia de consimţământ şi un baton de ciocolată ca formă de compensaţie pentru timpul oferit. Toate chestionarele înmânate clienţilor au fost înapoiate completate, cu excepţia a 6 chestionare, care au avut răspunsuri lipsă în cadrul aceleiaşi secţiuni (adecvarea utilizării intervenţiilor religioase), din cauză că terapeuţii clienţilor respectivi nu utilizaseră nici o intervenţie religioasă în cadrul terapiei. Cu excepţia acestor itemi lipsă, toate cele 152 de chestionare au fost incluse în analiză.

Instrument

Prima pagină a chestionarului solicită respondenţilor informaţii demografice şi

contextuale, inclusiv afilierea religioasă, vârsta, genul, originea geografică, numărul de şedinţe de terapie la care au participat până în prezent şi problemele iniţiale, care au motivat iniţierea terapiei. A fost măsurat nivelul de religiozitate, pentru a se verifica dacă respondenţi sunt într-adevăr foarte religioşi, aşa cum s-a specificat în obiectivele studiului. Pentru aceasta, s-a folosit un singur item, care ruga clienţii să estimeze cât de importantă este religia pentru ei. Răspunsurile au fost date pe o scală Likert cu 9 trepte, variind de la 1 = deloc, la 9 = extrem de importantă, credinţa mea religioasă este centrul

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întregii mele vieţi. S-a dovedit că această întrebare corelează pozitiv (0.84) cu un factor pro-religios intrinsec, derivat dintr-o scală cu itemi multipli (Gorsuch, 1972); această corelaţie are aproximativ aceeaşi valoare ca mediana intercorelaţiei itemilor ce măsoară religiozitatea (0.76) (Gorsuch, 1984). Scorul mediu obţinut la itemul care evaluează religiozitatea a fost de 8.2 (SD = 1.4), pe o scală cu 9 trepte, fapt ce indică un nivel foarte ridicat de religiozitate raportat de eşantionul folosit, aşa cum s-a preconizat (Richards, 1994). Deşi 12 participanţi (8%) au avut scoruri mai mici de 7 pe scala cu 9 trepte (indicând un nivel personal al devoţiunii religioase mai redus decât nivelele cele mai înalte), aceşti participanţi nu au fost excluşi din analiză deoarece am considerat că (a) nivele foarte înalte ale religiozităţii ar fi relevante, dar nu sunt absolut necesare pentru integrarea intervenţiei religioase în terapie; (b) variaţia interpersonală la nivel devoţiunii apare între membrii oricărui grup; şi (c) a fost important să reprezentăm experienţele tuturor clienţilor care au completat chestionarul. Pe a doua pagină a chestionarului, clienţii au notat dacă cele 18 intervenţii religioase au fost utilizate de către terapeuţii lor în cadrul terapiei. Lista a fost creată de Richards şi Potts (1995), care au elaborat lista şi definiţiile intervenţiilor religioase dintr-o listă de răspunsuri adunate de Ball şi Goodyear (1991). Deşi intervenţiile religioase evaluate în studiul curent nu sunt o listă exhaustivă a tuturor celor care ar putea fi încorporate în psihoterapie, lista prezintă cele mai comune intervenţii implementate şi procedura ne permite compararea cu cercetările anterioare care vizau opiniile terapeuţilor. Richards şi Potts au divizat cele 18 intervenţii în două categorii de intervenţii: 9 în cadrul sesiunii de terapie şi 9 în afara sesiunii (de terapie), pe baza celei mai probabile locaţii pentru intervenţie. Chestionar nostru oferă definiţii pentru fiecare intervenţie, pentru ca participanţii să înţeleagă corect sensul terminologiei. A treia pagină a chestionarului a interogat respondenţii cu privire la utilitatea oricăreia dintre cele 18 intervenţii religioase, pe care le-au identificat ca fiind utilizate de terapeutul lor. Intervenţiile au fost evaluate pe o scală de tip Likert cu 6 trepte (0 = foarte inutil, 1 = moderat de inutil, 2 = oarecum inutil, 3 = oarecum util, 4 = moderat de util, 5 = foarte util). În mod similar, a patra pagină a chestionarului a cerut respondenţilor să indice pe o scală Likert cu 6 trepte, în ce măsură au considerat ca fiind potrivit/adecvat ca terapeutul lor să utilizeze fiecare dintre cele 18 intervenţii religioase prezentate. (0 = foarte neadecvat, 1 = moderat de neadecvat, 2 = oarecum neadecvat, 3 = oarecum adecvat, 4 = moderat de adecvat, şi 5 = foarte adecvat). Pe a cincea pagină, respondenţilor li s-a cerut să-şi amintească dacă intervenţiile religioase au fost în mod particular eficiente în ajutorarea procesului de creştere/dezvoltare şi schimbare şi să scrie pe scurt despre experienţele lor. A şasea pagină a fost identică, cu excepţia faptului că respondenţilor li s-a cerut să noteze când intervenţia religioasă nu a fost eficientă. Răspunsurile scrise ale participanţilor la întrebările cu sfârşit deschis (open-ended questions) de pe ultimele două pagini au fost analizate folosind metode prestabilite pentru analiza de conţinut (Denzin & Lincoln, 2002). Răspunsurile oferite de participanţi au fost mai întâi dactilografiate şi apoi citite în întregime de mai multe ori pentru a obţine o înţelegere deplină a conţinutului acestora. Ulterior, au fost identificate şi evidenţiate sintagmele semnificative din răspunsuri. Pe urmă, a fost realizată o categorizare a conţinutului prin citirea iniţială a răspunsului şi generarea unei definiţii şi al unui nume pentru categorii preliminare care să reflecte modul de înţelegere al participantului.

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Răspunsul ficărui participant a fost citit şi adăugat într-o categorie sau a fost pus într-o categorie nouă. Acest proces de sortare a fost continuat până când fiecare răspuns a fost pus într-o categorie. Fiecare categorie a primit apoi un titlu şi o descriere. Procesul de categorizare a fost repetat, însă, de acestă dată, a fost ghidat de titlurile şi definiţiile stabilite. Deşi rezultatele au fost similare, câţiva dintre respondenţi au fost plasaţi în categorii diferite pe baza definiţiilor şi titlurilor care au fost identificate. Rezultatele celei de-a doua runde de analiză au fost date unui evaluator independent, care a evaluat dinstinctivitatea şi claritatea conceptuală a categoriilor, a examinat răspunsurile participanţilor pentru a detecta eventuale semnificaţii adiţionale, care nu au fost incluse în anumite categorii şi a verificat acurateţea globală a codificării. Evaluatorii au rezolvat discrepanţele la nivel de codificare prin revizuirea transcrierilor până la stabilirea unui acord. Tabel 1 Mediile şi abaterile standard ale corelaţiilor între evaluările adecvării şi utilităţii intervenţiilor religioase Intervenţie religioasă Evaluarea adecvării

M SD Evaluarea utilităţii M SD

n r

Intervenţii în timpul sesiunii 1. Referinţe din Scriptură 2. Rugăciunea privată a terapeutului 3. Predarea unor concepte religioase 4. Autodezvăluirea religioasă/spirituală 5. Evaluare religioasă/spirituală 6. Imagerie sau relaxare religioasă/spirituală 7. Confruntare religioasă/spirituală 8. Rugăciune terapeut-client 9. Binecuvântări din partea terapeutului Suma intervenţiilor din sesiune

3.76 3.69 3.47 3.32 3.11 3.07 3.04 2.70 1.99 28.3

1.0 1.2 1.2 1.3 1.5 1.3 1.5 1.5 1.5 8.0

3.65 1.91 3.97 3.77 3.66 2.40 3.55 1.44 2.00 31.5

1.3 1.9 1.2 1.5 1.3 2.1 1.6 1.9 2.4

63 11 73 47 71 15 51 89 11

0.35 -0.01 0.49 0.61 0.44 0.83 0.74 0.69 0.65

Intervenţii din afara sesiunii 1. Încurajarea iertării 2. Utilizarea comunităţii religioase 3. Jurnale spirituale/religioase 4. Rugăciune 5. Meditaţie religioasă/spirituală 6. Referinţe pentru binecuvântări 7. Biblioterapie religioasă 8. Încurajarea spovedirii clientului 9. Memorarea Scripturii Suma intervenţiilor din timpul sesiunii

4.26 3.98 3.95 3.94 3.83 3.65 3.60 3.35 2.84 33.7

1.0 1.1 1.0 1.1 1.2 1.3 1.2 1.5 1.4 8.6

3.70 3.33 2.58 2.80 3.10 1.11 1.44 1.44 0.0 26.5

1.4 1.6 1.8 1.9 1.8 1.9 1.9 0.0

50 40 19 20 21 9 23 9 6

0.37 0.36 0.17 0.47 0.29 0.00 0.10 -0.18 -

Notă: Cei 146 de participanţi au oferit evaluări privind adecvarea (6 au avut date lipsă), dar doar clienţii care au experienţiat o anumită intervenţie au oferit evaluări ale utilităţii pentru acea intervenţie. Evaluările mai ridicate au indicat o aprobare/susţinere mai mare.

Rezultate Adecvare raportată

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Mediile şi abaterile standard ale evaluărilor făcute de clienţi, privind adecvarea celor 18 intervenţii sunt prezentate în tabelul 1. Intervenţiile din timpul sesiunii, care au fost considerate ca fiind cele mai adecvate de către respondenţi au fost: referirile la scriptură, rugăciunea privată a terapeutului şi predarea conceptelor religioase/spirituale. Intervenţiile din afara sesiunii care au fost considerate mai adecvate sunt: încurajarea iertării, facilitarea tratamentului prin consultarea comunităţii religioase şi încurajarea rugăciunii private a clientului. Binecuvântarea dată de terapeut (prin punerea mâinilor) şi rugăciunile client-terapeut au fost intervenţiile considerate ca fiind cele mai neadecvate. Intervenţia din afara sesiunii care a fost evaluată ca fiind cea mai neadecvată a fost memorarea Scripturii. Per total, evaluările clienţilor cu privire la adecvarea intervenţiilor din afara sesiunii (M=33.7) au fost semnificativ mai mari t (144) = 10.4, p< .01, Cohen d=.65, decât evaluările intervenţiilor din timpul sesiunii, (M=28.3).

Utilitate raportată

Clienţii au evaluat utilitatea intervenţiilor folosite de terapeuţii lor. Un sumar al mediilor şi abaterilor standard puteţi găsi în tabelul 1. Numărul evaluărilor pentru fiecare intervenţie corespunde cu numărul de experienţe trăite de clienţi, şi nu cu numărul total al participanţilor. Aceste date contingente au oferit puţine informaţii despre intervenţiile care au fost utilizate rar, precum este raportat în tabelul 1.

Intervenţiile evaluate de clienţi ca fiind cele mai utile au fost: predarea unor concepte religioase, autodezvăluirea religioasă din partea terapeutului, încurajarea iertării, evaluarea religiozităţii clienţilor şi citarea unor pasaje din scriptură. Intervenţiile evaluate ca fiind mai puţin utile au fost: memorarea din scriptură, menţionarea binecuvântării unui preot, rugăciunea terapeut-client, încurajarea de către terapeut a spovedirii clientului, rugăciunea terapeutului, binecuvântarea dată de terapeut. Este de reţinut faptul că intervenţiile evaluate ca fiind utile au avut cele mai mari rate de prevalenţă, ceea ce înseamnă că intervenţiile percepute ca fiind mai utile au fost utilizate mai frecvent în terapie. Terapeuţii par să utilizeze cele mai utile intervenţii mai des decât cele percepute de client ca fiind mai puţin utile.

Media utilităţii percepute la nivelul intervenţiilor religioase a fost 3.3, care se află între oarecum util şi moderat util. Utilitatea fiecărei intevenţii a fost însumată pe baza categoriilor de intervenţii în cadrul terapiei şi în afara terapiei. Datele contingente au împiedicat aplicarea testului t, deoarece clienţii care nu au notat câte o intervenţie în fiecare categorie ar fi eliminaţi din listă (analiza ar fi rămas fără participanţi). Totuşi, media generală a utilităţii intervenţiilor din cadrul sesiunii (M = 3.50) a fost semnificativ mai mare (diferenţa standard a mediilor, Cohen d = .47) decât media evaluărilor din afara sesiunilor (M = 2,94). După cum se vede în tabelul 1, corelaţiile privind utilitatea şi gradul de adecvare au fost în general mari pentru intervenţiile din timpul sesiunii. Totuşi, deşi unii clienţi au perceput angajarea terapeutului în rugăciune privată ca fiind adecvată, nu au perceput această practică ca fiind utilă (după cum ar fi de aşteptat, deoarece rugăciunea privată a terapeutului nu este accesibilă în cadrul sesiunii). În comparaţie cu intervenţiile din cadrul sesiunilor, intervenţiile din afara sesiunii au fost semnificativ mai reduse ca număr. În mod tipic, percepţia utilităţii şi adecvării intervenţiilor din afara sesiunii a fost de magnitudine mică sau moderată. Nu a existat nici o corespondenţă între aceste evaluări pentru clienţii care au primit recomandarea unei binecuvântări din partea

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preotului sau a liderului ecleziastic; şi a fost o relaţie inversă între utilitatea percepută şi evaluarea adecvării printre clienţii care au primit recomandarea de a confesa păcatele unui preot. Prin urmare, clienţii care credeau că practica confesiunii este potrivită au avut tendinţa să considere această intervenţie ca fiind inutilă. Analiza cantitativă cu privire la intervenţiile eficiente şi ineficiente

Au fost analizate răspunsurile participanţilor cu privire la situaţiile în care interveţiile religioase au fost percepute ca fiind eficiente şi ineficiente. Răspunzând la întrebările privind eficienţa intervenţiilor, 125 dintre participanţi (82%) au oferit răspunsuri, însă doar 56 dintre ei (37%) au oferit răspunsuri cu privire la eficienţa/ineficienţa intevenţiilor. 26 din răspunsurile scrise conţineau descrieri ale intervenţiilor din afara terapiei (ale liderilor ecleziastici) şi au fost excluse, deoarece nu erau în concordanţă cu interesul nostru pentru intervenţiile oferite în centre de sănătate mentală. După examinări ulterioare ale datelor, am observat că unele răspunsuri cu privire la eficienţă reflectau de fapt opinii sau experienţe cu privire la aspectele considerate de către respondenţi ca fiind ineficiente, şi vice versa. Prin urmare, în codificarea datelor, am analizat declaraţiile după conţinutul lor şi nu după întrebare. În plus, am găsit 40 de răspunsuri la ambele întrebări care erau declaraţii generale cu privire la intervenţiile religioase şi nu evaluări ale eficienţei. Prin urmare, codificarea finală a datelor calitative au implicat trei arii de conţinut: motive pentru care intervenţiile au fost considerate ca fiind eficiente, motive pentru care intervenţiile religioase au fost considerate ineficiente şi răspunsuri neutre privind intervenţiile religioase. Motive pentru care intervenţiile au fost eficiente

Motivele pentru care participanţii au perceput intervenţiile religioase ca fiind eficiente au fost codate în 6 categorii (tabelul 2). În următoarele paragrafe sunt date citate directe, care exemplifică aceste categorii. Tabel 2 Categorii calitative de motive pentru care clienţii au perceput intervenţiile spirituale ca fiind eficiente şi ineficiente

Insight sporit ; percepţii restructurate (47%) Eficace (n = 78)

Confort personal sporit, prin împărtăşirea de valori similare cu terapeutul (19%) Recunoaştere mai bună a influenţelor/realităţilor spirituale (12%) Sentiment mai accentuat de empatie/conexiune cu terapeutul (8%) Credibilitate crescută a terapiei pentru clienţi iniţial sceptici (8%) Adresare către “sinele întreg” al clientului (6%)

Aplicarea inefiecientă a intervenţiei spirituale (32%) Ineficace (n = 37)

Sporirea sentimentelor de anxietate şi vină (27%) Rol neadecvat al terapeutului de a se comporta ca un lider ecleziastic (22%) Neadecvarea includerii intervenţiilor religioase în psihoterapie (19%)

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Insight sporit; percepţii restructurate. De departe cel mai comun motiv citat de

către clienţi, pentru care intervenţiile religioase au fost eficiente în cazul lor, a implicat un insight sporit sau reformarea percepţiilor. Abordarea problemelor dintr-un punct de vedere religios a oferit clienţilor noi modalităţi în care să-şi înţeleagă şi interpreteze starea.

Terapeutul meu mi-a prezentat un citat despre vrednicia sufletelor şi mi l-a explicat în aşa fel încât să realizez că Dumnezeu mă iubeşte necondiţionat, chiar dacă sufăr de depresie, nu mă duc la cursuri întotdeauna etc. Acel citat şi acel gând au fost foarte folositoare pentru mine şi mi l-am repetat de câteva ori de atunci. Presupun că e un simplu gând, dar chiar îmi dă speranţă şi încurajare.

Terapeutul meu m-a întrebat cât de importantă e religia mea pentru mine. Pentru că e centrul vieţii mele, mi-am dat seama că trebuia să fac nişte schimbări care să-mi schimbe viitorul în bine.

Indiferent de tehnicile specifice pe care terapeutul le-a folosit (de ex. învăţături despre doctrină/scriptură, confruntarea părerilor, întrebări), beneficiul general perceput a fost acela că clienţii au dobândit o nouă perspectivă/conştientizare cu privire la ei înşişi sau la problemele lor, ceea ce le-a facilitat progresul.

Confort personal sporit, prin congruenţa valorilor cu terapeutul. Spre deosebire de paleta preponderent cognitivă de răspunsuri pe care tocmai le-am descris, răspunsurile altor clienţi au tins să reliefeze componte relaţionale sau emoţionale. Răspunsurile câtorva clienţi au accentuat efectele emoţionale pozitive ale împărtăşirii de credinţe/valori similare cu terapeutul (congruenţa valorilor). Pentru aceşti clienţi, simplul fapt de a fi conştient că terapeutul lor are aceleaşi valori sau credinţe religioase ca ei a sporit confortul personal, încrederea şi deschiderea în cadrul terapiei. Tot ce conta pentru mine, în calitate de client, era să ştiu că terapeutul meu era familiar cu credinţele mele religioase. Ştiind că e membru al aceleiaşi biserici, mi-a conferit o senzaţie de confort şi înţelegere.

Nu am nici o problemă cu faptul că terapeutul meu citează pasaje din Scriptură, lideri bisericeşti sau teme spirituale – de fapt, mă ajută să mă simt mai confortabil când discut cu el. Pot să mă deschid mai mult, pentru că ştiu că mă înţelege la un alt nivel, dar şi pentru că nu sunt nevoit să-mi restricţionez vocabularul sau să evit subiecte religioase, ce ar putea să-mi facă relaţia (terapeutică) mai puţin confortabilă, cum ar fi în cazul unui terapeut laic (nereligios).

Când terapeuţii au abordat probleme religioase în cadrul discuţiilor teraputice cu aceşti clienţi, au demonstrat că sunt sensibili la problemele lor, ceea ce a îmbunătăţit relaţia terapeutică.

Recunoaşterea influenţelor/realităţilor spirituale la un nivel mai înalt. Alţi clienţi au discutat modul în care intervenţiile religioase în terapie i-a ajutat să recunoască influenţa transcendentului în alte circumstanţe/situaţii. Simplul fapt de a propune spre discuţie infuenţe religioase, ca parte a terapiei, a avut ca rezultat o mai mare conştientizare din partea clienţilor a sentimentelor către Dumnezeu, fapte atribuite intervenţiei divine, “atingerii” de către Duhul Sfânt etc. Un citat reprezentativ este: “Faptul că am auzit perspectiva terapeutului meu m-a ajutat să simt Duhul Sfânt, care mi-a adus pacea

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de care aveam atâta nevoie.” Discutarea problemelor spirituale/religioase în sesiunile de terapie poate, de asemenea, să sporească abilitatea clientului de a trăi o conexiune personală cu o putere superioară, care permite schimbarea în bine:

Eram destul de furios pe Dumnezeu pentru abuzurile care s-au întâmplat în viaţa mea şi, ajutându-mă să înţeleg importanţa liberului arbitru şi faptul că Dumnezeu mă iubeşte, [terapeutul] m-a făcut capabil să folosesc o conexiune spirituală pentru a mă vindeca, în loc să exclud acea sursă şi să încerc să fac totul pe cont propriu.

Pentru că intervenţiile religioase se bazează pe asumpţia unor realităţi transcendente, cum ar fi existenţa unei divinităţi, presupune că clienţii pot să îşi exprime senzaţia de a fi influenţaţi de acea divinitate. Aceşti clienţi au exprimat în mod clar percepţia influenţei divinităţii în viaţa lor ca rezultat al intervenţiilor religioase în terapie.

Sentiment mai accentuat de empatie/conexiune cu terapeutul. Un beneficiu emoţional descris de clienţi implica percepţia crescută a preocupării terapeutului pentru ei ca indivizi. Intervenţiile religioase i-au ajutat să se simtă iubiţi, de exemplu: “Ştiu că îi pasă de mine şi că mă cunoaşte bine, din moment ce ia spiritualitatea în considerare.” Aceşti clienţi au interpretat utilizarea de către terapeut a elementelor religioase ca fiind o dovadă a iubirii sau preocupării lor.

Mai mare credibilitate a terapiei. Pentru câţiva clienţi aparent sceptici, includerea intervenţiilor religioase a sporit percepţia pozitivă asupra terapiei în general. Aceste intervenţii nu doar s-au adresat unor probleme specifice experienţate de client, dar au şi avut, per ansamblu, efectul de a creşte încrederea lui în procesul terapeutic.

Din cauză că terapeutul îşi susţinea spusele cu cuvinte din Scriptură şi din cauză că m-a ajutat să văd cum pot trăi mai deplin acele concepte în care deja credeam, am fost capabil să am încredere în el, transferând asupra lui încrederea pe care o aveam în credinţa mea, în religie, în scripturi etc.

În terapie, consilierul meu a făcut câteva referiri la scripturi. Pentru mine, acest lucru a fost în mod special eficient, pentru că studiez scripturile şi cred în ele şi a adăugat validare externă la ceea ce de multe ori percep ca fiind fleacurile şi nimicurile psihologiei.

Pentru aceşti clienţi, intervenţiile religioase au mărit credibilitatea terapeutului şi au dus astfel la un angajament sporit al clientului în terapie.

Adresare către “sinele întreg” al clientului. Câţiva clienţi au menţionat că includerea problematicii religioase în terapie a permis o abordare mai comprehensivă a tratamentului: “Prin a afla despre covingerile mele spirituale şi religioase, [terapeutul] a fost capabil să aprecieze mai bine şi mai complet problema mea” şi “Am simţit că era un efort de a îmbunătăţi toate părţile, nu doar din punct de vedere psihologic, ci şi din punct de vedere spiritual.” Adresarea problemelor şi din punct de vedere religios a fost considerată necesară pentru schimbare de către unii clienţi, pentru care acest aspect al vieţii lor este extrem de important: “Religia mea călăuzeşte tot ce fac; trebuie să mă consilieze din perspectiva aceasta, ca să mă ajute să-mi schimb adevărata persoană.”, “Pentru că credinţele mele religioase sunt atât de importante pentru mine şi îmi ghidează viaţa, pare natural ca acele credinţe să fie parte a experienţei mele în consiliere. Multe din alegerile, deciziile şi felurile mele de a vedea lucrurile sunt guvernate de credinţele mele

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spirituale.” Adresarea problematicii religioase a fost privită de unii clienţi ca necesară pentru a reflecta cu acurateţe sinele lor în întregimea lui şi, deci, pentru ca experienţa lor în cadrul psihoterapiei să fie semnificativă. Motive pentru care intervenţiile religioase au fost ineficiente

Clienţii au expus, de asemenea, câteva moduri în care intervenţiile religioase au fost ineficace. Patru categorii principale au fost extrase din răspunsurile lor (Tabelul 2).

Livrare inefiecientă a intervenţiei spirituale. Au fost listate o varietate de dificultăţi întâmpinate în felul în care terapeuţii au “livrat” intervenţiile religioase. Câţiva clienţi au relatat că terapeuţii i-au tratat cu un aer patronal sau au fost chiar ofensivi în încercările lor de a integra conţinutul religios în terapie: “Se resimte aproape ca şi cum ar vrea să-mi închidă gura” şi “consilierul nu mi-a respectat sentimentele şi încerca să-mi explice cum poate Dumnezeu să mă ajute şi asta m-a jignit.” Şi recomandările simpliste au fost problematice pentru clienţi: “Simplul fapt de a-mi spune că pot să-mi depăşesc o slăbiciune prin rugăciune şi studiul scripturii a fost ineficient şi frustrant.” Uneori, terapeuţii au oferit prea multă informaţie: “Îmi amintesc o ocazie când s-au făcut prea multe referiri scripturale şi m-am zăpăcit din cauză că nu eram pregătit să absorb toată cantitatea de informaţie.” În alte cazuri, terapeuţii au oferit prea puţină informaţie, menţionând principii generale, fără vreun plan specific sau vreo aplicaţie concretă. Alţi clienţi au indicat faptul că intervenţiile religioase au fost ineficace din cauză că nivelul lor de pregătire pentru asta nu a fost în concordanţă cu momentul intervenţiei: “Nu simt că vreo tehnică religioasă a fost vreodată ineficientă din cauza tehnicii în sine. Când lucrurile au fost ineficiente, simt că a fost din cauză că nu aveam starea potrivită sau nu aveam disponibilitatea de a antrena un efort sincer.” Sincronizarea (timing) şi receptivitatea sunt în mod clar considerente importante pentru a decide dacă ar trebui utilizată o intervenţie religioasă cu un anumit client.

Sentimente accentuate de anxietate şi vină. Experienţe negative legate de intervenţiile religioase au intervenit atunci când a fost evocat sentimentul clientului de anxietate sau vină. Acestea au fost asociate ori cu nerespectarea intervenţiei recomandate, ori cu a-i fi fost amintite clientului deficienţe sau greşeli.

Tehnicile spirituale au fost întotdeauna eficiente pentru mine, deşi uneori, dacă îmi amintesc de vreun citat din Biblie pe care mi l-a spus, mă simt vinovat că nu l-am respectat întocmai, prin urmare am sentimetul de vinovăţie şi deci resimt mai multă presiune în a trebui să fiu mai perfect.

Am primit o listă de citate din Biblie referitoare la anxietate şi mi s-a spus să le citesc şi să reflectez la ele. Îmi pare rău să spun că nu le-am citit, din lipsă de timp. Aşadar, acest lucru mi-a sporit anxietatea, de fapt, în loc s-o reducă.

Intervenţiile religioase pot fi păgubitoare atunci când clienţii le asociază cu atitudini patronale şi cu a fi judecaţi sau cu alte situaţii cauzatoare de anxietate sau vină. Acesta poate fi cazul şi când clienţii au un istoric care implică anxietate sau atunci când nu respectă recomandările (fapt care este şi un indicator al disconfortului resimţit în intervenţie).

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Rol neadecvat al terapeutului de a se comporta ca un lider ecleziastic. Unii

respondenţi au exprimat ideea că includerea intervenţiilor religioase în terapie depăşeşte limitele şi încalcă atribuţiile de rol între responsabilităţile profesionale şi cele ecleziastice. Clienţii care au considerat necesară o separare între rolul de terapeut şi cel de lider bisericesc au făcut comentarii ca: “Nu mi se pare potrivit ca un consilier să-şi asume rolul unui episcop” sau “În opinia mea, se poate vorbi despre religie, dar nu trebuie folosită aşa mult înspre a influenţa. Asta e treaba preoţilor sau a părinţilor, dar consilierea ar trebui să rămână profesională.” Aceşti respondenţi şi-au exprimat explicit disconfortul resimţit din rolurile contrastante asumate de terapeut.

Inadecvare de a include intervenţii religioase în psihoterapie. Cu toate că participanţii la acest studiu au fost în medie foarte religioşi, câţiva dintre ei şi-au exprimat opinia că intervenţiile religioase au fost ineficace prin simplul fapt că psihoterapia e un mediu nepotrivit pentru aşa ceva. Aceştia au considerat că psihoterapia nu ar trebui să se ocupe de doctrina religioasă: “N-am avut niciodată vreo experienţă spirituală pozitivă în cadrul consilierii. Întotdeauna se pare că e o situaţie nepotrivită pentru asta” sau “Terapia spirituală n-ar trebui, probabil, amestecată cu psihoterapia.” Aceşti clienţi au preferat o distincţie clară între intervenţiile psihologice şi cele religioase, acestea din urmă fiind considerate nepotrivite pentru cadre relaţionate cu sănătatea mentală. Comentarii neutre în legătură cu intervenţiile religioase Cum am menţionat mai înainte, 40 de clienţi au dat răspunsuri scrise care nu conţineau motive pentru care intervenţiile religioase au fost eficiente/ineficiente. Aceste răspunsuri au conţinut mai degrabă comentarii generice sau sfaturi cu privire la condiţiile ideale pentru utilizarea intervenţiilor religioase în psihoterapie. Au fost ulterior împărţite în 3 categorii, descrise mai jos. Permiterea clienţilor să iniţieze teme religioase/spirituale. 17 respondenţi au considerat că clienţilor ar trebui să le fie permis să aducă în discuţie teme religioase sau spirituale – dar că terapeuţii nu ar trebui să se angajeze în discuţii extensive, decât dacă clientul iniţiază topicul discuţiei. Acest lucru a fost exprimat preponderent prin raportări ale satisfacţiei clienţilor ai căror terapeuţi care au aşteptat ca clientul să aducă în discuţie probleme religioase, fără a le aborda înainte în terapie.

Terapeutul n-a adus niciodată în discuţie religia. Eu am fost cel care a iniţiat acest subiect, iar discuţiile pe tema asta de obicei se centrau pe sentimente de obligaţie şi vină... iar el m-a ajutat să privesc lucrurile în perspectivă (nu sunt un om rău dacă nu merg la biserică etc.), iar problematica religioasă abordată în terapie s-a rezumat la aceste discuţii. Înafară de acestea, religia n-ar fi fost un subiect potrivit, iar pentru mine ar fi fost chiar dăunător. Aceşti clienţi au vrut ca terapeutul să fie dispus să abordeze probleme religioase atunci când ei le amintesc şi să le discute în moduri care sunt congruente cu reprezentările lor despre lume. Nu au vrut să se simtă “forţaţi” să abordeze problematica religioasă.

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Adecvarea intervenţiilor religioase depinde de obiectivele terapiei. 17 participanţi au indicat că intervenţiile religioase ar trebui să fie relaţionate cu obiectivele tratamentului. Utilizarea lor ar trebui să se potrivească valorilor clientului şi felul cum sunt implementate ar trebui să varieze în funcţie de client: “Nu văd nimic greşit în tehnicile religioase atâta timp cât sunt pertinente pentru progresul clientului” şi “religia e doar atât de utilă pe cât o facem noi să fie. Trebuie să fie inclusă în terapie într-un mod adecvat fiecărui client şi în funcţie de valoarea pe care acesta o dă tehnicilor religioase.” Aceste răspunsuri sugerează că terapeuţii ar trebui să ajusteze utilizarea intervenţiilor religioase în funcţie de necesităţile fiecărui client în parte. Ar fi fost de dorit mai multe intervenţii religioase. Un ultim set de comentarii, făcute de 6 clienţi, au fost caracterizate de dorinţa ca terapeutul lor să utilizeze mai multe intervenţii religioase în cadrul terapiei, pe viitor. De exemplu, “cred că aş putea avea experienţe pozitive dacă terapeutul ar vorbi mai mult despre lucruri spirituale” şi “nu am avut parte de multe intervenţii religioase. Într-un fel, îmi doresc să fi avut şi aş vrea să fie mai multe pe viitor.”

Discuţie Clienţii care au luat parte la acest studiu au susţinut câteva intervenţii religioase ca fiind adecvate şi de ajutor, în cadrul terapiei la un centru de consiliere al unei universităţi cu afiliere religioasă. Unii dintre ei şi-au exprimat dorinţa ca intervenţiile religioase să fie mai mult integrate în tratamentul lor, dar ratele de prevalenţă raportate de clienţi pentru intervenţii religioase specifice în acest studiu aproximează rezultatele obţinute în cercetări anterioare, ce implicau estimările terapeuţilor (Moon et al., 1993 ; Richards & Potts, 1995 ; Worthington et al., 1988). Cu privire la nivelul de adecvare al intervenţiilor religioase în psihoterapie, intervenţiile religioase din afara sesiunii terapeutice au fost considerate mai adecvate decât cele din cadrul ei. Cu toate acestea, intervenţiile din cadrul sesiunii de terapie au tins să fie evaluate ca mai de ajutor (helpful). Se poate ca intervenţiile din afara şedinţei de terapie să fi fost văzute ca fiind mai puţin invazive sau mai puţin ameninţătoare decât cele din cadrul şedinţei, care au loc în prezenţa terapeutului. Oricum, trebuie luat în considerare faptul că intervenţiile religioase în afara şedinţei teraputice au fost utilizate mai puţin de jumătate la fel de des precum cele din cadrul acesteia, cu doar 148 de intervenţii utilizate în afara şedinţei terapeutice raportate, faţă de 299 raportate în cadrul ei. Utiizarea mai puţin frecventă a intervenţiilor religioase în afara sesiunii terapeutice de către terapeuţi ar putea avea câteva explicaţii, care ar putea fi investigate în cercetări ulterioare, în cazul în care acest pattern se menţine şi în alte condiţii, cu alte eşantioane. Acest eşantion de clienţi, membri ai Bisericii Zilei Tuturor Sfinţilor, a evaluat anumite intervenţii religioase ca fiind moderat de ajutătoare (helpful) când sunt incluse în psihoterapie. Intervenţiile care au fost evaluate ca fiind cele mai de ajutor au fost instruirea de către terapeut în principii religioase/spirituale, deschiderea (self-disclosure) terapeutului în legătură cu problematica religioasă/spirituală, încurajarea terapeutului către client de a-i ierta pe ceilalţi, evaluarea religiozităţii/spiritualităţii clientului de către terapeut şi utilizarea citatelor din Biblie. Aceste rezultate se suprapun oarecum cu acelea obţinute de Worthington şi col. (1988), incluzând încurajarea înspre iertarea semenilor şi

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sarcini de lucru orientate spre Dumnezeu sau religie. Sunt, de asemenea, similare şi cu percepţiile terapeuţilor (Richards & Potts, 1995), care au enumerat instruirea în concepte religioase, utilizarea comunităţii religioase şi citatele din Scriptură ca fiind cele mai utile ajutoare pentru clienţi. Ar trebui, de asemenea, luat în considerare faptul că în studiul de faţă, cele mai utile intervenţii au fost şi cele evaluate de clienţi ca fiind cele mai adecvate şi cele mai utilizate. Astfel, se pare că terapeuţii din studiul curent au utilizat în general intervenţii care au fost percepute utile de către clienţii lor. Cu toate acestea, în anumite cazuri, clienţii au oferit evaluări combinate (în sensul că aceeaşi intervenţie era văzută de unii ca fiind utilă, iar de alţii ca fiind inutilă), ceea ce sugerează că alte variabile decât intervenţia specifică ar putea fi responsabile de eficienţa percepută a acesteia. Literatura precedentă sugerează că elemente cum ar fi variabile ce ţin de client, variabile ce ţin de terapeut şi variabile ce ţin de proces contribuie mai mult la eficienţa unei intervenţii decât intervenţia în sine (Bergin & Garfield, 1994). Analiza de conţinut a întrebărilor deschise la care au răspuns clienţii din studiul curent a extras teme centrale ale motivelor pentru care intervenţiile religioase au fost percepute ca fiind eficace sau ineficace. Per ansamblu, aceste răspunsuri au indicat o coincidere semnificativă între competenţa generală de consiliere şi competenţa în utilizarea intervenţiilor religioase. De exemplu, clienţii s-au concentrat în general pe factori ca dobândirea unei noi perspective, dobândirea atenţiei pozitive din partea terapeutului şi adresarea necesităţilor clientului, mai degrabă decât pe intervenţiile religioase specifice, atunci când au listat motive pentru care intervenţiile religioase ar putea fi eficace. În mod similar, s-au concentrat în general pe factori ca “livrarea” ineficientă atunci când au listat explicaţii pentru experienţele ineficiente legate de intervenţiile religioase în terapie. Date fiind aceste rezultate, nu ar fi surprinzător dacă cercetări ulterioare ar confirma faptul că efectele potenţate asociate cu intervenţiile religioase (Smith et al., in press) se datorează factorilor generali ce influenţează relaţia terapeutică şi expectanţele clientului, la fel de mult ca impactului intervenţiei în sine. Ca răspuns la cele două întrebări deschise despre eficienţa şi ineficienţa intervenţiilor religioase, clienţii din acest studiu au listat de două ori mai multe situaţii în care intervenţiile au fost eficiente faţă de situaţii în care au fost ineficiente. Au raportat, de asemenea, o varietate de efecte cognitive şi emoţionale pozitive care au emers din utilizarea intervenţiilor religioase. De exemplu, câţiva clienţi au indicat că au resimţit mai mult confort şi mai multă încredere interacţionând cu cineva care le împărtăşeşte credinţele religioase şi valorile, o concluzie care a fost consecventă şi în cercetările anterioare (de ex. Bergin & Jensen, 1990). În orice caz, o descoperire care nu a mai fost în mod particular menţionată în cercetările anterioare este faptul că unii dintre clienţii din studiul de faţă au considerat că abordarea problematicii religioase în terapie a încurajat experienţe transcendente, cum ar fi perceperea influenţei lui Dumnezeu în viaţa lor. Psihologii, în general, au evitat sau au minimizat experienţele care nu sunt observabile (Bergin, 1980 ; 1991), dar decizia de a a evita experienţele transcendente s-ar putea să nu fie justificabilă, dat fiind faptul că şi alte variabile psihologice (nereligioase) se bazează, de asemenea, exclusiv pe percepţiile participanţilor la terapie. Cercetările ulterioare ar putea avea de câştigat de pe urma mai bunei înţelegeri a acestor experienţe, din perspectiva clienţilor.

Cu toate că situaţiile în care intervenţiile religioase au fost eficiente au fost descrise mai frecvent decât situaţiile în care acestea au fost ineficiente, faptul că 37 dintre

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clienţi au raportat totuşi existenţa unor intervenţii religioase ineficiente este esenţial de a fi luat în considerare. Convergent cu accentul plasat de Chapelle (2000) pe importanţa ca terapeutul să nu impună valorile sale proprii, clienţii care au luat parte la acest studiu au preferat ca terapeuţii să se lase conduşi de ei în discutarea problemelor de ordin religios. Descrierile de către clienţi a altor aspecte de ineficienţă ale intervenţiilor religioase au mers în paralel cu aspectele discutate anterior în literatura de specialitate, cu privire la contextul în care se desfăşoară terapia şi la natura relaţiei terapeutice (Richards & Bergin, 2005), ca de exemplu preocupările referitoare la faptul că terapeutul îşi asumă un rol ecleziastic sau la timpul de inserare (timing) a intervenţiilor religioase. Aceste îngrijorări sunt în concordanţă cu constatările lui Worthington şi ale colegilor (1988), care au sesizat că momentul de inserare (timing) a unei intervenţii este mult mai important pentru terapia efectivă, decât numărul de intervenţii spirituale utilizate de către un terapeut. Clienţii care au acuzat în trecut experienţe provocatoare de anxietate sau insultătoare în legătură cu aspecte ce ţin de religie, au precizat faptul că, în cazul lor, simpla introducere a intervenţiilor religioase dobândeşte conotaţii negative, cu precădere sentimente de vinovăţie vizavi de propriile lor insuficienţe/inadecvări. Anumiţi clienţi cred că psihoterapia este este un cadru nepotrivit pentru a discuta subiecte religioase, indiferent de consideraţiile contrare. Prin urmare, intervenţiile religioase nu ar trebui privite ca un lucru subînţeles, chiar şi în cadrul clinicilor asociate cu organizaţii religioase, necesitând aprobarea clientului.

Uneori, clienţii percep intervenţia religioasă din cadrul psihoterapiei ca fiind ineficientă, din cauza dificultăţilor la nivelul aplicării (comunicare deficitară). Studii anterioare au indicat faptul că o minoritate dintre clinicieni exprimau încredere şi competenţă privind integrarea subiectelor religioase în cadrul terapiei (Shafranske şi Malony, 1990; Young, Cashwell, Wiggins-Frame, şi Belaire, 2002). Programele doctorale nu abordeză adecvat subiecte religioase (Brawer, Handal, Frabicatore, Roberts, şi Wajda Johnson, 2002; Walker şi colab. 2004), iar acestă lipsă de pregătire ar putea determina: evitarea acestor subiecte de către terapeut, supracompensarea pentru lipsa de pregătire printr-o preocupare excesivă pentru acest aspect sau aplicarea ineficientă a intevenţiilor religioase în momentul în care încearcă. Ne-am alăturat altor academicieni în recomandarea de a aborda în mod serios a aspectele privind pregătirea profesională pentru abordarea religiei şi pentru aplicarea intervenţiilor religioase (Crook-Lyon şi colab, 2007; Young, Cashwell şi Wiggins-Frame, 2007).

Limite ale studiului

Rezultatele studiului prezintă o serie de calităţi. În primul rând, deşi participanţii au

fost diverşi la nivel de vârstă, gen, origine geografică, probleme prezentate, au fost relativ omogeni prin statutul de studenţi ai unor colegii creştine (Biserica ZTS). Totuşi, rezultatele obţinute nu au fost diferite de cele găsite în alte cercetări (Moon şi colab, 1993; Worthington şi colab., 1988). Datele noastre nu prezintă experienţele individuale din alte denominaţii religioase sau cu alte orientări religioase. În plus, acest studiu investighează terapia religioasă practicată într-un centru universitar promovată de Biserica ZTS, deci rezultatele nu reprezintă practici din alte contexte de terapie. Din cauza omogenităţii din cadrul universităţii, este posibil ca terapeuţii să fie mai confortabili în adresarea sinceră unor subiecte religioase în cadrul terapiei, decât

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terapeuţii din cadre caracterizate prin diversitate denominală, unde ar fi clară necesitatea aplicării unei abordări ecumenice. Cu toate acestea, Bergin şi Payne (1991) au afirmat că studiul centrat pe denominare poate fi util pentru acest domeniu, iar noi îndemnăm efectuarea unor studii comparative cu alte populaţii şi în alte cadre. Cercetările ulterioare ar trebui să continue evaluarea perspectivei clientului cu privire la utilitatea intervenţiilor religioase în cadrul psihoterapiei, în mod particular când clienţii, inclusiv cei 26% de studenţi din universităţi religioase, raportează distres moderat spre extrem cauzat de problemele religioase sau spirituale. Utilizarea auto-rapoturilor ca metodă de colectare a datelor este o altă limită potenţială a studiului. Nu am putut face dinstincţia între intervenţiile realizate cu adevărat şi intervenţiile raportate, iar rezultatele sunt expuse unui bias de mono-operaţionalizare. (Cook şi Campbell, 1979). Am eşuat în evaluarea simptomatologiei sau stării de bine a clientului, ca funcţie a intervenţiei puse la dispoziţie. Mai mult, intervenţiile religioase nu au fost stardardizate între terapeuţi, deci se poate să fi existat o variabilitate considerabilă în felul în care a fost abordat fiecare tip de intervenţie pentru diversele cazuri de terapie. În cele din urmă, din cauză că nu toţi clienţii care s-au prezentat la centrul de consiliere au dorit să completeze chestionarul, participanţii la acest studiu se poate să fi diferit de non-participanţi în moduri care ar fi putut biasa rezultatele (de ex., participanţii au putut fi mai motivaţi sau mai complianţi decât non-participanţii, fapt ce poate reflecta diferenţe implicite în ceea ce priveşte simptomele depresive sau dispoziţia de a pune în discuţie convenţiile sociale, inclusiv normele religioase etc.)

Sumar Reacţionând la un hiatus existent în literatura actuală (Chamberlain, 1996; Richards & Bergin, 2005; Richards & Potts, 1995), acest studiu a evaluat perspectivele clienţilor legate de adecvarea şi utilitatea intervenţiilor religioase în cadrul psihoterapiei. Studiul a confirmat faptul că clienţii religioşi (LSD/ membri ai Bisericii Zilei Tuturor Sfinţilor) percep, în general, intervenţiile de natură religioasă ca fiind adecvate şi utile în psihoterapie. Cu toate acestea, există câteva aspecte importante, de care terapeuţii trebuie să ţină cont. Atunci când este implementată, orice intervenţie religioasă trebuie să fie în acord cu valorile clientului, cu nivelul său de pregătire pentru o asemenea intervenţie şi cu motivele pentru care acesta urmează terapia. Clienţii doresc să fie susţinuţi, nu manipulaţi. La fel cum se întâmplă cu orice alt fel de intervenţie terapeutică, şi în cazul acesta, terapeuţii ar trebui să evalueze cu atenţie şi să fie ghidaţi de preferinţele şi perspectivele clientului. Datele prezentate aici, ce ţin de preferinţele şi perspectivele privitoare la intervenţiile religioase, ar trebui să ofere informaţii studiilor ulterioare privitoare la rezultate/consecinţe (Worthington & Sandage, 2002). Studiile de psitoterapie existente susţin că intervenţiile religioase sunt într-adevăr mai eficace în cazul clienţilor religioşi, comparativ cu terapiile laice (Smith et al., in press), însă pasul următor pentru cercetători este să progreseze în înţelegerea proceselor prin care intervenţiile de natură religioasă ameliorează simptomele clienţilor. Studiul prezent accentuează importanţa insight-ului sporit şi a percepţiilor reformate prilejuite de inserarea perspectivei religioase în terapie, şi de asemenea a beneficiilor relaţionale şi emoţionale aparente. Atribuirile făcute de clienţi experienţelor transcendente (de ex., sentimente de apropiere faţă de Dumnezeu),

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necesită, de asemenea, o explorare mai amănunţită. Studierea proceselor psihoterapeutice care examinează explicit aceste chestiuni ar putea reprezenta o direcţie viitoare pentru eforturile de cercetare. Bibliografie (...)

ARTICOL TRADUS DE Laura Belean

Ramona Monica Rad Cristina Tacaciu

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The Role of Religion in Therapy: Time for Psychologists to Have a LittleFaith?

Kevin S. Masters

PII: S1077-7229(10)00052-0DOI: doi:10.1016/j.cbpra.2009.11.003Reference: CBPRA 272

To appear in: Cognitive and Behavioral Practice

Received date: 16 November 2009Accepted date: 23 November 2009

Please cite this article as: , The Role of Religion in Therapy: Time forPsychologists to Have a Little Faith?, Cognitive and Behavioral Practice (2010),doi:10.1016/j.cbpra.2009.11.003

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COMMENTARY

The Role of Religion in Therapy: Time for Psychologists to Have a Little Faith?

Kevin S. Masters, Syracuse University

Abstract

The argument has been made that religious and spiritual (R/S) forms of treatment, or R/S

adaptations of existing treatments, are an appropriate, culturally sensitive, and potentially

efficacious method of intervention when working clinically with religious patients experiencing

psychological, behavioral, or physiological dysfunction. The previous articles in this special

series describe four such interventions designed for use with patients with particular presenting

problems including serious mental illness, cancer, eating disorders, and scrupulosity. This article

offers a brief historical presentation on the growth of interest in R/S in clinical psychology and

behavioral medicine, with particular attention to the general issue of the role of values in therapy,

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and includes criticisms of integrating R/S in treatment. The difficulty of appreciating unique R/S

perspectives and their relevance for particular clients is emphasized and the question of whether

a “true” understanding of R/S beliefs necessarily leads to better health is examined. Each of the

four therapies presented in this special series is individually analyzed, and it is clear that they

offer sensitive and culturally relevant approaches to treating the various disorders, though areas

of potential improvement or possible confusion are highlighted. Finally, the following are

deemed essential if R/S-informed therapies are to impact the field and be appropriately

introduced with clients: (a) training of future and current practitioners; (b) longitudinal research

on R/S; (c) outcome studies of R/S interventions; and 4) adequate funding for the achievement of

these goals.

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Well-known sportswriter Mitch Albom has the current (November, 2009) New York Times

number-one nonfiction bestseller with his book Have a Little Faith (Albom, 2009). The work

chronicles the faith experiences of two men: Albom’s rabbi from his youth and an African-

American inner-city preacher working with the homeless in Detroit. In the rabbi, we read of a

man whose faith was a continuous lifelong journey that touched the lives not only of the

members of his synagogue but many others in profound ways. This is symbolized at one point by

the story of his delivery of a eulogy at the funeral of the Catholic priest whose church was next-

door to the synagogue. For the preacher, the faith journey was quite different. Heavily involved

in illicit drug abuse, one night he feared being shot by the dealers he had robbed and so he

prayed to Jesus, promising that if his life would be spared then he would serve God with his

remaining days. Though many have no doubt offered similar prayers in such times of duress and

failed to follow through, this man kept the promise. His life literally changed overnight: the next

day he began a self-imposed drug detoxification that started him down the path to a life of

ordination and religious service among the down-and-out of society. The book speaks of

transformation, of the power of faith to change and enrich lives in both dramatic and small,

everyday ways. It poignantly notes that for the person of religious faith, all of life is conceived

and viewed through the lens of belief. In short, these individuals cannot live without it.

This has, of course, been true throughout the ages. The major world religions have

survived numerous proclamations of their imminent demise precisely because they possess

extraordinary power to change lives, to offer rebirth and renewal, new beginnings. So I find it

strange that psychology, particularly the applied area of psychology—the area that is largely

concerned with change processes—has for so long viewed religious faith as, at best, irrelevant

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and perhaps pathogenic. Social psychologist Robert Hogan stated, “Religion is the most

important social force in the history of man [sic] … But in psychology, anyone who gets

involved in or tries to talk in an analytic, careful way about religion is immediately branded a

meathead; a mystic; an intuitive, touchy-feely sort of moron” (quoted in Bergin, 1980, p. 99).

Fortunately this view, though perhaps still held privately, is no longer dominant in psychology.

As demonstrated by this series, and many other special issues of prominent peer-reviewed

scientific journals over the last decade, religion and spirituality (R/S) have become legitimate

areas of inquiry in psychology and other behavioral sciences as well as in epidemiology and, to a

lesser extent, medicine. The Society of Behavioral Medicine has a Spirituality and Health

Special Interest Group (SIG) whose membership total ranks 10th out of 18 SIGs. Masters (2007)

surveyed the literature and found an increase in numbers of health-related publications

addressing R/S. This trend began in about 1980 and substantially increased in around 1990, with

recent movement showing a greater rate of increase for articles pertaining to spirituality than

religion.

There are many factors that likely played a role in this increased interest in R/S. As

articles in the present series noted, religious beliefs and practices are highly prevalent in the U.S.

population. Though accurate religious service attendance figures are difficult to gather and some

reports may be overestimates (Hadaway & Marler, 2005), it is clear that for at least a significant

percentage of the population, religion is important to daily life. This widespread acceptance of

religion in the American culture has potentially important research funding implications. To

obtain support from the National Institutes of Health, it has become essential to demonstrate the

public health significance of the study. Thus, introductory sections to published articles and grant

funding proposals consistently portray the disease or health relevant behavior under study as of

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utmost importance to the health of the country, often on the basis of how pervasive it is. In this

environment, demonstrating that religious faith is widespread is a noteworthy beginning. But

there is no reason to believe that the percentage of Americans for whom religion is important has

in any significant way increased in recent times. What is new, however, is the appearance of

several large epidemiological studies and meta-analyses, some of which included appropriate

statistical controls, demonstrating beneficial relationships between religion (typically defined as

religious service attendance) and various indices of morbidity and mortality (e.g., Clark,

Friedman, & Martin, 1999; Gillum & Ingram, 2006; Goldbourt, Yaari, & Medalie, 1993;

Hummer, Rogers, Nam, & Ellison, 1999; McCullough, Hoyt, Larson, Koenig, & Thoresen,

2000; Oman, Kurata, Strawbridge, & Cohen, 2002). A behavior or phenomenon that a large

segment of the population participates in, deems important, and also affects health should draw

the attention of researchers, practitioners, and perhaps even funding sources.

Another factor in the growth of R/S perspectives in therapy is the general

acknowledgment and acceptance of the importance of culture as an influential force in

understanding both behavioral pathology and its treatment. An important pioneer in this regard is

Jerome Frank, who in his classic 1961 work Persuasion and Healing (subsequent editions

published in 1973 and 1991) noted that the therapeutic encounter takes place within a certain

cultural context that influences definitions of illness, acceptable treatments, and what it means to

be healthy. Frank was clearly ahead of his time, but the movement toward respect and

understanding of ethnic and cultural factors as they impact therapy process and outcome has

been perhaps the major accomplishment in clinical psychology in the last two decades.

Currently, definitions of evidence-based practice by both the American Psychological

Association (APA Presidential Task Force on Evidence-Based Practice, 2006) and the Council

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for Training in Evidence-Based Behavioral Practice (2009) include specific reference to patient

values and culture. Further, the Guidelines and Principles for Accreditation of Programs in

Professional Psychology (APA Commission on Accreditation, 2009) and the APA Ethical

Principles of Psychologists and Code of Conduct (American Psychological Association, 2002)

explicitly recognize the importance of respect and competence when it comes to religious issues

in therapy and other applied contexts.

The factors noted above have important implications for psychological and behavioral

practice, but a watershed event of relevance to this discussion occurred in 1980 when Allen

Bergin pointedly challenged the psychotherapy community to embrace religious values. He

offered six theses and several empirically testable hypotheses based on his belief that religious

values were an important and potentially helpful aspect of therapy. Not everyone agreed then and

not everyone agrees now, but the work of Bergin and many others, particularly Larry Beutler,

demonstrated the centrality and importance of values in therapy and behavior change. Beutler’s

work through the 1970s to 1990s established that patients tended to adopt the values of their

specific therapists. Previously, other investigators (Murray, 1956; Truax, 1966) demonstrated

that even Carl Rogers was not able to keep values out of therapy—that he systematically

rewarded and punished expressions on the basis of what he liked and disliked. Clearly any

encounter wherein two people come together and one has as his/her function in the relationship

to help-influence-facilitate-teach some kind of change in the other cannot be an encounter that is

value free. In fact, such an encounter will necessarily be quite the opposite, call it value

saturated. Choice of outcome goals, techniques, appropriate sequencing of events, and so forth

are all heavily influenced by values. It is in this regard that a common and significant thread runs

through the presentations found in this special series. What is different about these therapies, as

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opposed to many of their more standard counterparts, is the explicit acknowledgment of the

importance of values, particularly religious values, and the need to not only respect but actively

incorporate them in the service of therapeutic change. Weisman de Mamani and colleagues

(2010; this issue) note that “…R/S values may bolster the effects of psychotherapy because they

incorporate themes of gratitude, forgiveness, and empathy, which are essential in the therapeutic

process” (p. xx). Karekla and Constantinou (2010; this issue) adapt Acceptance and Commitment

Therapy (ACT) for use with cancer patients, in part because of the central nature of values in this

approach and the importance it places on living in congruence with one’s values. Similarly,

Spangler (2010; this issue) notes that client values are “deliberately explored” (p. xx), again with

the likely possibility of uncovering discrepancies between what patients purposely and

consciously value and what they are doing when engaged in eating disordered behavior. Finally,

Huppert and Siev (2010; this issue) offer a very thoughtful and culturally sensitive approach to

treating scrupulosity among religious individuals and note that the therapeutic process includes

helping the patient notice how symptoms of obsessive-compulsive disorder (OCD) interfere with

other highly valued areas of life, including religious observance and family. These four

therapeutic approaches take seriously the imperative to be not only culturally sensitive but to go

beyond this and be culturally informed, the culture in this case being distinguished by its

religious perspective and traditions.

But do they go too far? Weisman de Mamani and colleagues (2010; this issue) note, “…

we talk to clients about the research pointing to positive links between religion and psychological

adjustment, and we engage them in a conversation about the potentially beneficial role of

religion and spirituality in their own lives as a means of coping with adversity” (p. xx). This is

exactly what Richard Sloan (Sloan & Bagiella, 2002; Sloan, Bagiella, & Powell, 1999, 2001) has

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warned behavioral medicine practitioners to avoid. Sloan posits many reasons why religion

should stay out of therapy, but principle among them are fears of coercion, violations of privacy,

the possibility of doing harm, and discrimination against individuals for whom religion is not

important. (Note that Sloan’s written comments seem more directed toward medical practice, but

clearly his point is that “health professionals” need to steer clear of religion when engaged in

practice. He presented his work to the Society of Behavioral Medicine, an organization

comprised of many psychologists. Further, therapists treating serious mental illness, eating

disorders, cancer, and OCD would presumably be considered health professionals and thus the

therapies in this issue fall under Sloan’s indictment.) Sloan analogizes that even though it is

known that marriage is good for mental and physical health, practitioners would not instruct an

unmarried patient to marry because this would be a violation of privacy that would overstep the

legitimate bounds of a practitioner’s scope of practice. Similarly, he reasons, religious practices

and beliefs are private matters that are not the purview of the health care professional.

In my opinion, Sloan’s conceptualization of the legitimate boundaries of intervention is

too narrow and consequently excludes much of what is essential to human health and well-being.

Though researchers and therapists operate in a world of highly differentiated and specific

theoretical constructs, patients come as whole organisms. They “connect the dots” of their lives;

they integrate experience and find understanding and meaning in it. In fact, a major drive of

humans is the quest for wholeness, to feel an integration and consistency among their beliefs,

feelings, actions, experiences, and so forth. For religious patients, their religious beliefs often

form the point of integration, the fulcrum in the void, that brings together life experiences. To

them, mental and physical function cannot be divorced from R/S aspects of life, and therapists

that attempt to do so with these patients will find themselves distant from those they are treating.

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But Sloan’s objections deserve hearing, for in the area of religion, as in any culturally

sensitive domain, the possibilities for misunderstanding, inefficiency, and even harm are

numerous. In one instance Sloan (Sloan et al., 2001) argues that discussions of religious

activities (e.g., suggestions to attend church) take up scarce intervention time that could be better

spent in many other ways that have stronger empirical support for their effectiveness. Indeed, it

seems that one of the risks of developing forms of therapy that specifically integrate religious

perspectives might be the tendency to overemphasize the importance of religious influences.

Therapists in the past were often accused of conforming patients’ problems to the therapists’

preferred form of treatment. The relevance of particular R/S interventions must vary according to

the idiographic characteristics of the patient, the problem, the particular point in time, etc.

Consequently, therapists trained in the application of religiously informed therapies need to

monitor their own exuberance to make sure that their therapeutic approach creates the best

chance for a successful outcome for the client.

A related issue pertains to developing an understanding for how the particular client

integrates religious concerns. Not only do different identified religious groups differ in their

beliefs, but individuals within religious groups also show substantial heterogeneity in terms of

not only the content of their beliefs but also in the relative importance those beliefs have for their

psychological functioning. Thus, for example, knowing that someone is Catholic, Mormon,

Presbyterian, or Jewish is informative but until the therapist understands what this means for the

particular individual as applied to the current therapeutic problem, the possibility for

misunderstanding remains great. Fortunately, the therapies presented in this special section are

very alert to this issue and clearly specify that therapists must understand the unique workings of

religion for their particular clients before effective integration of religious constructs can begin.

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The writers are also sensitive to the need to sometimes include clergy in order to better

understand particular beliefs from the “official” perspective of the religious group. This can be

important for correction when patients have a misunderstanding of their religious organization’s

views and thus are likely applying them in ways that reinforce pathology rather than health.

However, as these therapies become more widely disseminated it will be essential that those

training others in their application remain vigilant to emphasize the need for understanding the

religion of the individual.

An assumption potentially underlying the integration of R/S values into therapy that

deserves at least brief discussion is the idea that these religious values are, ipso facto, healthy.

Thus if individuals truly understood and applied the religious precepts in the manner intended by

the authors of the faith they would experience mental health and, to the extent that mental health

influences physiological functioning, physical health as well. I cannot say if this assumption is

accurate. In an empirical sense this seems to be a question that can be addressed, but not

answered. The obstacles are numerous. For example, whose interpretation of the faith is the

correct/intended interpretation and therefore the one to empirically study? What, in fact, are the

essential characteristics of mental health? Nevertheless, it is possible to make empirically

informed statements on the basis of testable hypotheses regarding the relations between specific

religious values and particular mental health variables. In fact, Bergin (1980) declared several

such hypotheses, and data addressing them are now available. Further, there are centuries of

evidence suggesting that the principles of the world’s religions have stood the test of time, that

they offer to believers something important and beneficial for their lives. But surely any

consideration of religious values and mental health also needs to take into account the particular

culture surrounding a person who holds specific beliefs. The Bible, for example, in many places

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suggests that faithfulness to Christian morals and principles is antithetical to the social standards

accepted by the surrounding culture (in biblical terms, the world). In such instances the believer

could expect persecution, ostracism, or at least a feeling of not fitting in. Could this cause mental

health concerns for these individuals? (I use Christianity as the example but the principle applies

to any faith). Finally, consider the purpose of religion. I make no pretense to being a theologian

or church historian, but it seems that the emphasis in religious teaching has historically been the

development of faith and the ability to follow the precepts of that particular religion because

these teaching are true, not because they are necessarily comfortable or emotionally satisfying in

one’s particular life circumstance. This is a noteworthy distinction. One might hypothesize that

certain religious teaching could, in some circumstances, be quite comforting. For example, when

one is ill and believes that a loving God is personally comforting and controlling the events, a

sense of peace or relaxation may follow. Alternatively, the belief that one should attempt to win

converts to the faith may present religious individuals with a significant inner struggle in terms

of being faithful to this teaching and acting on it in daily life in addition to desiring to not be

offensive to others or lose social relationships as a result of attempts to win converts. If

relationships are lost because of such actions, a new set of stressors is faced. In short, I believe it

is a mistake for psychologists to assume that religious teaching, if followed, will necessarily

bring about beneficial psychological results. After all, Jesus himself, the model for Christians

around the world, is described as a man who clearly experienced psychological distress during

his life.

Comments on Particular Articles

Keeping these general thoughts in mind, I will now offer brief comments on each of the

individual articles in the series.

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Incorporating Religions/Spirituality Into Treatment for Serious Mental Illness (Weisman de

Mamani and colleagues, 2010; this issue)

Weisman de Mamani et al. challenge traditional thinking by proposing a form of treatment for

those suffering from serious mental illness that purposely includes religious perspectives. They

offer an excellent and informative review of the literature on previous attempts to incorporate

religious principles into treatment and cite positive (e.g., discussions of spiritual resources,

strivings, forgiveness, intrinsic religiosity, positive religious coping) and negative (e.g.,

obsessive prayer or Bible reading) uses of religion. Importantly, they directly discuss the issue of

religiously themed delusions, clearly an area worthy of more research. In this regard one

question that seems deserving of investigation is the possible influence of a religiously oriented

or informed therapist on clients’ willingness to report religious delusions. Given the episodic

course of many serious mental illnesses, such as schizophrenia, patients have periods of greater

and lesser understanding of their external world and interpersonal relationships. During the times

when patients are in relatively better contact with their therapist and therefore have greater

sensitivity to interpersonal nuance and better communication, is it possible that patients could

feel inhibited about disclosing experiences of religious delusions when talking with a religiously

oriented therapist? This is an interesting question for study.

Weisman de Mamani’s team (2010; this issue) notes that they have two forms of their

Exploring Your Spirituality handout. One uses overtly religious or spiritual language whereas the

other, intended for families that are not religious, focuses on existential beliefs about meaning

and purpose. A possible research question pertains to whether religious families would actually

have better outcomes with the overtly R/S treatment. In this regard I am reminded of the

somewhat surprising results from the well-known study by Propst and colleagues (Propst,

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Ostrom, Watkins, Dean, & Mashburn, 1992), found that found nonreligious therapists who used

a religious form of cognitive-behavioral therapy (CBT) with religious clients had better

outcomes than religious therapists using the same treatment. This was not predicted and so far as

I know has never been adequately explained, but it demonstrates that when it comes to religion

in therapy one must be open to surprises.

Finally, case study one in this article raises a host of significant concerns that will be

encountered by those attempting to use spiritually oriented therapy. The client presents with an

unorthodox combination of beliefs drawn from many different traditions and streams of thought.

For some therapists, even those working within a spiritual perspective, it may be difficult to

meaningfully operate within a client’s worldview if that view presents unusual beliefs or beliefs

that the therapist personally finds untenable. It is noteworthy that one of the therapeutic tactics in

this case was steering the conversation away from “philosophical conjecture” and back toward

topics that seemed more directly related to coping. A basic pragmatism is, in my opinion, good

for therapists of all stripes. But one can easily see how it might be difficult to work toward

pragmatic ends without in some way conveying to clients that their particular beliefs are not

being taken seriously. A therapist’s philosophical conjecture may be a client’s central belief! To

avoid the trap of getting caught up in theological or philosophical discussion that may in fact be

irrelevant to the treatment, the therapist needs sensitivity and careful judgment. I appreciate the

authors sharing this case as it highlights many challenges to be understood and met when

applying an R/S-informed therapy.

Religious Coping and Cancer: Proposing an Acceptance and Commitment Therapy Approach

(Karekla & Constantinou, 2010; this issue)

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Karekla and Constantinou introduce the idea of adapting ACT to a spiritual perspective for use

with cancer patients. They provide a concise overview of religious coping, discuss subtypes of

coping styles, and note factors that influence whether and what type of religious coping is used.

They specifically identify mechanisms that may mediate effects of R/S for cancer patients and

provide a detailed review of religious coping measures. In their discussion of the Functional

Assessment of Chronic Illness Therapy-Spiritual Well-Being questionnaire, they briefly address

a key issue that should perhaps be highlighted because of its more general implications. Some,

maybe many, measures of R/S are worded such that in order to score high on them (i.e., to be

characterized as more spiritual or religious) one must answer in what would generally be

considered a mentally healthy way. In studies attempting to demonstrate that R/S predicts mental

health, use of these measures presents a case of confounding the predictor with the outcome. It is

important that when investigators are interested in ascertaining relations between R/S variables

and mental health outcomes that they carefully consider the issue of conceptual overlap between

measures. It is not enlightening for the study of R/S to demonstrate that one measure of mental

health predicts the score on another measure of mental health. Careful construct definition and

measurement is essential to avoid this pitfall.

Another major issue that these authors highlight is the paucity of studies that assess

religious coping over time (i.e., longitudinal investigations). They note that individuals may

experience change in the quantity (more or less) of their faith or they may even change faiths. In

fact, the recent Pew report on religion in America (Pew Research Center, 2008) noted a complex

pattern of change characterizing Americans that are members of a faith tradition different from

the one they were raised in. Though there are cross-sectional studies of individuals at all ages,

there are very few studies of individuals across time. This limits progress in many ways. Not

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only does it make it difficult to discuss R/S development across the lifespan but it also makes it

exceedingly hard to determine the temporal sequence of events. Prayer is one example. There is

logical and empirical support for the following hypotheses: (a) there is a positive relationship

between prayer and illness, and (b) there is a positive relationship between prayer and health.

When people become ill they are likely to increase their prayer life; thus, more prayer is

associated with worse health. But people who pray regularly may also find peace with God,

experience relaxation, and thus more prayer could be associated with better health or disease

prevention. These can only be teased apart if the progression over time of both prayer and health

status is known. This requires longitudinal investigation.

Incorporation of ACT into a treatment that utilizes R/S perspectives is both appropriate

and timely. Spangler (2010; this issue) also uses aspects of ACT in her approach to treating

eating disorders. It is noteworthy that many of the so-called third-wave CBTs allow—even

encourage—spiritual application. ACT is establishing an impressive empirical record and seems

philosophically amenable to most R/S perspectives. It is not coincidence that two of the therapies

in this series utilize it in their interventions.

Heavenly Bodies: Religious Issues in Cognitive Behavioral Treatment of Eating Disorders

(Spangler, 2010; this issue)

Spangler, a recognized expert in CBT, provides a well-thought-out plan for integrating religious

concepts into traditional CBT for eating disorders, though ACT and other approaches are also

included. She begins by citing data demonstrating that prevalence rates for eating disorders vary

across denominations and hypothesizes that different aspects of particular religious doctrines

may influence these varying rates. She freely acknowledges from the outset that cultural and

environmental factors with no connection to religion are also potent causal mechanisms.

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Throughout the article Spangler cites many different religious concepts or practices that are

relevant to eating and potentially to the development and sustenance of eating disorders. In

general, I agree with this premise, but I register two concerns. First, she seems somewhat

ambivalent as to whether religions promote pathogenic cognitions relative to eating disorders or

whether these are distortions by clients of healthier messages inherent in the religious teaching.

She states, “Several theologians from major world religious traditions similarly conceptualize the

nature of the body as carnal, degraded, in need of discipline, and something to eventually be

discarded… Some Christian religions regard the body as a vexation for the spirit … Moreover,

several major world religions that are based upon the Bible support anti-body conceptualizations

by interpreting sin as entering the world through the ‘disobedient bodily appetite of a woman’”

(p. x). Is this true? Again, the reader is cautioned that I am not a theologian. Nevertheless, I did

minor in biblical studies as an undergraduate, have degrees from universities affiliated with

Baptist, Catholic, and Mormon traditions, and over the last 35 years have been at least a

semiregular attendee of Presbyterian, Baptist, Lutheran, Independent-Liberal, Independent-

Conservative, and Mormon churches. I have never heard a healthy religious individual, be they

clergy, professor, or parishioner, espouse these views. There may be historical precedent for such

thoughts in centuries gone by, but I highly doubt that they have credibility or widespread

dissemination today, and I am therefore skeptical about their involvement in the etiology of

eating disorders, among religious individuals. Later in the manuscript Spangler repeats many of

these views, however, she also discusses at length how those with eating disorders distort Bible

passages to match their neurotic needs and that the cure for this is a proper understanding of

scripture. She also suggests that clients, as they make changes in therapy, should check with

clergy to determine if their beliefs about their body align with the teachings of their religious

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tradition. She states, “Typically, clients are pleasantly surprised to find that leaders in their

religious tradition endorse their new experiences and ideas of the body and its sensory capacities

as good and God-given” (p. xx). Spangler (2010; this issue) concludes by noting, “Moreover,

clients can marshal religious beliefs or practices to support maladaptive beliefs and behaviors

wholly unintended by the religion” (p. xx, emphasis added). On the one hand, she seems to state

that religious beliefs, endorsed by theologians, potentially reinforce disordered thinking that

could contribute to eating disorders, but on the other hand she notes that clients think in

maladaptive ways never intended by the religion. Based both on my understanding of these

matters, as well as the arguments presented by Spangler, the second option seems more likely.

My second concern, related to the first, is that I believe Spangler (2010; this issue)

overstates the potential role of religious belief and teaching in the development of eating

disorders. Clearly this point flows from the one above, and if I am wrong there I might well be

wrong here as well. But it seems to me that cultural ideals regarding beauty and attractiveness, as

communicated in a media-saturated world, possibly along with family dynamics and genetic

patterning, account for the major portion of variance in the etiology of eating disorders. R/S

beliefs, in my view, come in to play as attempts to somehow make the disordered thoughts

congruent with one’s religion, a valued aspect of life. This is, of course, an empirical question

suggesting, again, the need for longitudinal research.

None of my misgivings, however, regarding the role of religious factors in the etiology of

eating disorders should be interpreted as arguments against incorporation of religious precepts in

their treatment. Spangler (2010; this issue) cites evidence of the importance of R/S variables in

recovery, even for clients treated in non-spiritually-oriented therapy. Further, for exactly the

reasons cited by Spangler, I view the incorporation of healthy religious perspectives into

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treatment as a valuable strategy in helping clients appreciate that religion, properly understood,

teaches them the value of not only their life but also the gift that is their body. A particularly

poignant aspect of this treatment occurs when clients’ disappointed over how much of their time

is consumed by their eating disorder opens the door for expanded discussion of religious values

and better, more valued, uses of time. This section of the article is particularly worthy of note

and, in my opinion, contains the potential for powerful intervention.

Treating Scrupulosity in Religious Individuals Using Cognitive-Behavioral Therapy (Huppert

& Siev, 2010; this issue)

Huppert and Siev offer a fascinating discussion of and treatment for scrupulosity in religious

individuals, mostly focused on ultra-Orthodox Jewish patients. In the first paragraph they state,

“These and other characteristics of scrupulosity render it a paradigmatic example of the

complicated interplay between psychopathology and clinical technique on the one hand, and

cultural sensitivity and patient values on the other” (p. xx). Indeed, when I began reading their

manuscript this thought was central. Though their focus was with ultra-Orthodox Jewish

individuals, the issue has broad applicability across religious groups. From the perspective of

many mental health professionals, herein lies one of the common criticisms of religion—that it

promotes an irrational fear of sinning or not being perfect that causes anxiety and associated

emotional disturbance and dysfunction. Huppert and Siev put the question squarely: “So how

does one distinguish OCD from strict, devout observance?” (p. x). I found the treatment of this

theme, which permeated the article, to be not only thoroughly thoughtful and appropriate for

scrupulosity but applicable to virtually any potential mental disorder that exists within a religious

context. I will not repeat their observations here but strongly urge the reader to review them. The

related discussion pertaining to the risk of sin was brilliant, as was their recognition of the

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potential problems of such an approach and the need to consult with clergy to determine how this

concept integrates with religious teaching. The related discussion pertaining to thought exposure

as well as the differentiation between intentional and unintentional thoughts was similarly

important, yet probably difficult to implement with many religious clients. I am reminded of the

scripture where Jesus instructs that to lust after a woman is to commit sin, even in the absence of

any accompanying behavior. Many observant and devout religious individuals must struggle

with the meaning of this passage (or similar ones from their faith) and how it might or might not

be possible to, without violating sacred command, engage in the type of tasks demanded by an

exposure-response prevention form of therapy.

As Spangler (2010; this issue) noted with eating disordered patients, Huppert and Siev

(2010; this issue) point out that patients get so caught up in their symptomatic behavior that they,

inadvertently, end up failing at the very religious devotion they desire. The insight that, “…

distancing from sin has become a goal in its own right, ironically more than serving God, and

therefore tolerating acceptable risk of sin facilitates the service of God” (pp. xx) was particularly

compelling.

The discussion on including or consulting with clergy has broad applicability. Certainly

there is risk involved whenever a third party is included as an adjunct for therapy—and with

clergy unique perils in terms of potential misunderstanding, professional turf issues, and

philosophical conflicts are possible. The importance of resisting the temptation to “cherry pick”

more liberal, agreeable, or known clergy is consistent with the general theme of this manuscript,

i.e., that respect for clients and their faith is preeminent in treatment. These authors have a strong

and abiding conviction that it is possible to adapt the treatment approach to work within the

client’s religious-cultural orientation. I agree completely. But to do so requires something else

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these authors recommend—that is, knowledge of the rules, culture, and beliefs of the applicable

religious community.

Concluding Thoughts

Together the articles in this series represent an important step forward in the integration

of R/S frameworks and considerations into therapy. They present particular treatment approaches

for specific disorders, but, more importantly, they provide general frameworks to integrate R/S

into treatment more broadly. This is perhaps their greatest contribution.

But will those in charge of the curricula of professional training programs take notice and

implement instruction of such treatments? Rosmarin, Pargament, and Robb (2010; this issue), in

their introduction to this special series, noted that only 13% of doctoral training programs in

North America offered a course on R/S. What is potentially even more disconcerting is the extent

that R/S issues are (not) discussed in the context of training in cultural diversity. I do not have

hard data on this, but my over 9 years of experience as the director of a training clinic (in a

heavily religious area of the country) and 5-plus years as a Director of Clinical Training at a

different university in a different part of the country is that graduate students are, frankly, fearful

of approaching R/S issues in therapy and faculty generally lack any real understanding of them.

Consequently, R/S concerns are typically acknowledged as “important” but rarely discussed

much further. There are, however, encouraging developments. For example, I understand that a

special issue of Professional Psychology: Research and Practice is in preparation that will focus

on practice issues relevant to R/S. Further, the increase in empirical studies of R/S bodes well for

greater integration of R/S into treatment. Ultimately, however, psychologists will need to

overcome their own fears and biases if they are going to adequately learn about these patients

and the therapies that are adapted to their worldview.

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Finally, controlled outcome research demonstrating the efficacy and effectiveness of R/S-

informed treatments is essential. In the absence of such data, training directors and faculty can

hardly be criticized for offering a lukewarm reception to their implementation. This type of work

is necessary, difficult, and expensive. I earnestly hope that funding sources, including federal

agencies such as the National Institutes of Health, will recognize its importance and realize the

potential value to millions of Americans and others throughout the world. It is the culturally

responsible thing to do.

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References

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APA Presidential Task Force on Evidence-Based Practice. (2006). Evidence-based practice in

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Bergin, A.E., (1980). Psychotherapy and religious values. Journal of Consulting and Clinical

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Clark, K.M., Friedman, H.S., & Martin, L.R. (1999). A longitudinal study of religiosity and

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Cardiology, 82, 100-121.

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Hadaway, C.K., & Marler, P.L. (2005). How many Americans attend worship each week? An

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Propst, L.R., Ostrom, R., Watkins, P., Dean, T., & Mashburn, D. (1992). Cmparative efficacy of

religious and nonreligious cognitive-behavioral therapy for the treatment of clinical depression in

religious individuals. Journal of Consulting and Clinical Psychology, 60, 94-103.

Rosmarin, D.H., Pargament, K.I., & Robb III, H.B. (2010). Introduction to special series:

Spiritual and religious issues in behavior change. Cognitive and Behavioral Practice, 17, xx-xx.

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Sloan, R.P., & Bagiella, E. (2002). Claims about religious involvement and health outcomes.

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ethical challenges, and misrepresentations in the study of religion, spirituality, and

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perspectives (pp. 339-354). New York: Guilford Press.

Spangler, D. (2010). Heavenly bodies: Religious issues in cognitive behavioral treatment of

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Author Note

Address correspondence to Kevin S. Masters, Ph.D., Department of Psychology, 430 Huntington Hall, Syracuse

University, Syracuse, NY 13244; e-mail: kemaster@syr.edu

Rolul religiei si spiritualitatii asupra sanatatii fizice si mentale

Kevin S. Seybold si Peter C. Hill (2001)

Current Directions in Psychological Science 2001

Abstract

In literatura medicala si psihologica se observa un interes aparent crescut in efectul

religie si spiritulaismului asupra sanatatii. Desi in trecut se considera ca religia avea un

rol negativ asupra sanatatii, cercetarile recente arata ca relatia acestora este mult mai

complexa. Acest articol sumarizeaza rezultatele din literatura de specialitate referitoare la

impactul religie si spiritualitatii asupra sanatatii fizice si mentale, concluzionand ca acesta

relatie este una benefica. Sunt propuse mecanismele explicative ale efectelor pozitive ale

religie si spritualitatii.

Introducere

Nu este surprinzator ca religia si spiritualitate raman importante pentru marea

majoritate a indivizilor dintr-o societate ca S.U.A care poate fi caracterizata ca fiind

fragmentata, deconecata si imbatranita (Thoresen, 1999). In raspuns, literatura dintr-o

varietate de discipline precum psihologia, medicina, sociologia, gerontologia si educatia

contin un numar crescand de studii care examineaza rolul religiei si spritualitatii asupra

sanatatii fizice si mentale.

Considerand acest rol, cercetatorii ar trebui sa aiba grija sa conceptualizeze adecvat

natura complexa a conceptelor de religie si spiritualitate. Aceste constructe nu pot fi strict

definite in termenii unui set specific de credinte si comportamente. Natura

multidimensionala atat a religiei, cat si a spiritualitatii a fost recent clasificata de catre un

grup de experti organizati de Institutul National al Imbatranirii. Acest grup a identificat

10 dimensiuni ale religie si spiritualitatii: istoria religioasa/spirituala, preferinta/afilierea,

participarea sociala, practica privata, stilurile de coping, credintele si valorile,

angajamentul, experientele, nevoia de suport si motivatia pentru angajamentul in relatii

sociale (Institutul National al Imbatranirii, 1999).

Multe caracteristici comune religiei pot fi de altfel gasite in spritualitate, dar si vice

versa (Hill et al. 2000). De exemplu, spiritualitatea ca si religia poate sa implice o

transformare personala, o intalnire cu transcendenta sau o cautare a adevarului suprem,

sacru pentru individ. De asemenea, religiozitatea poate sa includa patern-uri de

comportament stipulat si incurajare a aderentei la anumite practici religioase sau forme de

exprimare, caracteristici carora anumite tipuri de spiritualism contemporan ar rezista.

Desi inca mai este o mare suprapunere intre aceste fenomene.

Masuratorile religiei si spiritualitatii trebuie de asemena sa ia in considerare natura

multidimensionala a acestora. Un studiu recent de 125 de masuratori a religiei si

spiritualitatii(Hill & Hood, 1999), cu o copie a fiecarei masurare acompaniata de un scurt

rezumat, sugereaza nu numai o surprinzatoare distanta in masurarea religie si

spiritualitatii, cat si apropiera multidimensionala pe care cercetatorii au abordat-o. De

exemplu, aditional celor 15 masuratori multidimensionale, studiul include scale a unor

dimensiuni mai specifice ale religiei si spiritualitatii, precum credintei si practici,

atitudini, orientare religioasa, dezvoltare religioasa, devotare si implicare, coping religios,

misticism si pareri despre moarte si viata de dupa. Poate ca cea mai patrunzatoare si

cuprinzatoare masuratoare standardizata este instrumentul construit de Institutul National

al Imbatranirii (1999). Intrumentul in forma sa scurta de 38 de itemi a fost conceput

pentru a masura cele 10 dimensiuni ale religiozitatii si spiritualitatii identificate de catre

comisie si ulterior a fost inclus in Chestionarul Social General, un chestionar national

creat de Programul National de Date pentru Stiintele Sociale. Analizele initiale au

evidentiat ca acest instrument confirma fundamentarea teoretica si are fidelitatea si

validitatea necesara pentru aplicarea in cercetare.

Aditional conceptualizarii atente si masurarii acurate a religiozitatii si spiritualitatii,

o masurare adecvata a variabilei de sanatate este necesara in studiile care evalueaza

efectele religiei si spiritualitatii asupra sanatatii. Ambii indici specifici ai sanatatii

(presiunea arteriala in cazul sanatatii fizice; iar delicventa si abuzul de droguri si alcool in

cazul sanatatii mentale) si mai general, masurarile subiective sunt folosite. Cateva

descoperiri ambigue si contradictorii au rezultat, in parte, datorita incosistentelor in

definirea masuratorilor adecvate religiei si spiritualitatii, cat si masurarii sanatatii. In

studiile recente, cercetatorii au incercat sa foloseasca masuratori multidimensionale ale

religiei si spiritualitatii si indici comportamentali specifici ai sanatatii mentale si fizice

(Larson, Swayers, & McCullough, 1998).

EFECTE BENEFICE SI DAUNATOARE ALE RELIGIEI

Studiile asupra influentei religiei asupra sanatatii fizice sugereaza faptul ca religia,

in mod uzual, dar nu intotdeauna, are un efect pozitiv. O posibila Influenta pozitiva a fost

descoperita in cercetariile care includeau subiecti de toate varstele, ambele genuri si o

varietate de religii (protestanta, catolica, iudaica, budista si musulmana). Subiectii

selecati din mai multe regiuni (America de Nord, Asia, Africa) si din mai multe grupuri

etnice, masurandu-li-se gradul de religiozitate printr-o varietate de indici (participarea

activa la biserica, activitatea de rugaciune si alte masuratori subiective).

Efectele pozitive ale experientei religioase si spirituale asupra sanatatii sunt bazate

pe asumptia ca experienta in sine este pozitiva si "sanatoasa". Bineinteles, religia si

spiritualitatea pot fi de altfel si patologice: obedienta oarba sau autoritarism, interpretarea

literala, strict extrinseca sau auto beneficiara, sau fragmentata. Intr-adevar, asemenea

comportamente religioase sau spirituale nesanatoase pot sa aibe implicatii serioase pentru

sanatatea fizica, fiind asociate cu abuzuri in copilarie si respingere, conflicte intergrupale

si violenta, si false perceptii de control, rezultand in indiferenta asupra starii medicale

(Paloutzian & Kirkpatrick, 1995). Asemenea asocieri nesanatoase pot sa apara cand

individul crede ca el sau ea poate comunica direct cu Dumnezeu cu putin sau fara

facilitare sociala(ex. "Dumnezeu mi-a spus...") sau implica o amanare, o responsabilizare,

a elementului divin (ex. Dumnezeu ma va ajuta"; Pargament, 1997).

Cercetarile care investigheaza sanatatea mentala indica un efect protector similar al

religiei. Intr-o metaanaliza a 139 de cercetari care foloseau masuratori cantitative ale

angajamentului religios, Larson et al. (1992) au descoperit ca doar 39% raportau orice

asocieri, si din acestea, 72% au fost pozitive. Masuratorile variabilei religioase in aceste

studii au inclus rugaciunea, suportul social, relatia cu Dumnezeu, participarea la

ceremoniile religioase si credintele si valorile. Gartner (1996) a rezumat literatura

existenta si a descoperit asocieri pozitive intre religiozitate/spiritualitate si starea de bine,

satisfactia maritala si functionarea psihologica generala; el a gasit asocieri negative cu

suicidul, delicventa, comportamentul criminal si abuzul de substante si alcool.

Religia a fost de asemenea asociata cu cateva forme de psihopatologie, ce includ

autoritarismul rigiditatea dogmatismul sugestibilitatea si dependenta (Gartner, 1996).

Aditional, s-au identificat forme de coping atat daunator cat si benefic, iar formele

daunatoare (nemultumire sau furie fata de Dumnzeu, clerici sau congregatie) au corelat

cu o stare de sanatate mentala proasta si disfunctionala (Pargament, 1997). Luata per

ansamblu, in literatura s-a sugerat faptul ca desi exista unele efecte dezadaptative ale

religiei asupra sanatatii mentale, frecventa depresiei sau a stimei de sine scazute sunt

uneori inevitabile in cazurile unor indivizi profund religiosi (Watters, 1992).

Posibilele mecanisme explicative

Un mecanism prin care religia si spiritualitatea poate sa aibe efecte benefice

asupra sanatatii este prin intermediul retelelor sociale (Hill& Butter, 1995). Comunitatile

religioase si spirituale ofera oportunitati pentru camaraderie, implicare in programe

sociale (vizite la aziluri, asigurarea meselor pentru cei saraci) si companie sociala. Acest

tip de suport poate sa aibe efecte benefice prin reducere stresorilor atat fiziologici, cat si

psihologici.

Stilul de viata poate sa constituie si el un mechanism prin care religia si

spiritualitatea au efecte positive. De exemplu, angajamentul religios poate constitui o

modalitate de determinare a unui individ sa adopte comportamente mai sanatoase,

precum abstinenta de la fumat, baut si consumul de substante sau comportamente

sexuale. Intr-adevar, gruparile religioase care urmaresc un stil de viata strict, precum

mormonii, comunitatea amish sau evreii, tind sa aibe o stare de sanatate mai buna decat a

populatiei generale(Hill &Butter, 1995).

Factorii psihologici pot de altfel sa medieze relatia dintre sanatate si religie.

Pargament (1997), in particular, a teoretizat variatele strategii de coping care pot facilita

rezolvarea benefica a diferitelor probleme de viata. Procesele cognitive precum credintele

despre locul de control, acceptarea de catre semeni sau de catre Dumnezeu, atribuirile de

sens si semnificatie a diferitelor evenimente negative si explicatiile optimiste ( perceperea

evenimentelor negative ca fiind cauzate de catre forte externe si situational-specifice, iar

cele pozitive ca fiind interne si consistente) au fost de asemenea postulate ca posibile

mecanisme, oferind oportunitati pentru noi directii de cercetare.

De exemplu, Sethi si Seligman (1993) au evidentiat ca persoanele care au

credinte religioase de tip fundamentalist sunt in mod tipic mai optimiste, pline de

speranta si mai implicate religios, decat cele care au credinte religioase moderate, care

totusi sunt mai optimiste, pline de speranta si implicate religios decat persoanele care se

declara nu foarte religioase. In lumina cesot rezultate, Sethi si Seligman au sugerat de

altfel ca cercetatorii ar trebui sa reexamineze credintele de simt-comun conform carora

religiile fundamentaliste au efecte negative asupra sanatatii mentale, dat fiiind faptul ca

acesti indivizi tind sa aibe o stare de sanatate decat populatia generala.

Cativa cercetatori au postulat ca factorii religiosi si spirituali pot sa afecte in mod

pozitiv diferitele mecanisme psihologice implicate in starea de sanatate (Larson et

al.,1998). Emotiile positive (iertarea, speranta, multumirea, iubirea) pot sa

imbunatateasca starea individului prin impactul pe care il au asupra circuitelor neuronale

care conecteaza sistemul endocrine de cel imun. Starile emotionale negative (furia si

frica) pot sa duca la activarae sistemului nervos simpatic (SNS) si la axei hipotalamo-

adrenopituitare (HPA), sisteme cunoscute ca fiind implicate in mobilizarea energiei

individului in situatiile de stress. Asemenea activare poate sa produca ca raspuns, stres

asupra organismului cu eliberarea excesiva a neurotransmitatorilor noradrenergici si a

cortizolului. Raspunsul de stress, in schimb, poate sa duca in timp la inhibarea sistemului

imun, cresterea riscului pentru infectii, cresterea presiunii sanguine, cu risc pentru

dezvoltarea atacurilor cerebrale sau miocardice. Astfel, meditatia, iertarea si alte practice

religioase s-au dovedita a reduce activarea SNS-ului si a HPA-ului (Thoresen, 1999),

restaurand homeostazia fiziologica a individului si intarind siatemul sau imunitar.

Uchino, Uno si Holt-Lunstad (1999) au rezumat literature de specialitate si au

gasit dovezi in sprijinul ideii ca suportul social poate influenta starea de sanatate, asupra

sistemului cardiovascular si al imunitatii, printr-un numar de procese fiziologice ale

functionarii optime ale sistemului cardiovascular, neuroendocrin si imun. Autorii au

evidentiat un model care subliniaza importanta evaluarii factorilor de stress, starea de

spirit pozitiva, stima de sine si comportamentele de sanatate ca modulatori ai functionarii

fiziologice. Acest model este consistent cu celelalte regasite in literatura, care emfazeaza

rolul religiei ca mecanism de coping care functioneaza prin intermediul resurselor

sociale (ex. camarderia), psihologice (ex. ingrijorarea) sau a credintelor de sens si

semnificatie ale individului (Levin & Chatters, 1998). Datele empirice insa nu numai ca

sugereaza ca religia are o contributie asupra starii de sanatate fizica si mentala, dar si

sustine argumentele modelelor mentionate anterior, cum ca suportul social din

comunitatile religioase are efecte benefice asupra indivizilor. Daca acest lucru este

sustinut prin intermediul mecanismelor teoretizate de Uchino et al., ramane un subiect de

interes pentru cercetarile din acest domeniu crescand al psihologiei. Insa, ceea ce este clar

momentan este faptul ca religiozitatea si spiritualitatea au devenit variabile importante in

investigatiile asupra factorilor care contribuie la starea de sanatate fizica si mentala a

indivizilor.

CONCLUZII

Desi exista o lunga relatie dde antagonism intre religie si sanatate, o istorie care

poate fi urmarita pana la repercursiunile ei ultime, precum diferenta dintre stiinta si

religie si a faptului ca aproximativ 50% dintre specialistii din domeniul sanatatii se

declara nereligiosi sau atei conform lui Thoresen(1999), este importanat ca cercetatorii

din domeniul sanatatii si specialistii din domeniul sanatatii sa nu lase ca astfel de bariere

sa le limiteze cnoasterea contribuitiei cruciale a rolului religiei si spiritualiatatii asupra

sanatatii fizice si mentale.

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Tradus de : Cristea Artemisa Zamfira Facultatea de Psihologie si Stiinte ale Educatiei

Journal of Affective Disorders 120 (2010) 149–157

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Journal of Affective Disorders

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Research report

A prospective study of religion/spirituality and depressive symptoms amongadolescent psychiatric patients

R.E. Dewa,⁎, S.S. Daniel b, D.B. Goldston a, W.V. McCall c, M. Kuchibhatla d, C. Schleifer e,M.F. Triplett f, H.G. Koenig g

a Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC, United Statesb University of North Carolina at Greensboro, Greensboro, NC, United Statesc Department of Psychiatry and Behavioral Medicine, Wake Forest University Health Sciences, Winston-Salem, NC, United Statesd Department of Biostatistics and Bioinformatics, Duke University Medical Center, Durham, NC, United Statese Duke Divinity School, Durham, NC, United Statesf Wake Forest University Department of Psychology, Winston-Salem, NC, United Statesg Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Geriatric Research, Education, and Clinical Center, VA Medical Center,Durham, NC, United States

a r t i c l e i n f o

⁎ Corresponding author. DUMC Box 3492, 718 Ruthe27705, United States. Tel.: +1 919 286 5260; fax: +1

E-mail address: rachel.dew@duke.edu (R.E. Dew).

0165-0327/$ – see front matter © 2009 Elsevier B.V.doi:10.1016/j.jad.2009.04.029

a b s t r a c t

Article history:Received 18 January 2009Received in revised form 11 April 2009Accepted 27 April 2009Available online 17 May 2009

Objective: Previous research has uncovered relationships between religion/spirituality anddepressive disorders. Proposed mechanisms through which religion may impact depressioninclude decreased substance use and enhanced social support. Little investigation of thesetopics has occurred with adolescent psychiatric patients, among whom depression, substanceuse, and social dysfunction are common.Method: 145 subjects, aged 12–18, from two psychiatric outpatient clinics completed the BeckDepression Inventory-II (BDI-II), the Fetzer multidimensional survey of religion/spirituality, andinventories of substance abuse and perceived social support. Measures were completed again sixmonths later. Longitudinal and cross-sectional relationships between depression and religionwere examined, controlling for substance abuse and social support.Results:Of thirteen religious/spiritual characteristics assessed, nine showed strong cross-sectionalrelationships to BDI-II score.When perceived social support and substance abusewere controlledfor, forgiveness, negative religious support, loss of faith, and negative religious coping retainedsignificant relationships to BDI-II. In longitudinal analyses, loss of faith predicted less improvementin depression scores over 6 months, controlling for depression at study entry.Limitations: Self-report data, clinical sample.Conclusions: Several aspects of religiousness/spirituality appear to relate cross-sectionally todepressive symptoms in adolescent psychiatric patients. Findings suggest that perceived socialsupport and substance abuse account for some of these correlations but do not explainrelationships to negative religious coping, loss of faith, or forgiveness. Endorsing a loss of faithmaybe a marker of poor prognosis among depressed youth.

© 2009 Elsevier B.V. All rights reserved.

Keywords:ReligionSpiritualityDepressionAdolescents

1. Introduction

Adolescent depression is an increasingly recognized andconcerning public health problem. Carrying a point preva-

rford St., Durham, NC,919 286 7081.

All rights reserved.

lence of 5–15%, depression affects up to 1 in 5 people beforeadulthood (Bhatia and Bhatia, 2007; Zuckerbrot and Jensen,2006). Acute and long-term outcomes may include recurrentdepression, psychosocial impairment, substance abuse, andsuicide.

Recent research has uncovered relationships linking adultand adolescent depression to religion and spirituality, prevalentphenomena in American and international life. The study of

150 R.E. Dew et al. / Journal of Affective Disorders 120 (2010) 149–157

religion in the context of health and medicine has been rapidlyincreasing over the last thirty years (Koenig, 2004). Althoughdefinitions of these terms may vary, this manuscript will usereligion to refer to an organized system of beliefs, rituals,practices, and community, oriented toward the sacred; spiri-tuality will refer to more personal experiences of or search forultimate reality or the transcendent that are not necessarilyinstitutionally connected (Josephson and Dell, 2004).

Studies among adults reveal fairly consistent relationshipsbetween level of religiousness/spirituality and depressivedisorders that are significant and inverse (Koenig et al., 2001).Research on this topic among adolescent subjects, however,has yielded mixed findings. Dew and colleagues (Dew et al.,2008a), in a review of 21 studies on religion and depression inadolescents, reported that most described conflicting results:some comparisons showed, as commonly found amongadults, that religiousness related to lower levels of depression,but some showed no relationship. In addition, four of the 21studies found religious variables (including personal impor-tance of religion (Cotton et al., 2005) and church attendance(Sorenson et al., 1995)) correlated with higher levels ofdepression.

Few studies on religion/depression relationships amongadolescents include psychiatric populations. Osman et al.(1996) found that moral objections to suicide, whichreferenced religious concepts, correlated negatively withdepression in adolescent psychiatric inpatients. Cole, how-ever, reported that, in juvenile delinquents in psychiatrictreatment, these same moral objections did not relate todepression (Cole,1989). Miller et al. (2002) followed a clinicalsample of depressed children longitudinally; when religiousvariables and depression were measured in adulthood, therelationship varied by childhood depression status. This raisesthe possibility that early depression affects religious devel-opment, determining whether or not religiousness is protec-tive against adult psychopathology. Dew and colleaguesfound that in adolescent psychiatric outpatients, scores onthe Beck Depression Inventory related positively to negativereligious coping (perceptions of God as punishing orabandoning), positively to negative religious support (per-ceptions of the religious community as critical or demand-ing), and inversely to forgiveness (self-reported tendency topractice forgiveness or feel that God is forgiving) (Dew et al.,2008b).

Population-based studies hold value due to the widegeneralizability of their results. However, a low case rate canlimit the ability to find correlations in a general sample.Psychiatric samples feature high rates of depressive disorders,as well as important covariates such as substance use, familypathology, and social disadvantage. Therefore, clinical sam-ples add much to research in this field. This article describesthe first study, known to the authors, of religion anddepression in adolescent psychiatric patients, using a long-itudinal design and accounting for psychosocial covariates.

Variability in findings of religion/depression research withadolescents complicates consideration of its clinical utility.Several factors likely contribute to this inconsistency. Onesuch factor is the diversity of definitions of religion. Thiscomplex subject has been contemplated in myriad fields suchas sociology, anthropology, theology, and psychology. Evenwithin medical research, which has overwhelmingly occurred

in relatively homogenous white American Christian samples,there is no consensus on how to define or measure religion.Investigators have conceptualized religiousness variously asattendance at services, self-reported devotion, frequency ofprayer, using religion to cope with adversity, and otherconstructs. A newer literature describes the concept of“negative religious coping”, defined as “expressions ofconflict, question, and doubt regarding matters of faith, God,and religious relationships” (McConnell et al., 2006) p.1470).This body of work has found a higher rate of depression inthose who feel abandoned or rejected by God or the religiouscommunity (Ano and Vasconcelles, 2005). Because several ofthe many constructs called “religion” correlate with mentalhealth outcomes, clarification of these questions will requireuse of multidimensional measures.

Inconsistency may also relate to geographic variabilitybetween studies. Concentrations of specific denominations, aswell as local culture in general, may cause religion/depressionrelationships to vary by region. Strong social cohesion seen incertain religious minorities may be helpful in some contextsand more stigmatizing in others. Regional differences haveproved important in previous studies examining religiosity inrelation to longevity (la Cour et al., 2006), delinquency (Starket al., 1982), and suicide (Zhang and Jin, 1996).

An additional issue to consider is the inconsistent use ofmultivariate analyses in religion/health studies. While mostresearchers account for demographics, psychosocial variablessuch as family cohesion or social support are not uniformlycontrolled for (or examined as explanatory/mediating vari-ables). In studies that consider suchvariables as familyclosenessor school stress, these constructs often weaken or eliminatezero-order correlations of religion to mental health outcomes(Benda and Corwyn, 1997; Nooney, 2005; Stewart et al., 1999).Furthermore, previous studies have rarely considered substanceuse as amediator, despite its consistent negative relationship toteenage religiosity (Koenig et al., 2001) and its status as aproposed mechanism through which spirituality positivelyimpacts mental health (George et al., 2002).

A major limitation of current religion/health research isthe dearth of longitudinal studies. Extrapolation of cross-sectional correlations to longitudinal or predictive relation-ships is questionable. A correlation between depressivesymptoms and religious variables at a single point in timemay indicate any of several long-term relationships betweenthese constructs. For example, depression could cause atemporary emergence of certain religious traits, such asseeing God as more punitive, or the decline in other traits,such as religious service attendance. Alternatively, certainreligious tendencies could either raise or lower risk fordepression. Clarification of such temporal relationships iscrucial to our understanding of the intersection of religionand mental health.

2. Methods

In order to address the above gaps in the religion/depression literature, the following prospective study wascarried out at two outpatient psychiatric clinics in NorthCarolina. Counties containing the two clinics are predomi-nantly Christian and Protestant, with the largest denomina-tions being Southern Baptist and United Methodist.

Table 1Subscales analyzed from the brief multidimensional measure of religiousness/spirituality.

Subscale # items Item range/directionality Sample item Mean SD

Daily spiritualexperiences

5 1–6, lower=more frequent experiences “I feel God's presence” 15.8 6.8

Forgiveness 3 1–4, lower=more forgiving “I have forgiven those who hurt me” 5.7 2.2Private religiouspractices

5 1–8, lower=more frequent practices “How often do you pray privately inplaces other than at a church, synagogue, or temple?”

24.2 8.1

Positive religiouscoping

4 1–4, lower=greater use “I look to God for strength, support, and guidance” 9.5 3.3

Negative religiouscoping

2 1–4, lower=greater use “I feel God is punishing me for my sins or lack ofspirituality”

6.4 1.7

Positive religioussupport

2 1–4, lower=greater support “If you had a problem or were facedwith a difficult situation, how muchcomfort would the people in yourcongregation be willing to give you?”

3.8 2.0

Negative religioussupport

2 1–4, lower=more negative support “How often are the people in yourcongregation critical of you and the things you do?”

6.3 1.8

Commitment 1 1–4, lower=stronger agreement “I try hard to carry my religious beliefsover into all my other dealings in life”

2.3 0.9

Positive religioushistory

2 1–2, higher higher=more religious or spiritual “Have you ever had a significant gain in your faith?” 3.0 0.9

Loss of faith 1 1–2, higher=more religious or spiritual “Have you ever had a significant loss in your faith?” 1.6 0.5Organizationalreligiousness

2 1–6, lower=more frequent attendance “How often do you go to religious services?” 7.0 3.1

Overallself-ranking

2 1–4, lower=more religious or spiritual “To what extent do you consider yourself a spiritual person?” 5.0 1.6

Meaning 2 1–4, lower=greater agreement “I have a sense of mission or calling in my own life” 4.1 1.6

151R.E. Dew et al. / Journal of Affective Disorders 120 (2010) 149–157

Adolescent participants were asked to complete self-reportmeasures of depressive symptoms, substance abuse, per-ceived social support, and a multidimensional measure ofreligiousness/spirituality. The same measures were adminis-tered a second time approximately six months later.

Parents/guardians provided treatment history and demo-graphics, and diagnosis made by the treating clinician wasrecorded. Because of possible reliability problems with non-standardized diagnosis, chart diagnosis was used to char-acterize the sample only. The primary aim of the study was toassess the cross-sectional and longitudinal relationshipsbetween religious/spiritual characteristics and depression inadolescent psychiatric outpatients. We hypothesized thatnegative religious coping, negative religious support, and lossof faith would relate positively with depressive symptoms,while the remaining variables would relate inversely withdepression. Additionally, we hypothesized that social supportand substance abuse would serve as mediators betweenreligion/spirituality and depression.

The study was approved by the Institutional ReviewBoards of Duke University Medical Center and Wake ForestUniversity Health Sciences. Participants were recruited con-secutively from clinic schedules. Potential subjects wereapproached by their treating clinicians. If subjects wereinterested, study staff explained the study and obtainedwritten informed consent from their parent or legallyresponsible person. Subjects could be included if they wereaged 12–18, were presenting for treatment, and were able tounderstand and complete the questionnaires. Assistance withreading was given as needed. Those with mental retardation,either reported by the treating clinician or documented in themedical record, were excluded.

Of 267 potential subjects identified from clinic schedules, 75were excluded because they were unable to understand andcomplete thequestionnaire, hadnoavailableparentor guardian

to give consent, or were otherwise deemed inappropriate forthe study by their treating clinician. Fifty-one potential subjectsrefused participation, usually citing lack of time. One hundredforty seven subjects gave consent/assent and completed thefirst data collection. Two were subsequently excluded due todiagnosis of mild mental retardation found on chart review.

3. Procedures

Following consent and assent, parents/guardians of partici-pants completed a demographic/treatment history form. In aseparate room, adolescent enrollees completed four instruments:theBeckDepression Inventory-II (BDI-II, (Osmanet al., 2004), theBrief Multidimensional Measure of Religiousness/Spirituality(BMMRS, (Fetzer,1999), theMultidimensional Scale of PerceivedSocial Support (MSPSS, (Canty-Mitchell and Zimet, 2000), andthe Problem Oriented Screening Instrument for Teenagers–Substance Abuse Subscale (POSIT,(Knight et al., 2001). Studypersonnel reviewed the clinical chart to obtain the diagnosisdocumentedby thesubject's primarymentalhealthcareprovideras near as possible to the day of data collection. Approximatelysixmonths later, participants completed themeasures again atthe clinic, by mail or by telephone interview. Subjects werepaid five dollars for participation in each data point.

4. Measures

Participants completed the Beck Depression Inventory-II(BDI-II, (Osman et al., 2004), a 21-item self-report scale(possible scores 0–63). This scale has been validated inadolescent psychiatric patients. Cronbach's alpha of the BDI-IIin this study was 0.90. Adolescents completed the BriefMultidimensional Measure of Religiousness/Spirituality(BMMRS, (Fetzer, 1999), a 40-item, 14-subscale inventoryquerying various aspects of religion and spirituality. For this

152 R.E. Dew et al. / Journal of Affective Disorders 120 (2010) 149–157

study, 34 items comprising 14 subscales were analyzed.Subscales include: daily spiritual experiences, forgiveness,private religious practices, positive religious coping, negativereligious coping, positive religious support, negative religioussupport, commitment, positive religious/spiritual history, lossof faith, organizational religiousness, overall self-ranking, andmeaning. These subscales and sample items for each arepresented in Table 1. Unanalyzed items include: the item “Ifeel deep inner peace and harmony”, as this item couldartificially inflate correlations with depression; an itemasking for a total number of hours spent weekly in religiousactivity, due to excessive missing data; the values/beliefsscale, due to poor internal reliability; the coping item “I try tomake sense of a situation and decide what to do withoutrelying on God”, due to poor correlation with either thepositive or negative religious coping items, and an itemquerying monetary donations to religious organizations,which was not felt to be age appropriate. This instrumenthas been recently validated in an adolescent clinical sample(Harris et al., 2008) and previously used in adolescent andadult populations (Fetzer, 1999; Knight et al., 2007; Pearceet al., 2003). Cronbach's alpha for subscales in this studyranged from 0.59 to 0.87.

The Problem Oriented Screening Instrument for Teen-agers–Substance Abuse Subscale (POSIT) contains 17 itemsrelated to drug and alcohol use, related behaviors, andconsequences. It has been shown to be internally consistentand reliable (Knight et al., 2001). Cronbach's alpha for thescale in this study was 0.88.

Social support has been theorized tomediate relationshipsbetween religiousness and mental health (George et al.,2002). Perceived social support was measured via the Multi-dimensional Scale of Perceived Social Support (MSPSS,(Canty-Mitchell and Zimet, 2000; Clara et al., 2003). TheMSPSS contains 12 items, and has been found reliable andvalid in adolescent populations. Cronbach's alpha for the scalein this study was 0.88.

Demographics and treatment history were obtained fromthe consenting parent or guardian. Demographics includedage, race/ethnicity, gender, and religious preference of theadolescent. Parents/guardians were asked to provide theirown highest level of education and family income. Treatmenthistory obtained included length and type of services used.

5. Analysis

Data imputation was performed on scales if at least 80% ofthe total items were completed, substituting the mean of theremaining items; if less than 80% of the scale was complete,the item remained missing. Imputed values represent b0.01%of the data.

Regression models were created with BDI-II score at time1 as the dependent variable and demographic and religious/spiritual variables as predictors. Models were then controlledfor substance abuse and social support. Our final modelincluded all religious/spiritual, control, and explanatoryvariables. Due to skew in the distribution of BDI-II scores attime 2, a change score was created using the differencebetween BDI-II at time 1 and time 2. This change score wasmodeled using linear regression and controlled for BDI-II attime 1. Analyses were repeated excluding five significant

outliers with no appreciable change in results. All analyseswere performed using SAS Enterprise Guide 3.0 (Cary, NC).

6. Results

Seventy-eight subjects (54%) were recruited from DukeUniversity and 67 (46%) from Wake Forest University HealthSciences. The 145 subjects had ameanage of 14.3 years (SD1.8).Sixty-one (42%)were female. Ethnic composition of the samplewas as follows: Caucasian n=82 (56%), African Americann=50 (35%), and other n=13 (9%). Fifty-two percent reportedfamily incomes of less than $40,000/year and 12% had incomesover $100,000. 92% of parents/guardians reported having atleast a high school education.

Religious affiliations of subjects, as reported by parents/guardians, were classified as Conservative Protestant (Baptist,non-denominational Christian, Church of Jesus Christ of LatterDay Saints (LDS), and others; 71% of sample), LiberalProtestant (Methodist, Presbyterian, and others; 15% ofsample), Roman Catholic (7%), other (5%), or none (5%).Although LDS youth could represent a unique category basedon theological and social distinctions, only two subjectsendorsed this preference; thus, based on shared views towardsubstance use, these subjects were included in the “Con-servative Protestant” category.

6.1. Illness and treatment parameters

Participants reported a mean substance use score of 0.8,with a median score of 0, on a possible scale of 0 to 17.Reported substance use scores ranged 0–13. Due to this skewin the data, scores on the POSIT were dichotomized. Thirty-two subjects (22%) scored one or greater on this inventory.

The sample had a mean BDI-II of 13.5 (SD 9.6). Forty-foursubjects reported past admissions to psychiatric hospitals(31%), and 116 (81%) had used psychotropic medications.Seventy-two subjects (51%) endorsed having been prescribedantidepressant medications. Depression (including majordepression, dysthymia, adjustment disorder with depressedmood, and depressive disorder not otherwise specified) wasdiagnosed in 52 patients (38%). Other mood disorders(including bipolar disorder and mood disorder not otherwisespecified) were noted in 15 patients (10%). ADHD, diagnosedin 75 subjects (55%), was the most common diagnosis. Noclinical diagnosis was available for 7 subjects.

6.2. Religious and social characteristics

Sample means of each BMMRS subscale are presented inTable 1. Mean item scores indicate that subjects generallyendorsed having spiritual experiences on most days, oftenused religion to cope with problems, and participated inorganized religious activities once or twice per month. Themean score on the MSPSS was 66.5 (SD 13.5; range 17–84).This indicates that the average respondent expressed mild tostrong perception of good social support.

6.3. Follow-up

One hundred four subjects (72%) of the original samplecompleted measures approximately six months following

Table 2Bivariable and multivariable correlates of BDI-II score at Time 1.

Uncontrolledanalysis

Controlled for gender, social support, andsubstance abuse⁎

Religious variables compete insingle model

Independent variable β p β p β p

Site 1.47 0.3772 –

Age −0.32 0.4795 –

Female gender 3.15 0.0599 –

Caucasian – – –

African American −0.84 0.6353 –

Other race 4.15 0.1595 –

SES 0.79 0.2194 –

No religion −1.91 0.5940 –

Conservative Protestant 1.33 0.4696 –

Liberal Protestant −1.06 0.6576 –

Catholic 0.74 0.8280 –

Other religion 4.20 0.3069 –

Substance abuse 6.05 0.0022 –

Social support −0.29 b .0001 –

Daily spiritual experiences −0.35 0.0032 −0.01 0.9157 −0.06 0.8054Forgiveness −1.84 b .0001 −1.14 0.0034 −1.18 0.0221Private religious practices −0.12 0.2248 0.13 0.2018 0.23 0.1228Positive religious coping −0.60 0.0176 0.09 0.7442 −0.33 0.4956Negative religious coping 2.00 b0.0001 1.53 0.0006 1.14 0.0223Positive religious support −0.98 0.0171 −0.14 0.7268 −0.06 0.9026Negative religious support 1.00 0.0360 1.22 0.0045 0.59 0.1936Commitment −1.08 0.2521 0.73 0.4185 2.26 0.0787Positive religious history 0.12 0.8963 −1.62 0.0612 −0.89 0.3806Loss of faith 5.81 0.0006 3.73 0.0185 4.33 0.0086Organizational religiousness −0.71 0.0066 −0.22 0.3941 −0.55 0.0975Overall self-ranking −1.41 0.0063 −0.28 0.5791 −0.87 0.2190Meaning −0.93 0.0760 0.24 0.6573 0.10 0.8789

⁎Religious variables entered into base model (gender, social support, and substance abuse).

153R.E. Dew et al. / Journal of Affective Disorders 120 (2010) 149–157

study entry. t-tests comparing demographics and depressionseverity of completers and non-completers revealed nosignificant differences between the groups.

6.4. Regression analyses

Uncontrolled cross-sectional correlations with BDI-IIscores are displayed in Table 2. Among demographicmeasures, only gender showed a near-significant correlationwith BDI-II scores. No treatment variables related to BDI-II.Religious characteristics which negatively correlated withBDI-II scores included the following: daily spiritual experi-ences, forgiveness, positive religious coping, positive religioussupport, loss of faith, organizational religiousness, and self-ranking as religious/spiritual. Negative religious coping,negative religious support, and loss of faith were relatedpositively to BDI-II, such that higher levels of these char-acteristics related to greater depressive symptoms. Bothsubstance abuse and perceived social support were signifi-cantly related to BDI-II score, such that greater levels ofsubstance abuse and lower levels of social support correlatedwith increased depression.

Multivariable results are summarized in Table 2. Whenperceived social support and substance abuse measures wereadded to models predicting BDI-II score, daily spiritualexperiences, positive religious coping, organizational reli-giousness, and self-ranking became non-significant (implyingthat social support and substance abuse explained theserelationships with depression). Only forgiveness, negative

religious support, negative religious history, and negativereligious coping remained significant and could not beexplained by social support or substance abuse. When allreligious variables were allowed to compete in the model,forgiveness, negative religious coping, and loss of faith wereretained, each contributing unique variance. When gender,substance abuse, and social support were added to thisparsimonious model, forgiveness and loss of faith retainedsignificance, and negative religious coping became non-significant (β=0.87, p=0.07).

Next, baseline predictors were sought of change in BDI-IIscore over time, controlling for the initial BDI-II. Only loss offaith predicted change in depression, such that endorsing aloss of faith at time 1 predicted less improvement in BDI-IIscore six months later (β=4.69, p=0.007). This effectpersisted when controlled for gender, social support, andsubstance abuse.

To further characterize the meaning of loss of faith in thissample, an attempt was made to correlate it with a lack ofreligiosity. Disagreeing with the BMMRS item “I believe in aGodwhowatches over me” did not relate to a loss of faith, nordid endorsing “no religion.”

7. Discussion

We hypothesized that negative religious coping, negativereligious support, and loss of faith would relate positively todepressive symptoms, while other aspects of religiousness/spirituality would relate negatively to depression.We expected

154 R.E. Dew et al. / Journal of Affective Disorders 120 (2010) 149–157

this relationship to be apparent cross-sectionally and long-itudinally. Our secondary hypothesis stated that social supportand substance abuse would mediate or explain the observedrelationships between religion/spirituality and depression.

The primary hypothesis was partially confirmed. Nine of13 religious subscales related significantly to BDI-II score inuncontrolled analysis. Greater use of negative religious copingand endorsing negative support from the religious commu-nity correlated with higher depression scores, as did endor-sing having experienced a loss of faith. In contrast, dailyspiritual experiences, forgiveness, positive religious coping,positive religious support, organizational religiousness, andself-ranking as religious/spiritual were inversely related todepressive symptoms. These findings are consistent withprevious research (Ano and Vasconcelles, 2005; Dew et al.,2008b; Knight et al., 2007; Koenig et al., 2001), and argue for amore complex model of the religion/depression relationship;all religious beliefs and experiences are not necessarilyrelated to better mental health.

Contrary to our hypothesis, longitudinal analysis showedthat only endorsing a loss of faith predicted less improvementin depressive symptoms over time. This argues against thehypothesis that religious beliefs or behaviors cause or preventdepression, but rather correspond to concurrent level ofdepression.

In accordance with our secondary hypothesis, that sub-stance abuse and social support may serve as mechanismsthrough which religiousness impacts depression, five of thenine subscales initially correlating with BDI-II score becamenon-significant when substance abuse and social supportwere controlled. However, these two control variables failedto completely explain the observed relationships: foursubscales — forgiveness, negative religious coping, negativereligious support, and loss of faith, continued to relatesignificantly to BDI-II score despite control for substanceabuse and social support. The prospective contribution of lossof faith to the variance in BDI-II change score also retainedsignificance when controlled for these potential explanatoryvariables. Accordingly, it appears that religion and spiritualitymay relate to adolescent depression both indirectly throughsocial support and substance abuse, and also directly.

These findings are consistent with other psychiatricresearch. First, as in the adult literature, several aspects ofreligiosity related inversely to depressive symptoms. Amongadults, similar relationships have been found cross-section-ally (Baetz et al., 2004; Hahn et al., 2004; Koenig et al., 2001),and longitudinally (Braam et al., 2004; Koenig et al., 1998).Also consistent is the observed association between negativereligious coping and higher levels of depression. Thisrelationship has been confirmed among adults in a recentmeta-analysis (Ano and Vasconcelles, 2005).

The finding that baseline “loss of faith” predicted lessimprovement in depressive symptoms over time is consistentwith the idea that faith somehow protects against depression.However, loss of faith does not seem to be the same as nothaving faith, as this construct did not correlate with measuresof atheism or having no religion. It may be that it isspecifically the loss rather than the absence of faith that isimportant. Previous literature supportive of this idea includesa study which found a decrease in religious faith predictedgreater use of mental health services among veterans with

PTSD (Fontana and Rosenheck, 2004), and a longitudinalsurvey which found that a decrease in religiosity predictedconduct problems equaling or exceeding the conduct pro-blems of those who were never religious at all (Peek et al.,1985).

It is possible that adolescents completing this surveyinterpreted “loss of faith” to mean “loss of hope”. Hope-lessness is a concept highly relevant to the study ofdepression, and has been found to relate to suicidality(Nrugham et al., 2008). Although therewas no direct measureof hopelessness in this study, it may be noted that loss of faithdid not correlate independently with suicidality. Furtherinvestigation, likely involving qualitative methodology, willbe needed to clarify this issue.

The findings of this study also mirror results of severalstudies in adolescents (Miller and Gur, 2002; Schapman andInderbitzen-Nolan, 2002; Wright et al., 1993; Pearce et al.,2003). Unlike our study, Harker found that religious atten-dance predicted lower depression scores one year lateramong adolescent participants of the Add Health Study(Harker, 2001). This study, however, did not control forbaseline depression.

As stated above, previous literature on religion anddepression among young psychiatric patients has been sparseand inconsistent. The current study provides partial replica-tion of previous results found among a sample of 117adolescent psychiatric outpatients (Dew et al., 2008b).Cross-sectionally related to lower scores on the BDI-II inthat sample, after controlling for substance use, wereforgiveness, negative religious coping, and negative religioussupport; in the current study, these scales, in addition to lossof faith, retained significant relationships to depression evencontrolling for potential mediators.

7.1. Interpretation of findings

Why might these religious variables relate to depressivesymptoms? Theories on how religion might impact mentalhealth abound (Koenig et al., 2001). The fact that five of thenine subscales lost significance when substance abuse andsocial support were added to the model gives us insight intopossible mechanisms. It has been consistently found thatreligious variables relate inversely with teenage substanceabuse (Brown et al., 2001b; Heath et al., 1999; Nonnemakeret al., 2003; Wallace et al., 2003). It is also known thatsubstance use relates to depression (Conway et al., 2006;Currie et al., 2005; Goldstein et al., 2007). It is therefore likelythat one way religion relates to depression is that those whoembrace religion use fewer substances, protecting themagainst depression.

Social support has also been found to relate to depression(Buist-Bouwman et al., 2004; Dahlem et al., 1991; Dennyet al., 2004a,b). Possible explanations of this relationshipinclude the theory that social support prevents or alleviatesdepression, as well as the idea that non-depressed personsare better able to engage with others socially. Religion andspirituality can provide social support in several ways. Churchmembership may allow teens to develop extra-familialrelationships with stable adult figures, sometimes providingguidance and affection lacking in their own families. Churchyouth groups likely help establish healthy peer bonds. Trends

155R.E. Dew et al. / Journal of Affective Disorders 120 (2010) 149–157

in contemporary American evangelical Christianity towardintense individual relationships with God, who is perceived toaccompany the adherent throughout daily life, have beenobserved in anthropological research (Luhrmann, 2004). Aclose and nourishing relationship with the Divine maymitigate the effects of negative life experiences or otherrisks for depression. Possibly, adolescents in this study whowere not depressed were better able to connect and bondwith social contacts. Alternatively, those who endorsedreligious connections may also tend, independently, to haveclose, supportive families and friends.

Four subscales contributed unique variance to the BDI-IIscore beyond that of substance abuse and social support: lackof forgiveness, negative religious coping, negative religioussupport, and loss of faith. These phenomena can be under-stood in several ways. Such feelings could precede andcontribute to the onset of depression. Alternatively, theymay represent depressive symptoms — negative thoughts ofthose looking at the world through the depressed lens.Cognitions about the harsh and punitive character of Godmayrepresent away to copewith depression; e.g., some depressedsubjects may understand their illness as divine retribution forpast sins. It is also possible that these phenomena representthe type of religion that emerges in someone who hasexperienced depression in youth; adolescent depression mayleave a scar on the personality or worldview that distortsmainstream religious experience. Finally, these religiousvariables and depression may in truth be unrelated, butinstead both related to a third variable not assessed in thisstudy.

Only one variable, loss of faith, related to change indepressive symptoms prospectively. Independent of the levelof depressive symptoms at Time 1, those endorsing a loss offaith showed less improvement over time. Thus loss of faithmay represent a marker of poor prognosis in treatment-seeking adolescents.

Most other religious variables correlated with depressivesymptoms cross-sectionally, but did not predict change indepression over time. This is noteworthy, in that the field tothis point has often supposed causal relationships betweenreligion and depression. Rather, these results support thehypothesis that such variables as lack of forgiveness, negativereligious coping, and negative religious support are depres-sive symptoms. These may to some extent represent state,rather than trait, attributes.

7.2. Clinical implications

Given associations with depression, religious/spiritualcharacteristics may require assessment in the mental healthcare setting. Inquiries can be made about perceptions of therelationship to the Divine and to the religious community,about inability to forgive oneself for past wrongs, and aboutloss of previously held religious faith. As these phenomenamay represent clinical symptoms, they may be monitoredover time as such. If they represent risk factors, then they maybe useful in terms of prognosis. Direct intervention intoreligious matters is more controversial. It is not clinicallyaccepted at present for therapists to attempt to reshape aclient's relationship with God, but referral to a chaplain orpastoral counselor may be helpful and appropriate (Koenig,

2001). If it is discovered that interpersonal interactionsbetween the patient and his or her religious congregationare in fact negative and stressful, discussionwith parents mayhelp alleviate this.

7.3. Limitations

This study has several features that limit its general-izability. First, subjects were all psychiatric patients. Differ-ences between depressed and non-depressed psychiatricpatients will not necessarily generalize to non-clinicalpopulations. Second, the data presented here are observa-tional and cannot prove or disprove causal relationshipsbetween any of the measured variables.

Thirdly, both clinical sites are in the Southeast UnitedStates, and the sample was dominated by those withconservative Protestant religious affiliations; thus, resultsmay not generalize to samples from other geographic areas orreligious groups. Religious groups growing out of othercultures as well as newer movements in American spiritualitymay differ vastly in emphasis and relationship to health.Important information may be gleaned by comparing theseresults to future studies in more religiously-diverse areas.Fourth, the sample size of 145 is relatively small given thenumber of comparisons made; thus replication with largersamples is needed. Larger studies may be better able toexplore how religious variables interact to predict healthoutcomes; for example, some studies find that level ofreligiousness interacts with denomination to predict sub-stance use (Dew et al., 2008a). Larger studies will also bebetter equipped to examine non-linear relationships, whichare sometimes found in substance abuse (Shedler and Block,1990) and religion/health research (Brown et al., 2001a). Inaddition, large studies will be able to analyze importantsubgroups such as lesbian/gay/bisexual youth.

Fifth, the substance abuse measure showed low variabilitynecessitating use of a dichotomized score; it is possible that ifmore variance in substance abuse could be captured, resultswould change. However, approximately 20% of the samplereported some substance abuse, a figure consistent withprevious literature on rates of substance abuse in mentalhealth care settings (Rush and Koegl, 2008). Sixth, recruit-ment for this study required the assistance of subjects'treatment providers; providers were approached by studypersonnel about all identified eligible candidates and exclu-sion criteria were explained. It is unknown if any treatmentprovider introduced bias by encouraging or discouragingparticipation based on any of our salient variables, e.g.,encouraging more religious or less depressed subjects toparticipate.

Despite these limitations, this study represents the mostextensive longitudinal analysis to date of the relationship ofreligiousness/spirituality to depression among adolescentpsychiatric patients, and the first such study (known to theauthors) to investigate the possibility of mediation throughsubstance abuse and social support. Future studies shouldattempt to replicate these findings. In addition, morequalitative research should be done to further understandthemeaning and function of spiritual concepts to adolescents.Such research will pave the way for more concrete clinicalapplications.

156 R.E. Dew et al. / Journal of Affective Disorders 120 (2010) 149–157

Role of funding sourceSupport for this manuscript provided by a grant from the John Templeton

Foundation, which had no further role in study design; in the collection,analysis and interpretation of data; in the writing of the report; and in thedecision to submit the paper for publication.

Conflict of interestsAll authors declare that they have no conflicts of interest.

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Clinical Psychology Review 24 (2004) 379–397

Religion and anxiety: A critical review of the literature

Andrea K. Shreve-Neiger*, Barry A. Edelstein

West Virginia University, Life Sciences Building, 53 Campus Drive, P.O. Box 6040, Morgantown, WV 26506, USA

Received 14 April 2003; accepted 10 February 2004

Abstract

Religion’s effects on mental health have been debated for years, yet only in the last half century have these

theories been empirically tested. While a number of mental health constructs have been linked to religion, one of

the most prevalent and debilitating mental health indices, anxiety, has been largely ignored. This paper categorizes

and critically reviews the current literature on religion and general indices of anxiety in terms of findings linking

decreased anxiety to religiosity, increased anxiety to religiosity, and those finding no relation between anxiety and

religiosity. Results from 17 studies are described and synthesized. Conceptual and methodological weaknesses that

potentially threaten the validity and generalizability of the findings are discussed. Finally, conclusions and

directions for future research are provided.

D 2004 Elsevier Ltd. All rights reserved.

Keywords: Anxiety; Religiosity; Mental health

1. Introduction

Physicians and mental health professionals are finding growing evidence that humans’ spiritual lives

are related to physical and mental well-being (Koenig, McCullough, & Larson, 2001). Aspects of

religion have been linked to the outcomes of such physical ailments as cancer (Acklin, Brown, &

Mauger, 1983), kidney disease (Baldree, Murphy, & Powers, 1982), and heart disease (Croog & Levine,

1972). Other studies have examined the relation between religion and emotional constructs such as

depression (Braam et al., 1998), well-being (Ayele, Mulligan, Gheorghiu, & Reyes-Ortiz, 1999), and

self-esteem (Commerford & Reznikoff, 1996; Sherkat & Reed, 1992).

Relatively fewer studies have examined the relation between anxiety, a pervasive and ubiquitous

index of mental health, and religion. This paper will include a summary of the research on general

0272-7358/$ - see front matter D 2004 Elsevier Ltd. All rights reserved.

doi:10.1016/j.cpr.2004.02.003

* Corresponding author. Tel.: +1-304-296-4440.

E-mail address: ashrev@mix.wvu.edu (A.K. Shreve-Neiger).

A.K. Shreve-Neiger, B.A. Edelstein / Clinical Psychology Review 24 (2004) 379–397380

indices of anxiety and religion. A critical review will follow that identifies potential conceptual and

methodological problems in the studies, as will a final section of recommendations for future research in

this area. Before this review, however, the definition of religion and the history of the debate on the

relation between religion and mental health will be discussed.

1.1. Defining religion

Many studies have tapped into one aspect of religion such as church attendance or frequency of

prayer. Relatively few have defined religion multidimensionally or utilized a psychometrically

standardized assessment of religion. This lack of a universally accepted definition and consequently

poor or varied operationalization of the construct has led to a number of contradictory or mixed findings.

Bergin (1983) asserted that ambiguous results reflect a multidimensional phenomenon that has both

positive and negative aspects.

Krause (1993) conceptualized religion as having three major components: organizational religiosity,

subjective religiosity, and religious beliefs. Organizational religiosity involves participation in religious

institutions and is frequently related to church attendance, church membership, or that aspect of religion

embedded in a larger organizational context. Subjective religiosity is related to commitment and the level

of importance people place on religion in their personal lives. Finally, religious beliefs are the core

beliefs people have as related to their religion and man or woman’s relationship to God. Krause claims

that the religious belief dimension has historically been that most neglected in religiosity research.

Some may posit that it is impossible to define a construct as personal and abstract as religion, but

recent work by researchers is demonstrating otherwise. Measures are being developed, such as that by

the Fetzer Institute (1999), that tap into multiple aspects of religion that have been identified by leading

researchers in the field.

Researchers from various disciplines at a series of recent conferences called for a definition of religion

that captured a number of characteristics and dimensions including ‘‘feelings, thoughts, experiences and

behaviors that arise from a search for the sacred,’’ with ‘‘sacred’’ referring to a ‘‘divine being, Ultimate

Reality, or Ultimate Truth, as perceived by the individual’’ (as cited in Koenig et al., 2001). While

assessing such seemingly abstract constructs as Ultimate Reality and Ultimate Truth appears daunting, a

move to define religion according to a number of dimensions that may affect mental health would be

advantageous for future research.

The terms ‘‘religiosity’’ and ‘‘spirituality’’ are used interchangeably in much of the literature.

Religiosity is frequently associated with overt behavior. It stipulates behavioral patterns and encourages

overt religious expression (Hill et al., 2000). As such, rituals and overt practice are key elements in the

construct of religion. Religion is generally linked to formal institutions such as churches, temples, or

synagogues. Personal beliefs are also a part of religiosity, but even more so are institutional beliefs (Hill

et al., 2000). The membership in an organization implicates the person’s belief system with that which is

already established by that institution. Because religiosity is often associated with institutions, church

attendance is frequently viewed as a measure of religiosity (Lester, 1987). Church attendance is an overt

behavior that may easily be quantified and equated with religiosity. Church attendance can also serve as

a measure of social support.

In contrast to the more overt behavioral and institutional emphasis of religiosity, spirituality has more

to do with individual experience, and is generally linked to private events and transcendence (George,

Larson, Koenig, & McCullough, 2000; Hill et al., 2000; Piedmont, 1999). Spirituality is most often

A.K. Shreve-Neiger, B.A. Edelstein / Clinical Psychology Review 24 (2004) 379–397 381

described in personal or experiential terms, including ‘‘belief’’ or ‘‘having a relationship with God or a

higher power’’ (Hill et al., 2000). Spirituality is idiographic and covert. It is a broader category of

experience than religiosity that is not restricted to institutions or religions. Thus, spirituality does not

depend upon a collective or institutional context (Pargament, 1997), but rather is an independent

experience marked by a quest for meaning and an appreciation for nature and life in general.

Unfortunately, due to a number of studies utilizing religiosity and spirituality interchangeably, one is

sometimes difficult to discriminate from the other. A number of recent studies are based on measures of

religion rather than spirituality, but these studies tend to neglect that portion of the population that

considers themselves spiritual and not religious (George et al., 2000). There are multiple similarities and

differences between religiosity and spirituality. For example, there are many overt behavioral practices

associated with religiosity such as going to church, and many covert private behaviors associated with

spirituality, such as praying or meditating.

Another body of literature has described an aspect of religiosity termed ‘‘religious coping,’’ where

one’s religion is a source through which critical life situations and stressors are dynamically processed

and understood. As a result, the person can cope and change can occur both cognitively and behaviorally

to meet the demands of the environment. The literature on religious coping and mental health is

extensive (see Pargament, 1997; Pargament, Smith, Koenig, & Perez, 1999), and interestingly, there

appear to be both positive (healthy) and negative (unhealthy) patterns of religious coping.

For the purposes of this review, the terms, ‘‘religion’’ and ‘‘religiosity’’ are defined broadly and

multidimensionally. Thus, studies are included that operationalize religion according to conceptual

aspects, such as intrinsic or extrinsic orientation, or organizational versus subjective religion. Studies that

examine one or more individual aspects of religion, such as affiliation, prayer, fundamentalism, or

church attendance, also are included.

1.2. The history of the debate

For years, prominent mental health professionals have commented on the relation between religion

and psychopathology, based primarily on anecdotes and case studies. Freud (1953) referred to religious

rituals as obsessive–compulsive acts and portrayed the religious person as neurotic, if not delusional.

Similarly, Ellis (1980) equated religiosity with being mentally unhealthy, inflexible, and intolerant.

Watters (1992) asserted that Christian doctrine, specifically, is incompatible with many components of

both sound mental and physical health (Koenig et al., 2001).

In stark contrast to these conceptualizations, other prominent mental health professionals, including

Rogers, Maslow, and Bandura, have claimed that religion is related to a number of positive mental

health outcomes (Bergin, 1985, 1991). Jung wrote that of his many hundreds of clients, he believed that

each ‘‘fell ill because he had lost that which the living religions of every age have given to their

followers, and none of them has been really healed who did not regain his religious outlook’’ (as cited in

Koenig et al., 2001).

Since the 1950s, various conceptualizations of religion as related to other constructs have been tested

empirically, resulting in a number of mixed and contradictory findings. In a critical review of the

literature relating religion to mental health, Sanua (1969) described a number of empirical studies that

found evidence for a positive relation between religiosity and psychopathology. Stark (1971), however,

also critically reviewed studies that attempted to test this relation and found the opposite to be

overwhelmingly the case, that religion was not only negatively correlated with psychopathology, but

A.K. Shreve-Neiger, B.A. Edelstein / Clinical Psychology Review 24 (2004) 379–397382

was also related to healthful outcomes. Interestingly, although both of these authors were purporting to

review the existing relevant literature relating some aspect of religiosity to mental health, the studies that

were reviewed did not overlap.

Bergin (1983) also reviewed the existing literature and found no support for the assertion that religion

is correlated with psychopathology, but also found only slight support for its relation to positive or

healthful outcomes. Bergin’s review found that sociological and psychiatric reports were more favorable

to religion while the psychological literature tended to be more negative. Thus, it appears that the history

of the debate over religion’s relation to mental health is racked with inconsistencies and contradictory

findings that may ultimately be attributed to the researchers’ biases, poor operationalization of

constructs, or both. Perhaps ‘‘overall mental health’’ is simply too broad a construct to attempt to

assess in an empirical context. Assessing religion’s relation to one both prevalent and pervasive index of

mental health that preliminary work has suggested may be related to religiosity is more pragmatic.

Anxiety, as an index of mental health, meets all of these criteria.

1.3. Anxiety and religion

Although religion and its relation to a number of mental health disorders have been studied, relatively

fewer studies have addressed general indices of anxiety and their relation to religion. This lack of

research is surprising in light of studies demonstrating the reliance of many on religion as a coping

mechanism when dealing with health-related stressors (Princeton Religion Research Center, 1982), and

the opposing assertion by others that religion exacerbates rather than relieves anxiety (Ellis, 1988;

Watters, 1992). Recent work with caregivers of older adults with Alzheimer’s disease (Burgener, 1994)

found that caregiver reliance on religion was positively related to general well-being, social functioning,

and successful coping.

It is apparent that many Americans utilize some aspect of religion or integrate it into their belief

systems. When many of the same people are experiencing anxiety at some level, with symptoms that

do not necessarily meet criteria for a disorder, it seems fitting that clinicians and other health

professionals would want some clarification as to the role religion may play in the formation,

prevention, and alleviation of anxiety. The relation between religiosity and several specific anxiety

disorders, especially obsessive–compulsive disorder (Taylor, 2002; Tek & Ulug, 2001), has been

examined previously in the literature, as has religiosity and death anxiety (Clements, 1998; Swanson

& Byrd, 1998). Inclusion of all studies pertaining to general indices of anxiety, specific anxiety

disorders, and death anxiety would make integration of findings quite difficult and yield an unwieldy

document. In addition, while the literature addressing the relation between religion and specific

anxiety disorders is useful, it offers little insight into how religion may be related to anxiety in those

who do not meet diagnostic threshold for a disorder. Thus, this review will only describe studies that

assess anxiety as a broad construct that also includes such related constructs as distress, worry,

insecurity, and fear.

This paper includes a critical review of the existing research on the relation between general indices

of anxiety and religion. Studies that have examined religiosity, or the degree to which one is religious,

or some other aspect of religion as related to anxiety are included. Studies are categorized according to

whether they linked religiosity to decreased anxiety, linked it to increased anxiety, or found no

significant relation between religiosity and anxiety. After presenting and summarizing study findings,

relevant problematic methodological and conceptual issues are discussed. Finally, conclusions and

A.K. Shreve-Neiger, B.A. Edelstein / Clinical Psychology Review 24 (2004) 379–397 383

future directions follow based on a synthesis of the research findings and relative shortcomings of the

reviewed studies.

1.4. Studies relating religiosity to decreased anxiety

For years, researchers have assessed religiosity in terms of overt behavioral practice. Church

attendance can easily be quantified and thus analyzed, so it is not surprising that many studies have

utilized it as a measure of religiosity. In a study that explored factors affecting anxiety, depression, and

hostility in rural women, Hertsgaard and Light (1984) administered the Multiple Affect Adjective Check

List (Zuckerman & Lubin, 1965) and a biographic and demographic questionnaire they developed to 760

randomly selected women (mean age = 44 years) living on farms in a Midwestern U.S. state. Personal

characteristics, including church attendance, were entered as predictors of anxiety in a stepwise

regression analysis. Women who attended church more than once per month scored significantly lower

on the Anxiety subscale than those who attended less often. The authors concluded that some factors,

including church attendance, minimize anxiety in rural women and that awareness of these factors can

enhance mental health service in rural areas.

In an effort to determine causal directionality between religiosity and psychological distress,

Williams, Larson, Buckler, Heckmann, and Pyle (1991) used data from participants in a longitudinal

study of mental health (Myers, Lindenthal, Pepper, & Ostrander, 1972) in New Haven, CT. Data were

available for 720 participants (mean age = 44.8) who were interviewed once in 1967 (Time 1) and then

again in 1969 (Time 2). Psychological distress was assessed with the Symptom Checklist Scale

(Gurin, Veroff, & Feld, 1960), where higher scores are indicative of less distress. In addition, two

measures of stressful life events developed for the study were used. The first measure indexed

undesirable stressful events and the second measure summed the number of physical health problems

experienced in the previous 2 years. Religious attendance was assessed with one question that asked

respondents to rate their frequency of church attendance. Participants were classified as ‘‘high

attenders’’ (who attended church once a week or more), ‘‘moderate attenders’’ (who attended once

per month to two or three times per month), and ‘‘low attenders’’ (who never attended or who only

attended a few times per year).

Regression analyses revealed religious attendance at Time 1 to be significantly positively related to

Symptom Checklist Scale scores at Time 2, and thus negatively related to psychological distress. In

addition, the authors tested whether religious attendance protected or buffered individuals from the

negative effects of stress. A regression model revealed that both the multiplicative terms for interactions

between life events and religious attendance and health problems and religious attendance were

significant. The authors concluded that religious attendance is negatively related to distress and that

religious attendance does appear to buffer the impact of stressful life events and physical health

complaints on psychological well-being.

Petersen and Roy (1985) studied the relation between anxiety and religiosity in an entirely Christian

sample (N= 318) in Memphis, TN. Church attendance was assessed with a single item that asked

respondents if they ‘‘attended Sunday worship services every week, several times a month, several times

a year, or never.’’ Anxiety was assessed utilizing a three-item scale developed by the authors. The

anxiety items were purported to assess ‘‘how often the respondent worries or feels discouraged about the

way his/her life is going and feels that life treats him/her unfairly,’’ but actual scale items were not

published. When religious variables were entered as predictors of anxiety in a multiple regression

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analysis, church attendance proved to be the only significant predictor. The authors concluded that

church attendance is an important factor in reducing anxiety, which may be due to emotional support

offered by the church community.

While church attendance is one easily measured aspect of religiosity, some researchers have

assessed other avenues of religious participation. Williams and Cole (1968) recruited 161 under-

graduates from a state college in the South. The authors expanded Ligon’s (1965) Religious

Participation Questionnaire and devised their own Religious Participation Scale, which instructed

participants to indicate the extent of their church attendance, personal prayer, reading of religious

material, Sunday school attendance, and church-related activity. Participants were also given Maslow’s

(1952) Security–Insecurity Inventory. High scores were reported to be indicative of generalized

psychological insecurity.

For analyses, those scoring at least one standard deviation below the mean on the Religious

Participation Scale were categorized as the ‘‘low religiosity group,’’ while those scoring at least one

standard deviation above the mean constituted the ‘‘high religiosity group.’’ Those falling between �.14

and +.14 standard deviations from the mean were labeled the ‘‘intermediate religiosity group.’’ Although

the high and intermediate religiosity groups did not differ significantly in indices of security, both high

and intermediate groups were significantly more secure than the low religiosity group. The authors

hypothesized that either more secure persons tend to become religious, religion facilitates security, or

religious individuals do not openly admit insecurities.

In an earlier study that explored the relation between affiliation and anxiety, Brown (1962) recruited

203 undergraduates (mean age = 22) from the University of Adelaide. Four questionnaires were

administered. Intensity of religious beliefs was assessed with Thouless’s (1935) questionnaire, and

personality measures included Eysenck’s (1958) questionnaires for neuroticism and extraversion, the

Taylor Manifest Anxiety Scale (MAS; Taylor, 1953), and items from the Minnesota Multi-Phasic

Personality Inventory (MMPI; Hathaway & McKinley, 1940). In addition, a questionnaire developed by

the author assessing a number of religious attitudes was included, and information on sex, age, and

religious affiliation was obtained. Religious affiliations included Roman Catholic, Church of England,

Methodist, Lutheran, Presbyterian, Baptist, Atheist/none, and miscellaneous. Higher manifest anxiety

scores for those with no religious affiliation were the only significant findings. There were no significant

differences in anxiety scores found among the other denominations. While this study did not find

evidence for direct positive effects of religiosity, it is notable that lack of religion in this instance was

related to higher anxiety.

Thus far, findings have been linked to church attendance and affiliation. The following study assessed

religiosity in terms of contemplative prayer, a more covert behavior. Finney and Malony (1985) recruited

nine nonpsychotic adult Christians (3 male, 6 female; mean age = 30.3) from an outpatient clinic. The

experimenters were testing whether the use of contemplative prayer as an adjunct to psychotherapy

would result in decreased anxiety and target complaint distress. Contemplative prayer was defined as

‘‘prayer that utilizes techniques of meditation as a means of relating to God in a nondemanding and

nondefensive way.’’

A set of cassette tapes providing approximately 3 hours of contemplative prayer instruction was

given to each participant. After listening to the tapes, each participant reviewed the content of the tapes

with a researcher who also presented written procedures for contemplative prayer. The researcher and

participant then prayed together in the prescribed manner. After the session, participants were instructed

to take the written procedure home and follow it carefully, spending 20 minutes per day in

A.K. Shreve-Neiger, B.A. Edelstein / Clinical Psychology Review 24 (2004) 379–397 385

contemplative prayer. Phone contact was maintained with the participants during the following weeks to

ensure compliance.

The dependent measure used to assess anxiety was the trait anxiety scale from the Spielberger State–

Trait Anxiety Inventory (STAI; Spielberger, Gorsuch, Lushene, Vagg, & Jacobs, 1983). After 6 weeks of

psychotherapy, participants were trained in contemplative prayer and told to practice it as described

above. The STAI was administered weekly, and participants were also encouraged to keep daily records

of length of contemplative prayer sessions, rate the ‘‘greatest focus of attention,’’ and indicate whether

the participant sensed the presence of God during the session. Participants engaged in contemplative

prayer for approximately 14 weeks total.

The relation between time spent in contemplative prayer and STAI scores for each week was

examined, revealing significant composite (using all nine participants’ data) correlations for three of

the weeks. The authors concluded that their results lend modest support for their hypothesis that

contemplative prayer would be related to lower anxiety. They cautioned, however, that their results could

also mean that participants tended to engage in more contemplative prayer when they were less anxious.

A number of researchers have altered the way they conceptualize and thus operationalize religion.

Allport and Ross (1967) conceptualized religiosity as having two primary components: intrinsic and

extrinsic. Allport and Ross and later Donahue (1985) conceptualized extrinsic religiosity as being

associated with comfort and social convention and intrinsic religiosity as a framework in terms of which

all life is understood. Allport and Ross claimed that the extrinsically religious persons use their religion

while the intrinsically religious persons live their religion. Several studies have explored each

dimension’s relation to anxiety.

Baker and Gorsuch (1982) recruited 52 participants from a religious wilderness camp in southern

California. Each participant was administered the Intrinsic–Extrinsic measure of the Religious

Orientation Scale (ROS; Allport & Ross, 1967) and the Institute for Personality and Ability Testing

(IPAT) Anxiety Scale (Scheier & Cattell, 1960). Total trait anxiety was significantly negatively

correlated with intrinsic religiousness. The authors concluded that intrinsicness is associated with

‘‘the ability to integrate anxiety into everyday life in an adaptive manner.’’

In a similar study, Bergin, Masters, and Richards (1987), administered the ROS and MAS to 61

undergraduate students at Brigham Young University. A significant negative correlation was found

between the Intrinsic subscale of the ROS and the total anxiety score. The authors concluded that their study

providedmoderate evidence that intrinsicness is negatively associated withmanifest anxiety, but cautioned

that because 98.6% of the sample was intrinsically oriented, their findings were not very generalizable.

Sturgeon and Hamley (1979) utilized an entirely Christian sample to examine the relation between

trait and existential anxiety and intrinsic/extrinsic religiosity. Existential anxiety was defined as ‘‘a

product of despair, alienation, and emptiness that results from an individual’s inability to see meaning

in life’’ (Good & Good, 1974). The authors recruited 148 students from a conservative, Protestant-

affiliated college. Each participant was administered the ROS, the STAI, the Existential Anxiety Scale

(Good & Good, 1974), and An Inventory of Religious Belief (Brown & Lowe, 1951). Only data from

participants with the 20 highest (intrinsic group) and 20 lowest (extrinsic group) ROS scores were used

for analyses; t tests revealed the intrinsic group to be significantly less existentially anxious and

evidence less trait anxiety than the extrinsic group. The groups did not differ significantly on state

anxiety, which was expected since no stress condition was present. The authors concluded that, as

found in previous studies, intrinsic believers evidenced lower anxiety and thus appeared to be better

adjusted.

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In a study that compared measures of worry and intrinsic/extrinsic religiosity in elderly Buddhists and

Christians, Tapanya, Nicki, and Jarusawad (1997) recruited 104 noninstitutionalized, middle-class,

healthy older adults. Half of the sample (18 males, 34 females; mean age = 73) were Christians from

Fredericton, New Brunswick, Canada, while the other half (23 males, 29 females; mean age = 69) were

Buddhists from Chiang Mai, Thailand.

Each participant was administered the Penn State Worry Questionnaire (PSWQ; Meyer, Miller,

Metzger, & Borkovec, 1990), the Age Universal I-E Scale (Gorsuch & Venable, 1983), an adaptation of

the ROS that widens its applicability to children and older adults, and were asked to keep a daily journal.

Both the PSWQ and Age Universal I-E Scale were translated into Thai, with words such as ‘‘church,’’

‘‘Bible,’’ and ‘‘God’’ modified to fit Buddhism, and then retranslated into English to ensure validity.

Participants were asked to keep their journal for 3 days, during which they recorded daily occurrences of

worrisome thoughts and their reactions to them, and rated their level of success in copingwith the thoughts.

Multiple regression analyses revealed intrinsic orientation to account for a significant amount of

variance in PSWQ scores. In addition, a significant negative correlation emerged between intrinsic

orientation and worry for Buddhists. Buddhists had more extreme scores on the Age Universal I-E Scale,

and thus were both more intrinsically and extrinsically oriented to religion than Christians. Entries in

daily journals differed between groups only with respect to Buddhists worrying more about matters

related to Church/Temple than Christians. The authors concluded that intrinsic religiosity is associated

with lower levels of worry, especially for Buddhists, although this may have to do with religion playing a

greater role in Buddhist Thais’ lives in general.

In summary, the findings from the previously reviewed studies suggested that church attendance was

related to decreased anxiety for several populations. Several authors concluded that having some type of

religious affiliation was related to lower anxiety levels, and contemplative prayer was associated with

increased security and less distress. Finally, when religiosity was conceptualized as intrinsic or extrinsic,

intrinsic religiosity was related to less worry and anxiety.

1.5. Studies relating religiosity to increased anxiety

While several studies found evidence for religious affiliation being linked to positive mental health

outcomes, it may be that some affiliations are more healthful than others, and that some may even prove

harmful. In Hertsgaard and Light’s (1984) study described previously, the authors explored factors

related to anxiety in 760 rural women. After administering the Multiple Affect Checklist and a

demographics questionnaire to each woman, analyses revealed that Catholic women scored significantly

higher on the Anxiety subscale of the Multiple Affect Checklist than women of other affiliations.

Spellman, Baskett, and Byrne (1971) investigated the relation between sudden religious conversion

and manifest anxiety. The authors defined religious conversion as ‘‘changing from one religion to

another or from a nonreligious state to a religious one,’’ with those who do this suddenly characterized as

‘‘sudden’’ converts. The experimenters asked two ministers to place members of a predominantly

Protestant Texas farming community into three categories. The categories comprised ‘‘the nonreligious’’

(n= 20; mean age = 38.6), ‘‘the regular attenders’’ (n = 20; mean age = 41.3), who were assumed to

represent a gradual conversion experience, and ‘‘sudden converts’’ (n= 20; mean age = 36.9). The

ministers evidenced 92% interrater agreement. All participants were given the MAS.

The MAS means for the three groups proved to be significantly different. Orthogonal comparisons

revealed a higher mean for the sudden converts than for the other two groups combined, which did not

A.K. Shreve-Neiger, B.A. Edelstein / Clinical Psychology Review 24 (2004) 379–397 387

differ significantly. The authors concluded that their study offered tentative support for the hypothesis

that people who have had a sudden religious conversion score higher on manifest anxiety than those

without such experiences. The authors further discussed conversion as being a ‘‘pseudosolution’’ to life’s

problems since the conversion experience fails to bring a permanent reduction in anxiety.

Wilson and Miller (1968) tested whether fear and anxiety were related to religious practice in a

sample of 100 undergraduates from the University of Alabama. The participants completed a short form

of the MAS (Bendig, 1956), an unpublished measure of fearfulness, and a self-report questionnaire that

included common dimensions of religious participation and beliefs (e.g., church attendance, belief in a

supreme being, soul immortality, and religious immortality) developed by the authors. Correlational

analyses revealed religiosity to be positively correlated with both fearfulness and anxiety. The authors

concluded that there seems to be a small but reliable tendency for nonreligious persons to give

‘‘healthier’’ answers on these measures of fear and anxiety.

When religion was broken into its intrinsic and extrinsic components in the studies described earlier,

the authors concluded that intrinsic religiosity was related to less anxiety. The same authors concluded

that the opposite was true for an extrinsic orientation. Baker and Gorsuch (1982) examined the relations

between trait anxiety assessed by the IPAT Anxiety Scale and the Intrinsic–Extrinsic measure of

Religious Orientation in a sample of 52 participants. The results revealed total trait anxiety scores to be

significantly positively correlated with ‘‘extrinsicness.’’ The authors concluded that extrinsicness is

associated with the ‘‘inability to integrate anxiety into everyday life in an adaptive manner.’’

Bergin et al. (1987) had similar findings in their study examining the relation between intrinsic/extrinsic

religiosity and anxiety. Correlation analysis of ROS and MAS scores revealed a significant positive

relation between extrinsic orientation and manifest anxiety. The authors concluded that extrinsicness is

associated with anxiety, and that previous studies have found conflicting evidence for the relation between

anxiety and religion because they failed to assess religion’s intrinsic/extrinsic dimensions.

Tapanya et al. (1997) compared intrinsic/extrinsic orientation and worry levels in Buddhists and

Christians by administering the PSWQ and Age Universal I-E Scale to samples previously described.

Multiple regression analyses revealed variance in PSWQ scores to be uniquely related to a two-way

interaction between extrinsic orientation and religious affiliation. The authors interpreted this as levels of

worry being associated with extrinsic orientation in different ways for Christians and Buddhists. Indeed,

first-order correlations revealed a significant correlation between worry level and extrinsic orientation for

Buddhist participants only. The authors theorized that the Buddhist belief in the law of karma, which

implies, in contrast to Christianity, that there is no escape from the consequences of one’s actions

through redemption, might have contributed to higher levels of worry in extrinsic Buddhists.

1.6. Studies finding no relation between anxiety and religiosity

Heintzelman and Fehr (1976) tested the relation between manifest anxiety and religiosity by adminis-

tering theBrownmodification of the Thouless Test of ReligiousOrthodoxy (Brown, 1962; Thouless, 1935)

and the MAS to 82 undergraduate students (41 male, 41 female; mean age = 20.6) at the University of

Cincinnati. Correlation analysis revealed no significant relation between anxiety and religiosity.

In a similar study, the same authors (Fehr & Heintzelman, 1977) administered the Allport, Vernon, &

Lindzey (1970) Study of Values, the Thouless Test of Religious Orthodoxy, and the MAS to 120

undergraduates (60 male, 60 female; mean age = 19.8) at the University of Cincinnati. Again, the

relations between the two measures of religiosity and anxiety were nonsignificant. The authors did not

A.K. Shreve-Neiger, B.A. Edelstein / Clinical Psychology Review 24 (2004) 379–397388

address their nonsignificant findings except to say that they were consistent with findings by Brown

(1962). They did, however, assert that using two divergent measures of religiosity as they did in their

second study does result in different profiles of the ‘‘religious’’ individual, thus lending further support

to the notion that religiosity is multidimensional and should be assessed as such.

Frenz and Carey (1989) examined the relation between intrinsic/extrinsic religiosity and trait

anxiety in a sample of 119 undergraduate students (76 female, 43 male) from a private university in

New York. Participants were administered the Intrinsic/Extrinsic Scale (Feagin, 1964), which is a 12-

item adaptation of the ROS, and the Trait version of the STAI. Participants were categorized as

‘‘intrinsic’’ (n= 12), ‘‘extrinsic’’ (n= 46), ‘‘indiscriminate’’ (n= 41), and ‘‘nonreligious’’ (n= 20),

based on Donahue’s (1985) fourfold typology for the ROS. The four religious groups did not differ

on trait anxiety, and correlations between trait anxiety and continuous scores on both ROS subscales

were also nonsignificant. The authors attributed their nonsignificant findings to their use of a more

heterogeneous sample in terms of intrinsic/extrinsic religiosity than those used in previous studies. The

authors opined that previous findings might have been distorted by a social desirability response bias

of samples recruited from religious institutions.

In a longitudinal study that tested models relating religiosity, stress, and self-esteem/mastery,

Krause and Van Tran (1989) analyzed data from 2107 people in the National Survey of Black

Americans (Neighbors, Jackson, Bowman, & Gurin, 1982). A 10-item checklist developed for the

study assessed stressful life events including health, financial, and interpersonal problems, and six

items assessing ‘‘organizational’’ and ‘‘nonorganizational’’ religiosity were used as the religiosity

measure.

A structural equation model was used to test three hypothetical models. The first was a ‘‘moderator

model,’’ which assumes that the correlation between stress and religiosity is low, and that a statistical

interaction effect exists between stress and religiosity and self-esteem. The second, a ‘‘suppressor

model,’’ assumes that the level of religious involvement is dependent on the amount of stress present in

the person’s life, and thus stress and religiosity are moderately correlated. The third was a ‘‘distress-

deterrent model,’’ which assumes that stress and religiosity are not correlated, but rather each exerts

direct, additive effects on self-esteem.

Findings revealed the distress-deterrent model had the highest goodness of fit and showed that

increases in the number of life event stressors failed to be related to either organizational or

nonorganizational/subjective religiosity. The authors concluded that their findings supported the

distress-deterrent model, with religious involvement appearing to be an important factor in maintaining

self-esteem, but that these additive effects operate independently of the amount of stress present. Thus,

religiosity and stress were unrelated.

In summary, conclusions from these studies revealed no significant relations between anxiety and

religiosity. The authors of these studies concluded that both manifest and trait anxiety appeared not to be

related to religiosity, and stress and religious involvement appeared to be unrelated.

2. Critical review of the literature

The studies reviewed above have rendered mixed and often contradictory findings when examining

the relation between anxiety and religion. This section will address methodological and conceptual

weaknesses that may have contributed to those findings.

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2.1. Methodological issues

2.1.1. Psychometric properties of religiosity measures

The psychometric properties of standardized instruments are critical to the assessment of a construct

and the conclusions drawn based on that measurement. The literature examining religiosity and its

relation to other variables is severely lacking with regard to standardized, psychometrically sound

religiosity measures.

Finney and Malony (1985) used the Batson Inventory of Religiosity, an unpublished measure with no

reported psychometric properties. The authors also utilized Hood’s Mysticism Scale, which has been

factor-analyzed and evidences satisfactory internal consistency and convergent validity (with Hoge’s

intrinsic religious motivation scale; Hood, 1975). However, the Pauline Comparison Scale, which was

also used, is unpublished and has no reported psychometric properties. Wilson and Miller (1968) also

used an unpublished measure with no reported psychometrics to assess fearfulness. Williams and Cole

(1968) used the Religious Participation Scale, an unpublished measure derived from a paper presented at

a regional conference, which again, included no reported psychometric properties. Petersen and Roy

(1985) reported satisfactory internal consistency for the Religious Salience scale used in their study, but

no additional psychometric properties were reported for either this scale or the other scales used.

Without well-documented reliability and validity estimates, it is imprudent to generalize the

findings from these studies to other populations, or more importantly, to compare these findings to

those from previous studies using comparable measures. Conclusions can only be accepted tentatively,

as without normative data for the scales used there is no reference point for data comparison. Perhaps

more importantly, there is no evidence to support that experimenters are indeed measuring the

constructs they purport to be measuring. The possibly poor psychometric properties of some of the

religiosity measures may be a significant contributor to the divergent and sometimes contradictory

findings in this area of research.

A number of experimenters utilized one- or two-item indices to assess religious variables.

Petersen and Roy (1985) assessed ‘‘religious comfort beliefs’’ with three items and both church

attendance and ‘‘other-worldly/this worldly orientation’’ with single items. Others (e.g., Krause &

Van Tran, 1989; Williams et al., 1991; Wilson & Miller, 1968) used one to three item indices

developed by the experimenters to measure a number of religious variables (e.g., church attendance,

affiliation, organizational and nonorganizational religiosity). When potentially complex constructs are

assessed with only one or two items, it is likely that important aspects of the construct are being

missed, yielding poor content validity. Moreover, the reliability of such a limited assessment is

questionable.

2.1.2. Sample size and sampling procedures

Several studies (e.g., Finney & Malony, 1985; Spellman et al., 1971; Sturgeon & Hamley, 1979) used

small sample sizes that threatened generalizability of findings. Although power, or the ability to reject

the null hypothesis as false if indeed it is false, may have also been lowered due to small samples, indices

of power were not provided by the authors, and thus power cannot be evaluated. However, the relatively

small size of the samples in these studies may have greatly limited the generalizability of the findings to

the greater population.

A number of experimenters also employed sampling procedures that rendered their studies especially

vulnerable to bias. For example, Spellman et al.’s (1971) sampling procedure involved three clergymen

A.K. Shreve-Neiger, B.A. Edelstein / Clinical Psychology Review 24 (2004) 379–397390

subjectively categorizing citizens of a farming community into ‘‘regular attender,’’ ‘‘nonreligious,’’ and

‘‘sudden convert’’ groups. While the authors did report interrater reliability, the validity of this sampling

method is questionable due to potential biases on the part of both clergy and the experimenters in their

selection of clergy. In addition to sampling procedure problems, several studies lacked generalizability

due to homogenous sample composition.

Finney and Malony’s (1985) sample consisted of nine Christian volunteers, whereas Bergin et al.

(1987) recruited a completely Mormon sample from Brigham Young University, 98.6% of whom

were categorized as intrinsically (vs. extrinsically) religious. Similarly, Sturgeon and Hamley (1979)

used a Christian sample from a conservative, Protestant, private college. Baker and Gorsuch (1982)

recruited their sample from a religious wilderness camp. These studies used participants who were

religiously homogeneous who may have responded to self-report questionnaires in ways they thought

were socially desirable in terms of their religion.

All of the reviewed studies, with the exception of one (Tapanya et al., 1997), used Christian-

based measures of religion and consequently tapped into only Christian samples. Interestingly,

Tapanya et al. (1997) found differences in measures of anxiety and intrinsic/extrinsic religiosity

between Christian and Buddhist samples. This finding demonstrates the potential for differential

findings according to the sample’s religion. Because religiosity was a variable of interest in each of

these reviewed studies, a religiously heterogeneous sample would have been optimal to ensure

validity and generalizability to other populations.

A number of studies (e.g., Bergin et al., 1987; Brown & Lowe, 1951; Fehr & Heintzelman, 1977;

Frenz & Carey, 1989; Heintzelman & Fehr, 1976; Sturgeon & Hamley, 1979; Williams & Cole, 1968;

Wilson & Miller, 1968) used entirely young, undergraduate samples. While using samples of

convenience is common in psychological research, results from these studies were severely limited

in their generalizability to other populations.

2.1.3. Statistical issues

Dichotomizing participants into ‘‘high’’ and ‘‘low’’ categories for analyses can be problematic

for several reasons. It may not only lower statistical power, but it in no way ensures that groups

defined as high or low correspond to groups so labeled in other studies or in the general

population (Allison, Gorman, & Primavera, 1993). Sturgeon and Hamley (1979) divided their

sample into quartiles, and then used only the 20 highest and lowest scorers on a measure of

intrinsic/extrinsic religiosity. While dichotomizing variables allowed for analysis of differences

between groups, there was no indication that these groups were indeed representative of the general

population.

In addition to validity threats from dichotomization of variables, a number of experimenters (e.g.,

Bergin, Masters, & Richards, 1991; Fehr & Heintzelman, 1977; Frenz & Carey, 1989; Heintzelman

& Fehr, 1976) conducted multiple correlational analyses without adjusting the alpha level in their

significance tests. Failure to use a more conservative alpha level increases the probability of a type 1

error suggesting that these studies may have erroneously found significant correlations that would

not have been evident had the proper statistical corrections been utilized.

Although many of the reviewed studies included multiple regression analyses, several experimenters

used other forms of analysis including multivariate regression (e.g., Hertsgaard & Light, 1984),

structural equation modeling (e.g., Krause & Van Tran, 1989; Williams et al., 1991), and mean

difference statistics (e.g., Spellman et al., 1971; Sturgeon & Hamley, 1979; Williams & Cole, 1968).

A.K. Shreve-Neiger, B.A. Edelstein / Clinical Psychology Review 24 (2004) 379–397 391

An explanation for how particular analyses were chosen over others when analyzing similar types of data

would be beneficial for a number of the reviewed studies.

2.2. Conceptual issues

2.2.1. Operationalization of constructs

Constructs such as religiosity and anxiety are complex and difficult to operationally define. For

years, researchers have relied on measuring the most simplistic and easily quantifiable manifestations

of religion such as church attendance or affiliation. As a result, much of religion as a construct may

have been missed. Several of the reviewed studies attempted to assess other more abstract aspects of

religion but failed to define these constructs in concise, measurable ways. For example, Finney and

Malony (1985) referred to contemplative prayer as ‘‘a means of relating to God in a nondemanding

and defensive way,’’ but did not explain what specifically is involved when one is relating to God in

this manner or how this differs from other types of prayer.

Similarly, Spellman et al. (1971) asked three ministers to categorize members of a community

into ‘‘regular church attender,’’ ‘‘nonreligious,’’ and ‘‘sudden conversion experience’’ categories.

They asserted that ‘‘typically the lines between these groups are easily drawn by clergymen,

particularly in small communities.’’ They did not, however, describe the selection criteria used by

the clergy, or explain why it was assumed that regular church attendance could be equated with a

‘‘gradual conversion experience.’’ The construct of conversion experience remained vague, as did the

method by which people were categorized. A vague operational definition of a construct not only

threatens study replicability, but also makes generalizability of findings unlikely since the parameters

by which people were classified remain unclear.

Wilson and Miller (1968) employed self-rating items purported to be ‘‘commonly associated with

religious practices’’ as their measure of religiosity. The items were categorized as assessing ‘‘church

attendance, belief in a supreme being, soul immortality, and religious morality,’’ but no definitions or

item examples were offered. While church attendance is fairly straightforward, ‘‘soul immortality’’

and ‘‘religious morality’’ are abstract constructs that require definition, yet none was offered, and no

reference given. Again, without clear definitions or sample items, it is difficult to know exactly what

the authors were assessing.

In summary, poor operationalization of constructs suggests a weakness in this area of research.

Because religiosity is a complex, multidimensional construct, when religious variables are studied,

specific, empirically supported definitions are needed to back the measurement and conceptual-

ization of these constructs. The implications of poorly operationalized religious constructs are that

the authors may have failed to assess what they were initially targeting, and/or they and the

reader may have very different ideas as to what was actually measured and manipulated in these

studies.

2.2.2. Assessment of anxiety

In every study reviewed, anxiety was assessed through the use of self-report measures. The

manifestation of anxiety perhaps typifies the interplay between cognitive, physiological, and

behavioral response systems. As such, it is troubling that the reviewed studies did not examine

the relation between physiological or behavioral parameters of generalized anxiety and religiosity.

This reliance on self-report is a limitation to all of the reviewed studies. Just as the multidimensional

A.K. Shreve-Neiger, B.A. Edelstein / Clinical Psychology Review 24 (2004) 379–397392

nature of religion has been espoused throughout this paper, the already well established multiple

dimensions or tripartite model of anxiety should not be ignored.

2.2.3. Faulty conclusions

A number of conclusions drawn from the reviewed studies were unfounded because the

experimenters inferred causation from correlation. Hertsgaard and Light (1984) concluded from a

significant negative correlation that factors, including church attendance, appear to minimize anxiety

in rural women. Similarly, Petersen and Roy (1985) concluded that church attendance reduces

anxiety, again from a significant negative correlation. Spellman et al. (1971) referred to sudden

conversion as a ‘‘pseudosolution’’ to anxiety, suggesting that it momentarily reduces anxiety, but

then is ultimately related to higher anxiety levels. Although this conclusion may be plausible,

findings from this study did not empirically support this assumption because there were no indices

of anxiety taken before the conversion experience that could be compared to post conversion

anxiety.

Finney and Malony (1985) administered the trait version of the STAI on a weekly basis in their

study to assess changes in anxiety as related to increases in contemplative prayer. The authors

concluded that their findings of decreased anxiety levels for three of the weeks gave some support

to their hypothesis that engaging in contemplative prayer would be related to less anxiety. It is

notable, however, that by using the trait rather than state version of the STAI, the authors were

employing a measure developed to assess stable, traitlike characteristics rather than one to assess

transient context-dependent characteristics that would be expected to vary as a result of contem-

plative prayer. Conclusions made by these authors can only be accepted tentatively as it remains

unclear why the state version of the STAI was not utilized for this study when anxiety levels were

expected to covary with contextual change (e.g., the practice of contemplative prayer).

2.3. Synthesis of the findings

Taken together, findings from several studies (e.g., Hertsgaard & Light, 1984; Petersen & Roy, 1985)

suggest that while overt interpersonal behaviors may be linked to decreased anxiety, other more covert

and personal behaviors may be linked to increased anxiety. One study (e.g., Krause & Van Tran, 1989)

found that for older adults, there was not a relation. Other studies (e.g., Levendusky & Belfer, 1988;

Williams et al., 1991) found that religious affiliations may vary in relation to anxiety. Results from

several studies (e.g., Baker & Gorsuch, 1982; Bergin et al., 1987; Sturgeon & Hamley, 1979; Tapanya

et al., 1997) suggested that those who ‘‘live’’ their religion (e.g., intrinsic) endorse less anxiety than

those who ‘‘use’’ their religion (e.g., extrinsic). These findings are tentative, however, due to

methodological and conceptual problems that likely contributed to the contradictory findings of a

number of these and other studies that have attempted to examine the relation between religion and

mental health.

3. Conclusion and future directions

For the last half century, experimenters have been studying the relation between religiosity and mental

health. Anxiety is a debilitating and ubiquitous emotion, yet only a handful of studies has examined the

A.K. Shreve-Neiger, B.A. Edelstein / Clinical Psychology Review 24 (2004) 379–397 393

relation between general anxiety and religiosity. These studies yielded mixed and often contradictory

results that may be attributed to a lack of standardized measures, poor sampling procedures, failure to

control for threats to validity, limited assessment of anxiety, experimenter bias, and poor operationaliza-

tion of religious constructs. It is also likely that some religious aspects are positively related to anxiety

while others are not, and results vary according to which is assessed. No study in this review escaped

methodological and/or conceptual criticism. This leaves much work for future researchers who can

address these shortcomings in a number of ways.

Several studies failed to use a multidimensional measure of religiosity or poorly operationalized the

religious aspect they were purporting to measure. Just as with other psychological constructs such as

depression or well being, initial research has historically been informed by theory and hypotheses, and

dimensions of constructs have subsequently been identified and empirically validated through

thorough assessment. Psychometrically sound, multidimensional assessment of religion is just in its

developing stages. Future studies utilizing well-validated multidimensional measures can clarify

specifically which aspects of religiosity are linked to anxiety. The Fetzer Institute (1999) has devised

such a measure that includes multiple subscales (e.g., religious commitment, organizational religious-

ness, religious support, private religious practices, values, beliefs, forgiveness, and daily spiritual

experiences). Preliminary studies have demonstrated the measure’s promising psychometric properties.

Future work with this measure may further elucidate the nature of the relation between religiosity and

anxiety.

Physiological or behavioral assessments of anxiety were also largely absent from the literature.

Because anxiety is manifested in cognitive, physiological and behavioral response systems, this is a great

limitation. Future work can address this limitation by incorporating physiological or autonomic measures

in addition to direct observation of behavioral anxiety-related responses to supplement and further clarify

the relation between anxiety and religion.

Numerous studies have demonstrated that older adults are especially religious and tend to integrate

religiosity into their daily lives (Koenig, George, Blazer, Pritchett, & Meador, 1993; Krause & Van

Tran, 1989). Future work with older adults is promising both because religiosity is especially salient to

many in this population, and because there is growing evidence to suggest that this population taps into

some of the more positive and healthful aspects of religion. In fact, Crowther, Parker, Achenbai,.

Larimore, and Koenig (2002) propose adding a ‘‘positive spirituality’’ dimension to Rowe and Kahn’s

(1998) model of successful aging because they believe it is the missing component that addresses the

relations between older adults’ beliefs, values, community, and the efficacy of interventions focused on

successful aging.

There is also evidence to suggest that although anxiety disorders are less frequent in older adults,

subsyndromal or subthreshold anxiety is more common (Heun et al., 2000; Papassotiroopoulos & Heun,

1999). Studies that incorporate general measures of anxiety instead of standard diagnostic measures

when utilizing older adult populations may find relations between religion and anxiety that would not

and have not been detected otherwise.

In addition to using multidimensional measures, future researchers could broaden their samples in

terms of demographics and religiosity. Many studies relied solely on homogenous samples of

convenience recruited from religious, primarily Christian, institutions. Sample inclusion of nonreli-

gious or diversely religious individuals would increase generalizability of findings. In terms of

statistical analyses, studies that utilize mean difference statistics and path analyses to test buffering

and moderator hypotheses, would offer information regarding directionality not provided in most of

A.K. Shreve-Neiger, B.A. Edelstein / Clinical Psychology Review 24 (2004) 379–397394

these studies. It would also be beneficial for future researchers to support their choices of statistical

analyses and incorporate additional methods that could supplement these traditionally correlational

studies.

Finally, while one study (Finney & Malony, 1985) attempted to examine the relation between

integration of religion into clinical treatment and efficacy of outcome, this study poorly operation-

alized and assessed the religious construct involved. The utility of integrating or simply acknowl-

edging religious aspects/practice in clinical treatment for those who are religious is worthy of future

examination. Specifically, clinicians might assess a client’s degree of religious involvement as a

standard part of an intake interview. Through continued scientific inquiry, a therapist can be

informed on how to successfully validate or discuss the role of religion in a client’s life while

maintaining objectivity. In addition, through the identification of aspects of religion that may protect

one from or increase the chances of developing anxiety, proactive or preventative treatments may be

developed. This is not a call for clinicians to practice religion in therapy or let religion influence

therapy, but rather acknowledge and discuss the role religion may play in the client’s life and

potentially in treatment. Because religion appears to be important to so many people, including it as

a variable for study in clinical settings may contribute greatly to our understanding of the interplay

between religiosity and mental health for much of the clinical population.

In conclusion, healthcare professionals are calling for increased awareness and study of religious

variables and their impact on mental and physical health. Anxiety is a prevalent and pervasive

mental health construct that has been understudied in relation to religion. Preliminary evidence

suggests that anxiety and religion are related in some ways. Empirically and conceptually sound

research addressing the anxiety–religiosity relations, with an eye to the shortcomings of previous

research, will hopefully further our understanding of the relations between religion and anxiety,.

Finally, it also may inform treatment and prevention of anxiety in a variety of populations,

especially the many for whom some aspect of religion is fundamentally important.

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Religious Factors and Values in Counseling: A Symposium 263

Psychotherapy as a Religious Value

Henry Enoch KaganSinai Temple, Mount Vernon, New York

The topic "Religious Factors and Valuesin Counseling" excites this dilemma—wheredoes psychology end and theology begin?At a comparable symposium at New YorkMedical Center, a psychiatrist admittedreligious faith might be helpful in healing,but he refused to define religious faith onthe grounds that it was outside his pro-fessional competence. A professor of pas-toral theology, on the other hand, wasshocked when the writer made the sugges-tion that the effect of prayer be submittedto an objective psychological investigation.This, he contended, would not only be aninvasion of a man's religious privacy butan insult to God even though it should havebeen obvious that the proposed study wouldperforce be confined to prayer's effect onman's and not on God's mind.

The dilemma does exist. It exists not be-cause psychology and theology disagree onthe reality of religious experience as a sub-jective phenomenon, but because they maydiffer on the objective validity of that ex-perience. Even so, the relation betweenreligion and psychotherapy is inextricable,certainly from their historical developmentand the theoretical point of view and in-creasingly so from their contemporary func-tional mutuality.

Freud and ReligionFreud, himself, devoted much of his in-

tellectual energies to theorizing about re-ligion. To be sure, most of his speculationswere about religion as an obsessional deter-rent or unhealthy retardation of maturity.Freud did reckon with religion as a factor,indeed, as the most profound of factors, buthe did not recognize it as a value in psy-chotherapy. However, even on this matterof religious values, recent anniversarystudies by Jones and others reveal Freud'sown ambivalence.

At one point Freud's pride in his ownJewishness appears to be simply defensive

or entirely ethnic; but at another he pro-claims strong positive feelings towardJudaism which he seems to claim to be theonly historical religion to have successfullyresolved his prehistoric crime of father-murder. "It has seldom been so clear to meas now," Freud wrote, "what a psychologi-cal advantage it signifies to be born aJew and to have been spared in one's child-hood all the atavistic nonsense," and hedeclared, "Judaism is a triumph of spiritual-ity over the senses and a self-confidencethat accompanies progress in spirituality"(Freud, 1939, p. 178).

Freud did not confine his ambivalenceon religious values to his Jewish heritage.Among the many letters written to his stu-dent, the Swiss Christian clergyman, OscarPfister, whom in good humor Freud calls"a true servant of God the very idea ofwhose existence seems to me highly un-likely" we read: "In itself psychoanalysisis neither religious nor the opposite but animportant instrument which can serve theclergy as well as laity when it is used onlyto free suffering people. I have been verystuck at realizing how I had never thoughtof the extraordinary help the psychoanaly-tic method can be in pastoral work, prob-ably because wicked heretics like myselfare far away from that circle" (Jones, Vol.2, 1955, p. 440). In that same letter thisstrictly moralistic heretic suggested that itis because most people are no longer re-ligious that those among them who cannotendure their suffering must needs turn topsychoanalysis to master their "obdurateinstincts."

Freud even admired proper religious sub-limation, adding, to be sure, that such re-ligious success will depend on the maturityof the person-to-person relationship be-tween pastor and parishioner, for Freudwrites to Pfister: "You are in the fortunateposition of leading them to God and re-constructing conditions of earlier times,.

264 Henry Enoch Kagan

fortunate at least in the one respect thatreligious piety stifles neuroses" (Jones, Vol.2, 1955, p. 440). In discussing transferencewhich he considered to be a "curse," Freudwrote to Pfister: "psychoanalysis perhapsachieves a cure but not the necessary de-gree of independence or a guaranteeagainst relapse" and to the clergy therapist,he continued, "it is easier for you in thisrespect than for us physicians because yousublimate the transference on to religionand ethics and that is not easy with serious-ly ill people. From the therapeutic pointof view I can only envy your opportunityof bringing about sublimation into religion.But the beauty of religion assuredly hasno place in psychoanalysis" (Jones, Vol. 2,1955, p. 448).

Since Freud made this statement 40 yearsago, has the development of dynamic psy-chology reached the point, unrelated to thepresent popular and suspect religious re-vival, where "the beauty of religion" cantake place in the psychotherapeutic pro-cess? In the long run, Freud's critique ofreligion may prove to be more constructivethan Jung's affirmations of religion whichare so frequently referred to in order tobring "the beauty of religion" into therapy.If "any statement about the transcendent"is "always only a ridiculous presumption ofthe human mind which is unconscious ofits boundaries" and "God for our psychol-ogy is only a function of the unconscious,"to quote Jung (Buber, 1952, p. 79), wehave to deal here with something, but it isnot religion. While religion does glorifyman for being able to communicate withGod, it is also humble enough not to makeGod's existence depend upon man. Thereligious philosopher, Martin Buber, prop-erly criticizes Jung for failing to make thisdistinction between the religious and thepseudo-religious in which every "allegedcolloquy with the divine is only a solilo-quy" (Buber, 1952, p. 134).

Psychology and Religion in GuiltThis sensitive distinction between the

religious and the pseudo-religious will haveto be made if positive values are to be

derived in dealing with religious factors incounseling. The religious connotations andeven stubborn religious convictions thatunderlie many factors in the therapeuticrelationship cannot be categorically deniedby the rigid formulas of frigid counselorsnor be cavalierly circumlocuted by a con-fidant because of his own religious un-certainties.

How can the feeling of guilt in our cul-ture be completely separated from thereligious concepts of sin? The anxiety ofguilt is one of the most painful of psychicillnesses just because its roots are deep inreligious origins which intensify guilt. Af-ter a period of dark despair following adecimating persecution, there arose amongEast European Jews in the eighteenth cen-tury a religious movement of joyful pietismcalled Hassidism. The Hassidic Rabbis wereconcerned about the abnormal guilt whichprofoundly depressed the Jew, derived asit was from his belief that his suffering wasa punishment by God. A piquant exampleof their effort to normalize guilt is theHassidic explanation of why the liturgicallisting of sins recited on the Jewish Dayof Atonement is arranged in alphabeticalorder. "If it was not otherwise," theseRabbis said, "we should not know when tostop beating our breasts for there is noend to sin and no end to being aware ofsin, but there is an end to the alphabet."

Today, it is popular to accuse the psycho-therapist of relieving the person of all senseof guilt for the sake of his physical healthand to charge the clergyman with inducinga sense of guilt for the sake of the person'sspiritual improvement. Such can only bethe case when either party is insensitiveto the distinction between normal guilt andneurotic guilt which can be as harmful asbeing unable to distinguish between exis-tential anxiety and pathological anxiety.Into this area of guilt there can impingethe theological concept of original sinwhich does compound anxiety because itbears with it not only the sinfulness of sexbut the forfeiture of free will. Judaism doesnot ascribe man's conscious awakening tosexuality as punishment for Adam's fall

Religious Factors and Values in Counseling: A Symposium 265

from grace and therefore does not believemen are predetermined by the act of birthto evil. However, regarding religious con-cepts which do abnormalize the natural, theobservation of the Christian theologian,Paul Tillich, is relevant. "If religion," hesays, "does not lead to or does not directlysupport pathological self-reduction, it canreduce the openness of man to reality,above all the reality which is himself. Inthis way religion can protect and feed apotentially neurotic state" (Tillich, 1952,p. 73). To what extent will the highestlevel of aspiration which religion demands,itself contribute to the frustration-aggres-sion pattern which can lead to a violencewithout shame in the very name of religion?

Contrariwise, can the symbol of God asa forgiving and a loving Father help to healguilt? Here again the patience to discrim-inate on the part of a counselor becomesappropriate. How often is overt rebellionagainst a so-called angry God by a coun-selee but a temporary concealment of hishate for his own father? Does rebellionagainst God reflect the presence of an over-powering father in the home or does itpoint even more to resentment over theabsence of paternal authority in the mod-ern family? Will the deification of a mater-nal figure provide a greater feeling of athomeness in the world any more than doesthe mother-dominated, absentee-fatherhome provide security for the child? Unlesscounseling is to be conducted in a spiritualvacuum, this current complex between fam-ily role and religious figure will requireincreasing attention as a pertinent factor.

Serious as is anxiety over guilt, sex, freewill or family role and their religious over-tones, the greater anxiety which compelspersons to seek counseling arises from mod-ern man's search for meaning and quest forhope. Those who think with Macbeth thatlife "is but a tale told by an idot, full ofsound and fury, signifying nothing" do be-come as emotionally distraught and hope-lessly depressed as Macbeth. Recent psy-chiatric studies lead to the conclusion thatwhere there is hope there is greater successin enduring pain, in healing and prolonging

life. Hope vanishes when the need to be-long, the need to be loved and the needto believe are unmet. These three needsappear to be so closely interrelated thatit ought to be investigated how the absenceof belief will warp the capacity for humanlove, physical and psychic, and will abusecompanionship to conquer loneliness. As thecase histories of Mortimer Ostow show,the disavowal of religion does not cancelthis need to believe (Ostow, 1954). Somemay place their faith in scientific methodand others will create objects imageswhich are quasi-religious. Self-made fan-tasies are like acquired classic religioussuperstitions in that both are used by theself to protect it against a hostile world.They are intrapsychic, whereas the high-est aspirations of religion are interpsychicin that they relate self to others in a hos-pitable world.

Clergyman as Psychologist

Because our society is no longer madeup of integrated communities with religiousorientation, there is a crisis in meeting theneed to believe. A recent study of thechanging role of the clergyman shows thatas his role as ritual symbolizer or congre-gational leader has declined, his role aspastoral counselor has grown because thereare isolated, mobile individuals in ourextensive, secularized and atomized societyin search of roots they hope to find througha personal spiritual relationship which theycan no longer find in traditional theologicalsymbols. This will not sound sacrilegiousto those who remember that the foundersof all religions clearly differentiated be-tween the outward symbolic and the in-ward spiritual. To them the beginning ofthe latter was a unique relationship of manto man, each concerned for the other'smutual sanctity. Thus conceived, therapeu-tic counseling, whether done by a seculartherapist or by an equally trained clergytherapist (whose role must become a newreligious specialization relieving him of themore obvious judgmental ecclesiasticalfunctions), not only deals with religiousvalues since value judgments are intrinsic

266 Charles A. Curran

to the counselor as well as to the counseleeno matter how objective and nondirectivethe technique, but the relationship maywell be in itself a religious value.

The crux of the matter depends uponhow the counselor looks upon himself aswell as upon the other as a person. Thisapplies to counselor and to clergy alike.Whether the one or the other conceivesof himself as acting in the role of inter-mediaryship or in the role of relationshipwill not depend on whether he feels or-dained by God or ordained by degrees. Allof us are persons of doubt as well as faith.Some of us consciously devout are un-consciously skeptical; and some consciouslyskeptical are unconsciously devout. As per-sons we will not assume an omnipotencewhich is not ours. The expectancy of suchomnipotence in us by our clients is a meas-urement of their neuroticism. We will notlook upon ourselves solely as the expertswho have the skill to help others. Totalpreoccupation with technique may concealone's own uncertainty in the art of living.Rather we should say of ourselves, "I ama person who is myself helped when Ihelp others." This requires the intimateconverse of two in a dialogical interchangewhose essential element is experiencing theother side. In the first attitude, the relation-ship is that of subject to an object, an I toan It; in the second attitude, the relation-ship is one of person to person, an I toThou relationship which in Martin Buber'sdefinition is itself a religious experience.Such an interhuman relationship is of therarest sanctity beyond the most knowledg-

able psychology and theology which oneHassidic Rabbi said he learned from anuntutored peasant.

Said Rabbi Moshe Leib of Sassov (died1807), "How to love men is something Ilearned from a peasant. He was sitting inan inn along with other peasants drinking.For a long time he was as silent as all therest, but when he was moved by the wine,he asked one of the men seated besidehim, "Tell me do you love me, or don't youlove me?" The other replied, "I love youvery much," but the first peasant in hiswine replied, "You say that you love mebut you do not know what I need. If youreally loved me, you would know!" Theother had not a word to say to this and thepeasant who had put the question fell silentagain. "But I understood," said Rabbi Leib,"To know the needs of men and to helpthem bear the burden of their sorrows,that is the true love of men."

ReferencesBuber, M, I and thou. Edinburgh: T. & T. Clarlc,

1937.Buber, M. The eclipse of God. New York: Harper,

1952.Freedman, M. S. Martin Buber: The life of dia-

logue. Chicago: Univer. of Chicago, 1955.Freud, S, Moses and monotheism. New York:

Knopf, 1939.Jones, E. The life and work of Sigmund Freud,

Vol. 2. New York: Basic Books, 1955.Kagan, H. E. Atonement for the modern Jew.

CCAR Journal, 1958, 4, 8-15.Ostow, M., & Scharfstein, B. The need to believe

New York: International Univer., 1954.Tilhch, P. The courage to be. New Haven: Yale,

1952.

The Counseling Relationship and Some Religious FactorsCharles A. Curran

Loyola University

In some of the old classic Dutch andItalian paintings, it was the artists' practice,as Stephen Tennant (1949) has pointedout, to give adrawing-room or kitchen in which there is awindow open, through which you see the mastsof ships, or a strip of grey sea, or vistas or colon-nades or a balcony, a garden or a court . . .

The experience afforded the viewer here. . . is essentially one of gazing beyond the im-mediate scene to a timeless sky or a timeless room,in which the future and the past, the unspokenand the unknown, forever beckon . . .

If we were to ask what religious factorsand values introduce into the counselingprocess, we might answer that, like the

Percepţiile despre smerenie: studiu preliminar

Julie Juola Exiline, Anne L. Geyer

Case Western Reserve University, Cleveland, Ohio,

USA

Percep oamenii smerenia ca fiind o forţă sau ca o slăbiciune? Studiul acesta a încercat

să răspundă întrebării având un eşantion de 127 de studenţi. Contrar definiţiilor date de

dicţionare, care adesea asociază smerenia cu auto-retrogradarea, participanţi studiului au avut o

opinie bună despre smerenie. La reamintirea situaţiilor în care s-au simţit umili, ei susţin că au

fost experienţe cu succes asociate cu emoţii pozitive. Participanţi au asociat smerenia cu o bună

reglare psihologică, deşi nu erau decişi dacă smerenia poate fi asociată cu încrederea sau

leadershipul. Deşi participanţii au privit smerenia ca pe o forţă în rolurile sociale, părerile mai

favorabile au suţinut că smerenia este o calitate a persoanelor religioase, nu este o calitate cu care

poţi să îi subordonezi pe ceilalţi, cu atât mai puţin o calitate a liderilor. Opiniile pozitive despre

smerenie au fost asociate cu o stimă de sine ridicată şi religiozitate. Opiniile mai puţin favorabile

au fost asociate cu narcisismul-în special faţă de exploatarea/intitularea dimensiunii.

Percep oamenii smerenia ca fiind o forţă sau ca o slăbiciune? Aşa cum a fost descris de

către Tangney (2000), definiţiile date de dicţionare descriu smerenia în sens negativ, asociind-o

cu auro-retrogradarea, stimă de sine scăzută şi umilinţă. Pe de altă parte smerenia poate fi văzută

ca pe o forţă, o virtute, aşa cum aste sugerat în scrierile religioase (de ex. Casey, 2001;Murray,

2001) tratate filozofice (ex. Morgan, 2001; Richard, 1992) şi cercetările recente din psihologie

(ex. Exline, Campbell, Baumeister, Joiner & Kruger, 2004; Emmons, 1999;Friesen, 2001;

Landrum, 2002, Sandage, 1999, 2001; Tangney, 2000, 2002).

În ciuda atenţiei care se acordă recent smereniei, psihologii încă ştiu puţine lucruri despre

percepţiile oamenilor despre smerenie- o văd doar ca pe o slăbiciune sau o forţă. Scopul acestui

studiu preliminar a fost să analizeze percepţiile despre smerenie dintr-un eşantion cu studenţi din

America de Nord. Ne-am axat în particular pe următoarele întrebări: cred oamenii că smerenia

este o virtute care se poate cultiva, sau o slăbiciune care trebuie minimalizată? Este smerenia

văzută ca o trăsătură dezirabilă doar pentru anumite tipure de oameni-figuri religioase poate,

opusă liderilor? Totodată am dorit să cercetăm în ce fel diferenţele individuale variabile cum

este religiozitatea, narcisismul şi stima de sine, pot fi relevante asupra percepţiilor despre

smerenie.

Culturile vestice moderne pledează intens în ajutarea oamenilor să se vadă pe ei înşişi

într-o lumină pozitivă. Stima de sine scăzută a fost blamată din cauza serioaselor probleme

sociale cum este violenţa (de văzut Baumeister, Smart & Boden, 1996, pentru o discuţie mai

largă). În ultimele secole am fost martori la finanţări din partea statului pentru a creşte stima de

sine (Mecca, Smeler & Vasconcellos, 1989) şi o mulţime de cărţi de auto-ajutorare pentru a-ţi

creşte stima de sine (de ex. Braden, 1994). Atunci când oamenii se confruntă cu slăbiciuni

personale sau eşecuri, au nevoie să distorsioneze adevărul în aşa fel încât să se simte bine cu ei

înşişi. Unele dovezi sugerează că o asemenea distorsionare favorabilă, folosită cu moderaţie, se

poate asocia cu o sănătate mentală bună şi posibil că şi cu una fizică la fel (ex. Taylor & Brown,

1988; Taylor, Kemeny, Reed, Bower & Gruenewald, 2000). A te privi te tine în sens favorabil

generează încredere şi emoţii pozitie, care pot aduce beneficii şi în alte domenii care au nevoie

de ajustare.

Conform preocupării actuale a Vestului, de a promova perceperea în sens favorabil a

propriei persoane, este uşor de imaginat că neasumarea trăsăturii de smerenie poate fi dezagreată.

Aşa cum a fost discutat de Tangney (2000), oamenii pot asocia rapid termenul de smerenie cu o

părere negativă despre sine şi un sens al inutilităţii.

În contrast cu această imagine negativă a smereniei, scrierile recente oferă o amplă

viziune că smerenia poate fi încadrată ca o virtute sau o forţă. Teologii şi scriitorii devotaţi au

scris mult despre meritele smereniei (ex. Casey, 2001; Mogabgab, 2000; Murray, 2001; Roberts ,

1982; von Hildebrand, 1997) şi capcanele mândriei, care adesea apar printre “Cele 7 păcate

capitale” (ex. Schimmel, 1992). Filozofii au scris tot despre smerenia ca virtute şiau dezbătut

îndelung definiţia exactă a acesteia, beneficiile şi riscurile smereniei (ex. Ben-Ze‟ev, 1993;

Driver, 1989; Hare, 1996; Morgan, 2001; Richards, 1992).

Smerenia este o piatră de temelie pentru “Alcoolici Anonimi” şi alte programe de tip “12

paşi”, create pentru a distruge adicţiile (ex. Kurtz & Ketcham, 1992).

Cei care au scris despre programul “Alcoolici Anonimi” s-au referit la faptul că smerenia

este văzută aici ca fiind abilitatea de a accepta onest umanitatea omului, cunoştinţele sale limitate

şi imperfecţiunile sale-inclusiv slăbiciunea omului faţă de alcool (Pasul 1) (Kurtz & Ketcham,

1992). Conform lui Kurtz şi Ketcham (1992), smerenia implică respingerea implicită a cererilor

de genul “totul sau nimic” şi în locul acesteia să se pună alegerea unui statut de om simplu. Se

descrie cum smerenia poate pava calea alcoolicilor spre a se supune Marii Puteri (Pasul 2) şi să

cedeze controlul recuperării acetei Mari Puteri (Pasul3). După aceste raţionări, o lipsă a

smereniei ar împiedica recuperearea din alcoolism (de văzut Tiebout, 1994). Cercetări empirice

recente despre noile recuperări ale pacienţilor alcoolici (Hart & Huggett, 2003) oferă rezultate

relevante care susţin acest argument. Studiile arată că o auto-percepţie narcisistă a autorităţii şi

superiorităţii corelează negativ cu recuperarea alcoolicilor şi cu predarea în faţa Marii Puteri aşa

cum s-a descris la paşii 2 şi 3.

Alte conceptualizări recente ale smereniei oferă perspective complementare. De exemplu

Means, Wilson, Sturn, Biron şi Bach (1990) au spus că smerenia implică: a) o dorinţă a fiecăruia

de a-şi admite greşelile; b) o recunoştere a faptului că nu se pot controla toate evenimentele

sociale care ne întâmpină; c) o atitudine de răbdare şi bunătate faţă de ceilalţi oameni şi d) simţul

empatiei faţă de ceilalţi. Roberts (1982) subliniază că există o lipsă de preocupări în ceea ce

priveşte rangul social ca o caracteristică de bază a smereniei.. Sandage (1999) foloseşte termenul

de “ego-smerenie”, ca referire la orientarea realistă asupra sinelui, care include dorinţa de a ne

cunoaşte forţele şi de a face faţă limitelor noastre.

Mai recent psihologi sociali şi ai personalităţii au început să cerceteze smerenia ca pe o

formă de virtute sau forţă personală. Emmons (1999) sugerează că smerenia implică precizie,

auto-acceptare, înţelegerea proprilor imperfecţiuni, păstrarea talentelor proprii şi perspective de

realizare şi eliberare din aroganţă şi stima de sine scăzută. În lista sa caracteristicile cheie ale

smereniei, Tangney (2000, 2002), include un sens acurat al abilităţilor, abilitatea de a-şi

recunoaşte propriile greşeli, imperfecţiuni, lacune în cunoştinţe şi limitări (adesea cu referire la

Puterea cea Mare), deschidere spre noi idei, informaţie contradictorie,sfaturi, şi abilitatea de a-şi

păstra propriile abilităţi în perspectivă de viitor. După Landrum (2002), smerenia implică o

atitudine open-mind, o dorinţa de a-şi recunoaşte greşelile şi de a căuta sfaturi, şi o dorinţă de

învăţăre. În opinia noastră (Exeline et al., 2004) smerenia implică o dorinţă nedefensivă de a-şi

vedea sinele acurat, incluzâns atât forţe cât şi limitările. Noi am propus că smerenia constă în

căutarea unui sens de siguranţă în care sentimentul de valoare este stabil, sursă de încredere, (de

ex. a te simţi iubit necondiţionat), credinţa în viaţă ca având valoare, mai degrabă decât ceva

tranzitoriu, din surse externe ca realizarea, aparenţa sau aprobarea socială. Un asemenea

sentiment de siguranţă poate fi tulpina valorilor personale, opinii despre religie sau experienţele

vieţii.

Aceste definiţii psihologice recente sugerează o viziune pozitivă asupra smereniei,

portretizând-o în primul rând ca pe o sursă de putere, decât ca pe o slăbiciune. Oricum definiţiile

laice nu se aliniază întotdeauna cu cele ale savanţilor, aceasta este o problemă care apare în

cercetare şi asupra unor constructe ca iertarea (pentru mai multe discuţii vezi Exeline,

Worthington, Hill şi McCullough, 2003). Date fiind preocupările noastre culturale privind

părerea pozitivă despre sine, este uşor de imaginat că smerenia poate fi foarte simplu văzută ca

fiind dezamagitoare. Aşa cum s-a discutat de către Tangney (2000) oamenii pot repede asocia

termenul de smerenie cu o opinie negativă despre sine însuşi incluzând sensul de inutilitate.

Chiar dacă oamenii pot păstra o opinie bună despre smerenie, pot avea rezerve în ceea ce

priveşte anumite persoane în anumite situaţii. O să ne întoarcem mai târziu asupra acestei idei.

Potenţialele beneficii şi costuri ale smereniei

Date fiind numeroasele posibilităţi de a definii şi conceptualiza smerenia, este evident că

opiniile individuale asupra acestui construct pot avea atât un ton negativ cât şi unul pozitiv. Din

punct de vedere pozitiv oamenii pot vedea smerenia ca pe o alternativă sănătoasă în locul unei

atitudini arogante, sau lăudăroase. Pot vedea oamenii smeriţi ca având calităţi de ajustare,

casentimentul de siguranţă, o părere clară despre sine şi o atitudine deschisă non-defensivă. La

fel pot asocia smerenia cu modestia. Ambele calităţi se pare că luptă împotriva lăudăroşeniei şi a

aroganţei, iar o opinie umilă a sinelui poate duce la o auto-prezentare modestă, opusă unei auto-

promovări grandioase.În final pare rezonabilă predicţia că oamenii smeriţi sunt mai agreaţi, mai

plăcuţi. Smerenia ar trebui să ajute la evitarea capcanelor date de periculizitatea lăudăroşeniei şi

atitudinile vizibile de grandomanie, care amândouă pot promova o impresie negativă în rândul

celorlalte persoane (ex. Calvin, Black & Funder, 1995; Godfrey, Jones & Lord, 1986; Leary,

Bednarski, Hammon & Duncan, 1997)

Acum avem deja motive să precizăm că oamenii îşi vor păstra opinia negativă asupra

smereniei. Aşa cum am menţionat mai devreme, indivizii pot asocia smerenia cu umilinţa, stima

de sine scăzută, sau auto-critică aspră- nici una ne fiind câtuşi de puţin pozitivă. Chiar dacă

oamenii au definiţii ale smereniei care se apropie de definiţiile savanţilor, ei se pot focusa pe

potenţialele costuri ale smereniei. Pentru că smerenia implică neajunsuri oamenii o pot asocia cu

experienţe eşuate ca depresia sau ameninţarea unei recăderi. Oamenii pot asocia smerenia cu

riscurile interpersonale, de exemplu în situaţiile competitive sau când se confruntă cu indivizi

foarte agresivi şi dominanţi, cei care eşuează în a se auto-promova, ori a-şi demonsta

superioritatea, au riscul de a fi rapid înlocuiţi. De altfel oamenii smeriţi ar trebui să îşi pună în

discuţie forţele propri (cum ar fi în cazul interviului pentru un job sau într-un rol de leadership),

a discuta despre propriile limite poate fi în detrimentul lor, dacă punctele lor forte nu se cunosc

(vezi Aronson, Willerman & Floyd, 1966), sau dacă audienţa respectivă preferă oamenii perfecţi

şi o încredere mare în auto-prezentare.

Rolurile sociale şi smerenia

De asemenea susţinem ideea că oamenii văd smerenia mai mult sau mai puţin pozitiv în

funcţie de rolul social al persoanei smerite. Pentru că smerenia este asociată cu religia (ex.

Morgan, 2001; Murray, 2001), este văzută ca pe o calitate printre figurile religioase. Mai departe

smerenia facilitează cooperarea, arătând o lipsă a preocupării despre sine, oamenii pot aprecia

prin smerenie pe ceilalţi ca prietenii, familia, sau partenerii romantici (vezi Friesen 2001, pentru

o discuţie despre cum poate smerenia să faciliteze comunicarea maritală).

Luând în considereare şi alte tipuri de roluri-poate fi smerenia considerată ca o trăsătură

dezirabilă la persoanele care trebuie să se arate puternice, cum sunt militarii sau lideri de

afaceri? Se observă diferenţele între stilurile de lideri (ex. directiv vs. participativ; Janis, 1982),

susţinem că imaginea prototip a unui lider nu trebuie să fie asociată profund cu smerenia. Avem

ca exemplu entertainerii care se aşteaptă să atragă atenţia asupra lor. Mai general vorbind poate fi

smerenia în detrimentul oamenilor care vor să conducă sau să performeze în faţa celorlalţi?

Susţinem că studenţii din studiul nostru vor trebui să facă aceste distincţii, considerând smerenia

ca o calitate mai puţin favorabilă pentru entertaineri şi lideri, decât la indivizii cu care aceştia

sunt în relaţii apropiate.

Diferenţele individuale

Ne aşteptăm să obţinem diferenţe individuale în atitudinea despre smerenie. Mai specific

prevedem că cei care practică smerenia să fie mai apropiaţi de religiozitate, narcisim şi stimă de

sine.

Raţionamentele nostre sunt următoarele:

Religiozitatea. Avem o ipoteză ce susţine o asociere pozitivă între religie şi părerea

despre smerenie. Mai multe perosoane religioase consideră smerenia ca pe o votrute, în contrast

cu viciul mândriei (ex. Schimmel, 1992). Multe dintre scrieerile ştiinţifice despre smerenie vin

cu o perspectivă devotată teologiei.

Uni cercetători argumentează că smerenia este o virtute fundamental religioasă, ceea ce

are sens doar atunci când se ia în considerare relaţia dintree fiinţa umană care va muri şi un D-

zeu omniscient (Morgan, 2001; Murray, 2001). Religiozitatea are legătură cu valorile mari şi

virtuţile ca iertarea (ex. Tsang, McCullogh & Hoyt, 2004). Pentru toate aceste motive noi

prezicem că religiozitatea este asociată cu o opinie pozitivă despre smerenie.

Genul. Cercetările sugerează că femeile se comportă cel mai adesea mai modest decât

bărbaţii (ex. Heatherington et al., 1993) şi tot ele sunt adesea mai sensibile decât bărbaţii în ceea

ce priveşte riscul social al supraperformării faţă de ceilalţi oameni (vezi Exeline &Label, 1999).

În procesul de socializare bărbaţii învaţă să valorifice individualismul şi căutarea de dominanţă

mai mult decât femeile (ex. Brod, 1987. Ne aşteptăm deci ca relativ la bărbaţi, femeile să aibă o

opinie mai pozitivă despre smerenie.

Narcisismul. Prin definiţie trăsatura narcisistă pare antagonistă smereniei. Indivizii

narcisişti se preocupă cu căutarea şi prezentarea lor într-o lumină pozitivă. Adesea reacţionează

defensiv la ameninţările stimei de sine (Baumeister et al. 1996; Bushman & Baumeister, 1998;

Rhodewalt & Mart, 1998) şi sunt motivaţi să domine în relaţiile interpersonale (Emmons, 1984;

Raskin, Novacek & Hogan, 1991; Raskin & Terry, 1988). Presupunem că indivizii narcisişti vor

avea o opinie nefavorabilă asupra smereniei, asociată cu slăbiciunea, pasivitatea şi lipsa de

încredere.

Stima de sine. Predicţii concurente se pot face pentru stima de sine şi părerile despre

smerenie. În ideea că stima de sine corelează cu narcisismul ne aşteptăm ca o stimă de sine

ridicată să fie asociată cu o opinie mai negativă despre smerenie, însă în ideea că stima de sine

este separată de narcisism, o stimă de sine înaltă poate fi asociată şi cu o opinie mai pozitivă

asupra smereniei. De ce? Pentru că aşa cum am discutat mai devreme un număr mare de

cercetători au propus că smerenia este facilitată de un sentiment de siguranţă sau auto-acceptare.

În ideea că constructul stimă de sine aduce un sentiment de onorabilitate, sau o atitudine pozitivă

asupra sinelui, smerenia ar trebui văzută într-o lumină pozitivă.

Dezirabilitatea socială. Cercetările prioritare (Landram, 2002) au sugerat că credinţele

auto-raportate despre smerenie pot fi asociate cu dezirabilitatea socială. Totuşi noi am dorit să

testăm aceste asocieri în studiul curent.

Metoda

Participanţi şi procedură

Avem ca participanţi 127 de studenţi în primul an la psihologie (61-băieţi şi 66-fete), de

la Universitatea privată din Vestul Mijlociu U. S. Toţi participanţii au completat un chestionar

pentru a primi credite parţiale pentru cursuri. Media a fost de 18,9. În eşantion au fost 77% albi

caucazieni, 19% asiatici, 6% afro-americani sau albi, 1% latini, 1% americani nativi şi 2% Estul

Mijlociu. Procentajul însumat a depăşit 100% pentru că participanţii au selectat mai multe

opţiuni asemănătoare.

Afilierea religioasă a fost: 30% protestanţi, 29% catolici, 5% evrei, 2% hinduşi, 2%

budişti, 2% islamici şi 20% atei sau ne având nici o religie.

Măsurare

Am utilizat scala Likert pentru o analiză preliminară de statistică descriptivă (Alfa

Cronbach, medii, abateri standard, ranguri) care sunt descrise în tabelul 1.

Dată fiind pornirea cercetării asupra topicului smereniei am inclus şi întrebări deschise la sfârşit.

Aceste întrebări au fost codate pentru a suplimenta datele descriptive.

Asociaţiile cu smerenia. Participanţii au utilizat scala cu 11 puncte (-5=negativă,

5=pozitiv) pentru a evalua asocierile lor imediate cu cuvântul smerenie. De asemenea au ales de

la 0-deloc la 10-foarte mult, răspunsurile lor la itemii: “În ce măsură crezi că ar fi bine dacă ai fi

mai puţin smerit/umil?” şi “ În ce măsură crezi că ar fi bine dacă ai fi mai smerit/umil?”. Pe o

scală de la 0-deloc la 10-foarte mult, participanţii au ales măsura în care ei au perceput smerenia

similară cu stima de sine scăzută, modestia, umilinţa şi ruşinea.

Definiţii ale smereniei. Participanţii au fost întrebaţi despre definiţiile smereniei într-un

format deschis. Răspunsurile au intrat într-un text pentru a ne asigura că cei care codifică inlud

scorurile în toate măsurătorile. Bazaţi pe prima teoretizare şi o citire iniţială a răspnsurilor, cel de

al doilea autor a codat categoriile şi a calificat rata independentă în utilizarea sistemului de

codare.

Al doilea autor a fost cel care a codificat al doilea. Înţelegerea dintre cei doi a fost bună,

rangul k de 0,89 până la 1,0. Discrepanţele au fost rezolvate de către primul autor.

Situaţii în care participanţii s-au simţit umili/smeriţi. Participanţii au fost rugaţi să-şi

amintească situaţii în care ei s-au simţit umili/smeriţi. Au fost rugaţi apoi să descrie situaţia şi

emoţiile pe care le-au experimentat în acea situaţie. S-a notat de la 0-deloc la 10-foarte mult în

funcţie de măsura în care şi-au amintit. Au utilizat apoi aceaşi scală pentru a nota situaţiile

neplăcute pe care şi le-au amintit. Răspunsurile deschise au fost codate folosind aceaşi procedură

descrisă mai devreme, iar k dintre cei doi care au codificat a fost între 0,89 şi 0,92. Discrepanţele

au fost rezolvate de către primul autor.

Exemple de persoane smerite. Participanţii au citit prompt-ul “ Te rog să te gândeşti la o

persoană pe care tu o vezi ca fiind foarte umilă/smerită”. Apoi ei au fost rugaţi să facă o scurtă

descriere a acelei persoane. Răspunsurile au fost codate cu aceaşi procedură descrisă mai sus şi k

între cei doi care au codat a fost 0,85 şi 1,0. Discrepanţele au fost rezolvate de către primul autor.

Calităţile plăcute găsite la o persoană smerită. Participanţii au citit “ O persoană smerită

este plăcută dacă este...” urmâbd 35 de adjective dihotomice (legat de ipotezele studiului).

Psrticipanţii au plasat fiecare cuvânt pe o scală cu 11 puncte (-5=ancora pentru un singur cuvânt,

5= pentru alt cuvânt din pereche). Analiza factorială cea mai potrivită a fost cea a rotaţiilor

varimax, ce sugera crearea a două subscale. Prima subscală are 8 caracteristici asociate cu

ajustarea psihologică. Ancora fiecărui item a fost după cum urmează: instabilitate

emiţională/stabilitate emoţională, respingerea ajutorului/acceptarea ajutorului, respect faţă de

sine/ lipsă respectului faţă de sine, pesimism/optimism, iubire faţă de sine/ ură faţă de sine,

sănătate mentală/ lipsa sănătăţii mentale, fericire/nefericire şi opinie clară despre sine/opinie

neclară despre sine. Alfa Cronbach a fost 0,94. A doua subscală are 4 caracteristici asociate cu

încrederea sau leadershipul, următor/lider, lisă de încredere/încredere, pasiv/activ,

asertiv/neasertiv. Alfa Cronbach a fost 0,85. De asemenea am reţinut un singur item

religios/spiritual şi nerelogios/ ne spiritual pentru o analiză separată.

Tipuri de persoane pentru care smerenia este o slăbiciune sau un punct forte. Participanţi

au citi:” Dacă ai şti că........(vezi lista de alături) a fost o persoană smerită ai vedea asta ca pe o

slăbiciune sau ca pe un punct forte pentru acest tip de persoană?” Promptul a fost urmat de o listă

de persoane având diferite roluri sociale. O scală cu 11 puncte a fost folosită pentru a marca

fiecare item (-5=slăbiciune, 0=neutru, 5=punct forte. Analiza factorială sugerează crearea a 4

subscale: lider/entertainer (lider de afaceri, lider militar, preşedinte al SUA, entertainer,

instructor de cursuri) alfa=0,91. alţii (partener de întâlnire, prieten, părinte, alfa 0,86; subordonat

(servitor, angajat, 0,83) şi lider religios (vorbitor religios sau spiritual, lider religios, alfa 0,79).

Stima de sine. Am utilizat scala Rosenberg a stimei de sine (Rosenberg, 1965, 1979)

pentru a măsura stima de sine. Participanţii au raspuns la 10 itemi pe o scală cu 5 puncte (1=în

dezacord, 5=foarte de acord)

Religiozitate. Am urmat o procedură folosită de Exeline, Yali & Sandersen (2000), un

index religios a fost creat pentru a combina măsusarea credinţelor principale şi participarea

religioasă. Credinţele principale au fost testate folosind măsura Blaine şiCrocker (1995) adoptată

la o scală de 11 puncte (0=puternic dezacord, 10=acord puternic). Scala include 5 itemi: Permit

credinţelor mele religioase să îmi influenţeze alte părţi ale vieţii mele”; “ Credinţele mele sunt

legate de părerea mea despre viaţă” ; “Este important pentru mine să fiu o persoană religioasă” şi

“ Mă simt frecvent aproape de D-zeu, într-un mod personal”. Scala presupune realizarea mediilor

itemilor. O măsură a participării religioase a fost descrisă de Exeline şi colegii (2000) şi a fost

abreviată în acest studiu. Participanţii au fost rugaţi să noteze cât de frecvent au partcipat în toate

din următoarele activităţii în luna trecută: rugăciune şi meditaţie, citirea unor cărţi religioase sau

urmărirea unor programe religioase, apelarea la servicii religioase, gândirea la probleme

religioase şi discutarea cu ceilalţi a unor probleme religioase. S-a notat de la 0=deloc la 5= mai

mult decât o dată pe zi. S-a făcut media itemilor. Aşa cum s-a anticipat cele 2 măsuri au corelat

r(127)=0,80 şi p<.001. Toate au fost standardizate şi combinate intr-un singur index la

religiozităţii.

Narcisismul. A fost măsurat folosind 14 itemi foarte utilizaţi în NPI (Inventarul

Personalităţii Narcisiste, Raskin & Terry. 1988; pentru versiunea originală vezi Raskin& Hall,

1979). Scala conţine 14 itemi şi răspunsurile se fac forţat între un răspuns narcisist sau unul ne

narcisist. Itemi sunt însumaţi pentru a obţine scorurile.

Dezirabilitate socială. Versiunea cu 30 de itemi a Scalei Marlow-Crowne de dezirabilitate

socială, a fost utilizată în acest studiu. Participanţii au răspuns la o serie de itemi în formatul

Adevărat/ Fals. Estimarea reabilitării şi validarea datelor pot fi găsite în Reynolds (1982), unde

vresiunea folosită în acest studiu este etichetată Forma C.

Rezultate.

Este smerenia văzută ca o slăbiciune sau ca un punct forte?

Rezultatele sugerează constant că studenţii au avut o opinie favorabilă despre smerenie.

Aşa cum arată Tab. 1 asocierile imediate a termenului smerenie au fost în general pozitive.

m=2,4, SD=2,7, diferenţiindu-se semnifcativ de scala neutră a punctului de mijloc la

t(126)=9,81, p<.oo1. Participanţii au fost mai înclinaţi să spună că vor să devină mai smeriţi,

m=6,1 , decât să spună că vor să fie mai puţin smeriţi m=2,3 F(1, 124)=125.05 Wilk, landa=0,50

p<.001, pattern cocnsistent cu opinia despre smerenie ca fiind un punct forte.

Contrar a ceea ce ne aştempat bazaţi fiind pe definiţiile date de dicţionare, smerenia nu a

fost văzută ca similară stimei de sine scăzute, m=2,3 SD=3,4 pe o scală de la 0 la 10. Smerenia

nu a fost văzută ca similară umilinţei, m=2,4 SD=2,9 sau ruşinii m=2,2, SD=2,7.

În schimb a fost văzută ca similară modestiei m=7,8 SD= 2,2.Media pentru modestie

deferă faţă de media pentru stimă de sien scazută, ruşine sau umulinţă la p<.oo1, utilizând măsuri

de contrast repetate. Legat de corelaţiile ridicate între itemii smereniei similară cu cei ai ruşinii,

jenei sau umilinţei (Alfa Crombach=0,84), aceşti 3 itemi au fost combinaţi într-unul singur

pentru analiza rămasă.

Definiţiile deschise ale smereniei sugerează apropieri substanţiale de modestie. Aproape

jumătate dintre participanţi (44%) au utilizat cuvântul “modestie” în definiţiile lor, făcând

referinţa la un comportament religios cum ar fi ne lăudăroşenia sau ne dând credit numai

succesului în viaţă.

Alte caracteristici asociate cu smerenia includ lipsa egoismului (17%), lipsa vanităţii sau

a aroganţei (19%) şi prezenţa atributelor pozitive sau a abilităţilor (17%). Mai degrabă decât a

încadra smerenia ca pe o preocupare pentru deficienţe, participanţii au asociat smerenia cu

atitudinile despre calităţile pozitive ale fiecăruia.

În ciuda acestei opinii pozitive uni participanţi au asociat smerenia cu rşinea, umilinţa şi

jena (10%) sau cu atitudinea sumisivă sau pasivă (5%).

Situația în care smerenia a fost experiată

Când au fost rugați să-și amintească o situație reală de viață în care s-au simțit smeriți,

participanții au raportat un nivel mult mai mare al afectelor plăcute. (M= 6.6, SD=3.0)față de

afecte neplăcute (M=2.6, SD=2.8) associate cu amintirea, F (1, 119)=66.44, Wilks λ= .64,

p<.001. Potrivit cu părerile pozitive ale smereniei raportate mai sus, majoritatea participanților

(61% și-au reamintit experiențele implicând succesul și împlinirea (i.e., a face ceva bun ;

primesc laude ; ulterioare sau câștigătoare ; a primi mai multă apreciere decât merit). O

minoritate din participanți (24%) au raportat situatia care a implicat o scădere a sinelui, o înjosire

(i.e. expunerea la o persoană mai bine situată ; pierdere sau eșec; rectificare a părerilor despre

sine umflate, exagerate). Participanții care și-au amintit incidente care au implicat succesul sau

împlinirea au raportat mai multe efecte pozitive , M=7.3, SD=2.5, decât afecte negative, M=2.0,

SD= 2,4, F(1, 73)= 105.46 Wilhs λ=.41, p<.001. În contrast, participanții care și-au amintit

evenimente negative au raportat aproximativ nivele egale de afecte pozitive, M= 5.1, SD=2.9, și

afecte negative, M=4.6, SD= 3.0, F(1, 27)=0.25, Wilks λ=.99, p>.10.

Caracteristicile smereniei individuale

Când au fost rugați să se gândească la o persoană pe care o văd foarte smerită, participanții au

ales colegi cum ar fi prieteni, colegi de clasă sau colegi de cameră (41%), rude (22%), figuri

religioase populare cum ar fi lideri religioși , Iisus Hristos sau sfinții (13%), celebrități sau

indivizi faimoși (10%), și personalul religios conducător cum ar fi pastori sau preoți (3%). Când

au fost rugați să descrie persoana sau /și de ce au văzut-o ca smerită participanții au identificat

caracteristici pozitive cum ar fi bunătatea, îngrijirea celorlalți (56%) abținere de la laudă (55%)

succesul sau inteligența (47% ) și un altruist sau atitudine de sacrificiu de sine (21%). Oricum,

unii indivizi (47%) au remarcat un potențial dezavantaj al smereniei menționând că persoanele

smerite sunt timide, tăcute și neasertive. Când participanții au fost întrebați despre calitățile

asociate cu oamnii smeriți, ei au dat evaluări pozitive. Indivizii smeriți au primit evaluările de

mai sus pe scala cu mijlocul 0 pe ambele indicele de adaptare și indicele de leadership /încredere

(pentru adaptare, M= 2.0, SD= 1.9, t(126)=11.78, p<.001 ; pentru leadership /încredere, M=0.7,

SD= 2.0) t(126)=4.0, p<.001. Oricum, evaluările adaptării au fost superioare evaluărilor

leadership-ului și încrederii, F(126)=103.39, Wilks λ=.54, p<.001. Acestea sugerează că oamenii

umili sunt în general văzuți ca bine adaptați și amabili. Dar sunt oamenii smeriți la fel de buni în

rolul în care sunt chemați de lider sau dominanță. Această întrebare va fi examinată în

următoarea analiză.

Este văzută smerenia ca mai mult decât o rezistență în anumite roluri sociale?

Dacă ne gândim la cum este văzută smerenia la alți oameni, ca rezistență, putere sau ca

slăbiciune, participanții au raportat că în general smerenia este văzută ca punct forte.Chiar și

participanții au făcut distincția între meritele smereniei bazate pe rolul social și persoana smerită.

Măsurătorile repetate au arătat că smerenia a fost evaluată mai favorabil la căutătorii religioșii

(M=3.4, SD= 1.7) decât în ceilalți apropiați (M=2.9, SD=1.8)sau subalterni(M=2.7, SD= 2.1,

ambii ps<.01 ). Aceste constatări oglindite sunt rezultate din itemi ce sugerează că indivizii

smeriți au fost percepuți ca fiind religioși saa spirituali, M=1.6, SD=2.2 care diferă de la punctul

neutru de mijloc de la 0 la t(125)=7.99, p<.001. Smerenia a fost evaluată mai puțin favorabil în

grupul lider/animator decât în orice alt rol social (M=1.0, SD= 2.6, ps împotriva celorlalte trei

grupuri <.001).

Diferențe individuale în vizualizarea smereniei

Potrivit cu predicția, religiozitatea a fost asociată cu concepții pozitive ale smereniei. Așa cum

arătăm în tabelul 2 religiozitatea a fost asociată cu dorința de a deveni mai smerit, cu credința că

smerenia este asociată cu o bună adaptare și încredere și cu o vizualizare a smereniei ca putere,

tărie în oameni în diverse roluri (căutătorii religioși/liderii, subalternii și alții aproape).

Religiozitatea a fost de altfel asociată cu o probabilitate mai mare ca emoție pozitivă și cu o

probabilitate mai mică, ca emoție negativă. Genul nu a arătat asociații consistente cu vizualizarea

smereniei așa cum se vede în tabelul 2 .

Mai multe corelații sunt nesemnificative. În cazul femeilor este mai probabil decât în cel

al bărbaților să vadă smerenia ca un punct forte în cazul căutătorilor religioși sau liderilor și au o

mai amre tendință să asocieze smerenia cu o bună adaptare. În cazul femeilor este ai probabil ca

în descrierea situațiilor în care s-au simțit smerite să menționeze și emoții negative. Investigați

recente au arătat că este mai probabil ca femeile să raporteze emoții negative în situațiile care

implică succesul (femei 72%, bărbați 28%, x²(77)=6.12, p<.01). Mai specific, când femeile și-au

reamintit situații de succes în care s-au simțit smerite ele raportează într-o măsură mai mare ca

bărbații, jenă (femei 23%, 8% bărbați, x²(75)=3.52, p<.10). În urma cercetărilor s-a constat că

femeile sunt mult mai sensibile decât bărbații în ceea ce privește costurile sociale (e.g., Exline &

Lobel, 1999, Heatherington et al. 1993; Heatherington, Burns, &Gustafson, 1998). Așa cum se

vede în tabelul 2, narcisismul este corelat negativ cu credința că smerenia este asociată cu o bună

adaptare și încredere. Stima de sine nu a arătat asociații potrivite cu vizualizarea smereniei.

Pentru a extinde asta, participanții cu stimă de sine ridicată au manifestat o probabilitate mai

mare de a lega smerenia cu o adaptare bună și mai puțin probabil cu rușinea, jena, umilința.

Aceste rezultate sugerează că stima de sine și narcisismul pot să se deosebească în termenii de

asocieție cu smerenia.

Narcisismul și stima de sine corelează pozitiv în exemplul dat, r(126)=.23, p<.01,

potrivit cu idea că ambele, narcisismul și stima de sine ridicată implică păreri despre sine

pozitive. Pentru a examina contribuția unică a ambelor, narcisismul și stima de sine am făcut o

serie de analize care sunt prezentate în tabelul 3. Aici se rescoperă asociațiile divergente ale

narcisismului și stimei de sine cu vizualizările smereniei.

Discuții

În cultura noatră de vest auto-absorbită, va fi ușor să se respingă o virtute modestă cum ar fi

smerenia. Dar încă, rapoartele studenților din acest studiu arată că mare parte din ei văd

smerenia ca putere mai degrabă decât ca slăbiciune. Asociațiile imediate cu termenul de

smerenie au fost pozitive și cea mai mare parte dintre participanți au declarat că vreau să devină

mai smeriți. Când s-a reamintit situația în care aceștia se simțeau smeriți, majoritatea

participanților și-au reamintit situația implicând succesul sau realizarea mai degrabă decât eșecul

sau scădere a sinelui. Practic, ei au descris umilința individuală ca amabil, modest și înalt în

abilități sau alte atribute pozitive. Mai degrabă decât a se gândi la indivizi umili ca aspru ca

auto-critică sau cu stimă de sine scăzută, ei au asociat smerenia cu atitudini și comportamente

care erau relevante pentru o persoană puternică. Răspunsurile lor sugerează puncte de vedere

pozitive asupra indivizilor smeriți atât în termeni de adaptare și în termeni de încredere cât și în

abilități de leadership. Au evaluat smerenia ca u atuu în toate rolurile sociale care au fost

incluse în eșantion.

În ciuda acestor puncte de vedere favolabile, participanții au arătat unele distincții în gradul de

valoare atribuit smereniei. Deși ei au arătat clar că cred că smerenia a fost asociată cu bune

adaptări personale, au fost mai puțin deciși dacă smerenia ar fi un avantaj în domenii care

implică leadership-ul și încrederea. Când au fost rugați să-și imagineze oameni smeriți ocupând

diverse roluri sociale ei au privit smerenia ca fiind mai puțin un punct forte la animatori sau

lideri decât în alte grupuri incluse în eșantion, care includea pe cei care căutau religia sau

liderii, cei aproape și subordonații.

Reticența participaților de a asocia smerenia cu leadership-ul sau poziția dominantă

completează cercetarea în percepția social a narcisismului și auto-exagerare. Cercetările făcute

de Colvin și colegii lui sugerează că deși auto îmbunănătățirea nu este percepută ca o bună

adaptare de către colegi, acesta nu arată calități evaluate social ca un grad ridicat de entuziasm

sau un nivel de energie ridicat. Oamneii cu auto-vizionări mărite , cum ar fi narcisismul pot de

asemenea să facă impresii bune la prima vedere : potrivit lui Paulhus, narcisiștii sunt în mod

consistent văzuți ca fiind siguri pe sine poziția de leader. ceea ce poate fi văzut ca un punct forte

în poziția de leader. Inițial colegii lor i-au evaluat ca distractivi și inteligenți deși aceste percepții

par să dispară de-a lungul timpului. În contrast, chiar dacă indivizii smeriți par bine adaptați

simpatizați, ei pot apărea ca retrași în societate pentru că nu au fost vizualizați ca deosebiți de

dinamici sau colorați. Beneficiile smereniei pot fi mai evidente într-o relație de lungă durată(vezi

Campbell 1999 pentru un constrast cu narcisismul).

Potrivit cu ideea că narcisismul este antagonic smereniei, rezultatele curente sugerează

că narcisiștii sunt mai puțin plăcuți decât alte persoane, pentru a vedea smerenia într-o lumină

pozitivă. În exemplul curent, narcisismul a fost asociat cu o perspectivă a smereniei mai puțin

pozitivă în special în termeni d eadaptare, de lider și de încredere. Mai precis, scorurile înalte la

subscala exploatare/intitulat (vezi Emmons, 1987) a Inventarului de EPrsonalitate Narcisistă au

fost asociate cu reducerea tendinței de a lega smerenia cu buna adaptare. Pare adecvat că

pentru narcisiști, care sunt preocupați cu promovarea lor și cu apărarea punctelor de vedere

proprii positive, ideea de a se comporta într-o manieră smerită poate părea prostesc sau

amenințător. În viitor va fi folositor să vedem cum percepția smereniei corelată cu alte trăsături

de personalitate ca „Big Five”.

Implicații metodologice din activitatea curentă.

Chiar dacă stima de sine se suprapune cu narcisismul, stima de sine a fost asociată cu păreri

favolabile asupra smereniei în exemplul nostru- mai precis când asociațiile cu narcisismul au fost

din punct de vedere statistic controlate. În alte cuvinte, pentru a extinde această înaltă stimă de

sine implică un rezultat pozitiv, acceptând orientarea spre sine mai degrabă decât un sentiment

de superioritate față de ceilalți, acesta este asociat cuo perspectivă pozitivă pe smerenie. Pentru a

face acest pas logic mai departe, speculăm că acea persoană ci stimă de sine ridicată și

narcisism scăzut poate fi categorizat ca fiind umilitor- în special dacă stima de sine este uan

stabilă. (Kernis, Cornell, Sun, Berry, & Harlow, 1993). În general păreri pozitive dar fără să fie

umflate, exagerate, a sinelui pare să se potrivească cu recentele descrieri ale caracteristicilor

smereniei. (Tangney, 2000, 2002). Date fiind serioase bariere de măsurare care au înconjurat

încercarea de a evalua smerenia prin auto raport (Exline et al. , 2004 ; Tangney, 2000, 2002), ar

fi extrem de util dacă scorurile existente cu privire la măsurătorile pe narcisism, nivelul stimei de

sine și stabilitatea stimei de sine pot fi combinate pentru a identifica indivizi smeriți. Evaluarea

altor cosntructe legate cum ar fi auto-compasiunea (Neff, 2003a, 2003b), validare căutării

(Dykman, 1998) sau nevoia de a câștiga stima de sine (Forsman & Johnson, 1996) pot de

asemenea să ajute la identificarea inivizilor smeriți. O altă tehnică posibilă ar putea fi să

evaluăm smerenia prin auto raport dar controlate pentru dezirabilitățile sociale(vezi Landrum,

2002).

Când reamintim situația în care s-au simțit umili, participanții și-au amintti situația

implicând succesul și împlinirea. Cu alte cuvinte, este mai probabil ca ei să fi văzut smerenia ca

o atitudine spre un punct forte decât ca o preocupare pentru slăbiciune. Gândindu-ne la smerenie

ca o atitudine spre un punct forte, ridică noi posibilități pentru modul în care statului smereniei

poate fi indus în setările experimentale. Dacă smerenia este văzută ca o focusare pe o limită ar

însemna să rugăm participanții să reflecteze asupra limitărilor sau căderilor. Oricum, am găsit

că astfel, inducerea auto-scăderii de multe ori provoacă reacții defensive și/sau efecte negative

de dispoziție sufletească. Datele recente sugerează că cea mai eficientă cale de a induce

smerenia poate fi focusarea pe atribute pozitive sau experiențe. O altă alternativă poate fi să

rugăm oamenii să se focuseze pentru început asupra atributelor lor pozitive (sau să folosească

alte mijloace pentru a se afirma pe ei înșiși) înainte să-i rugăm să se focuseze asupra defectelor l

or (vezi Schimel, Arndt, Pyszczynski , & Greenberg, 2001).

Un mijloc alternativ de a induce smerenia poate să implice furnizarea participanților o

experiență de succes înainte să le ofere un fedbeck negativ. Astfel de design ar da probabil

participanților un sentiment de securitate sau pozitivism înainte să se deplaseze focalizarea lor

pe limitele lor. Idee de a precede experiența auto scăderii cu acele ecouri pozitive, abordare

utilizată în studii pe procese de auto afirmare, care sugerează că oamenii sunt mult mai capabili

să tolereze efectele negative dacă ei au avut șansa înainte să se autoafirme(pentru a revizui vezi

Steele, 1999). Indiferent ce tehnică este folosită pentru încercarea de inducere a statutului de

smerenie, se pare că trebuie să ne așteptăm la diferențe individuale în succesul acesti manipulări.

De exemplu, indivizii cu stimă de sine instabilă sau apărare narcisistă pot să nu răspundă

succesului sau eșecului în același fel în care cea mai mare parte dintre indivizii smeriți ar face-

o.

Religiozitatea și smerenia

Religiozitatea ne-a arătat clar și consistent asociațiile cu percepția smereniei

predominant în exemplul creștin. Înainte de toate, participanții au raportat că acele persoane care

erau smerite erau susceptibile de a fi religioase sau spirituale. Participanții de asemenea au arătat

smerenia ca o mai mare rezistență la solicitațiile religioase / spirituale sau la lideri decât în

oricare celellalte roluri sociale pe care le-am exemplificat. În sfârșit, participanții cu propriul lor

nivel de religiozitate au fost asociați cu opiniile lor de smerenie- o mai mare religiozitate a fost

asociată cu așteptarea petnru an fi mai umil, legând umilința cu o bună ajustare, încredere, și

leadership, și văzând smerenia ca putere în ceilalți oameni. Modele similare au fost găsite la

celelalte virtuți ca tendința pentru religiozitate individuală pentru a atribui înalte valori iertării.

În viitor va fi interesant dacă rezultatul obținut aici cu religiozitatea se aplică la fel și

spiritualității.

Deși am găsit corelații între religiozitate și percepția smereniei, datele actuale nu

abordează problema dacă indivizii cu o religiozitate și spiritualitate ridicată sunt de fapt mai

smeriți decât decât alți indivizi. Aceasta rămâne o întrebare empirică. Ambele imperative

religioase spre smerenie și credința într-o Putere Supremă pot să încurajeze persoanele

religioase să cultive o atitudine umilă. Totuși o potențială barieră a smereniei pentru indivizii cu

o religiozitate înaltă poate să fie mândria religioasă în care oamenii religioși se văd pe ei înșiși

ca fiind „mai sfânt decât tine”. (Rowatt, Ottenbreit, Nesselroade, & Cunningham, 2002). În

măsura în care strădaniile religioase sau spirituale duc la o îmbunătățire în alte comportamente

morale, ele pot paradoxal să crească sentimentul mândriei- care este în preent considerată printre

păcatele de moarte de mulți savanți. (vezi Schimmel, 1992, pentru discuții).

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JOURNAL FOR THE SCIENTIFIC STUDY OF RELIGION

Evenimente negative de viață,

tipuri de coping religios pozitiv și negativ

și funcționare mentală

JEFFREY P. BJORCK

JOHN W. THURMAN

Copingul religios poate fi atât adaptativ, cât și dezadaptativ. Noi am

investigat efectul moderator pe care îl are copingul religios pozitiv și negativ

în relația dintre evenimentele negative de viață și funcționarea mentală.

Chestionarele utilizate includ măsurători ale evenimentelor negative de viață,

ale copingului religios pozitiv și negativ și ale funcționării mentale. Acestea

au fost completate de 336 de adulți, membri ai Bisericii Protestante. Chiar și

după intervenție (participarea la manifestări religioase), evenimentele

negative au fost corelate cu o creștere a frecvenței utilizării copingului pozitiv

și negativ. Mai mult decât atât, evenimentele negative și copingul religios

pozitiv au avut efect și asupra depresiei, în sensul că utilizarea frecventă a

copingului religios pozitiv a redus efectele nocive ale evenimentelor negative.

Jeffrey P. Bjorck, Professor of Psychology, Graduate School of Psychology, Fuller Theological

Seminary, 180 North Oakland Avenue, Pasadena, CA 91101. E-mail: jbjorck@fuller.edu

John W. Thurman is a clinical psychologist in private practice with Psychological Consulting

Services, 112 E. Myrtle Avenue 508, Johnson City, TN 37601. E-mail: john@walnutgrovefarm.org

Journal for the Scientific Study of Religion (2007) 46(2):159–167

JOURNAL FOR THE SCIENTIFIC STUDY OF RELIGION

Numeroși cercetători au studiat modul în care oamenii utilizează copingul religios

pentru a face față evenimentelor stresante (Pargament, 1997). Aceste studii au pornit de la

necesitatea de a afla care sunt factorii care moderează relația dintre evenimentele negative,

stresante de viață și funcționarea umană (e.g., Holmes and Rahe 1967; Cohen 1988). Chiar

dacă această corelație este constant raportată, evenimentele negative singure explică cel mult

10% din varietatea de posibile reacții, iar răspunsurile indivizilor puși în aceeași situație diferă

foarte mult (Holahan, Moos, and Schaefer 1996).

Pentru a explica această varietate a răspunsurilor, copingul comportamental general a

fost intens investigat ca și factor moderator al impactului pe care îl au evenimentele negative

asupra funcționării (e.g., Folkman și Moskowitz 2004). A fost de asemenea studiat și copingul

religios, în special examinând reacțiile persoanelor la evenimente specifice, precum explozia

unei bombe în orașul Oklahoma (Pargament et al. 1998), decesul unui prieten (Thompson și

Vardaman 1997), probleme medicale grave (Koenig, Pargament, and Nielsen 1998), și diferiți

stresori precum: amenințare, pierdere sau provocare (Bjorck and Cohen 1993; Bjorck și

Klewicki 1997). Studiul unui singur eveniment este desigur util, dar nu asigură înțelegerea

completă a impactului pe care îl are copingul religios. Așadar, copingul religios nu poate fi

cercetat doar în relație cu un număr discret de evenimente. Pentru a îndepărta această limită și

pentru a oferi informații despre efectul cumulativ al evenimentelor stresante de-a lungul

timpului (Rahe și Arthur 1987), am investigat rolul copingului religios asupra unui agregat de

evenimente negative de viață. În plus, am luat în considerare ambele tipuri de coping religios:

pozitiv și negativ.

Până acum, religiozitatea a fost evaluată ca și factor de micșorare a efectelor negative

ale evenimentelor stresante (Hood et al. 1996; Koenig 1998). Mai recent, a fost luată în

considerare și posibilitatea ca religia să intensifice stresul. De exemplu, într-o meta-analiză a

46 de studii empirice, religia, definită în sens larg, a fost evaluată ca diminuator al stresului în

procent de 34% din studii, iar în procent de 4% ca factor care agravează stresul (Pargament

1997). Plecând de la aceste rezultate, cercetările viitoare trebuie să investigheze modul în care

religia, și în particular copingul religios, este cu adevărat folositoare în situații stresante și de

ce de cele mai multe ori este un factor pozitiv, iar uneori un factor negativ.

Mai multe studii recente (Koenig, Pargament, and Nielsen 1998; Pargament, Koenig,

and Perez 2000; Pargament et al. 1998) au avut ca rezultat faptul că strategiile de coping

religios pot fi relaționate atât cu rezultate pozitive, cât și cu rezultate negative. Pargament și

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colaboratorii săi (1998) au descris două tipuri de coping religios: pozitiv și negativ. Primul

exprimă spiritualitate, conștientizarea unui sens al vieții, a unei relații sigure cu Dumnezeu și

apropiere spirituală de Acesta. O asemenea fumnamentare religioasă stabilă este manifestată

prin „reevaluări religioase pozitive, coping religios colaborativ, căutarea suportului spiritual,

conexiune spirituală, purificare spirituală, căutarea suportului membrilor Bisericii, oferirea de

ajutor și iertare” (1998:712). Spre depsebire de acesta, copingul religios negativ este

caracterizat de o relație tensionată cu Dumnezeu, o viziune amenințătoare asupra lumii și o

luptă continua de a găsi un sens al vieții. Această bază religioasă șubredă se manifestă prin

„reaprecieri religioase negative, demonice, reevaluări negative ale puterii Lui Dumnezeu,

nemulțumire spirituală, coping religios direcționat spre sine și nemulțumire față de relațiile

interpersonale (1998:712)”. Pargament a evaluat copingul religios la trei eșantioane: membrii

bisericii din Oklahoma după explozia unei bombe în oraș, un grup de studenți care au

experiențiat un eveniment negativ foarte serios, și un grup de pacienți în vârstă, internați într-

un spital. În fiecare eșantion, copingul religios pozitiv a fost mai des utilizat decât cel negativ,

iar primul tip a fost corelat cu o sănătate mentală mai bună, în timp ce copingul negativ a fost

corelat cu efecte negative.

Koenig, Pargament, and Nielsen (1998) au identificat atât strategii de coping pozitive,

cât și negative pe un eșanțion de 557 adulți bolnavi, internați într-un spital. Copingul religios

negativ a fost corelat cu o sănătate fizică mai precară, o calitate a vieții mai scăzută și nivele

mai înalte de depresie. În schimb, personale care utilizau copingul religios pozitiv aveau o

sănătate mentală mai bună și un nivel mai înalt de satisfacție față de viață.

Așa cum am menționat anterior, majoritatea studiilor s-au focusat pe răspunsurile la

evenimente stresante singulare (e.g., Koenig, Pargament, and Nielsen 1998; Pargament et al.

1998). Doar Park, Cohen, and Herb (1990) au studiat copingul religios ca răspuns la stresul

general cauzat de multiple evenimente de viață, însă rezultatele lor au fost ambigue. În

consecință, studiul nostru a extins spectrul cercetărilor anterioare în două moduri. Primul,

copingul religios a fost investigat în relație cu impactul unui agregat de evenimente negative

și nu ca răspuns la un stresor specific. Al doilea, ambele tipuri de coping religios au fost

evaluate prin scale sumative.

Niciun studiu anterior nu a cercetat modul în care evenimentele negative cumulate

interacționează cu tipurile de coping religios pozitiv și negativ. Conceptul de „reevaluare” al

lui Lazarus și Folkman (1984) și teoria clasică a lui Caplan (1964) ne sunt utile aici. Lazarus

JOURNAL FOR THE SCIENTIFIC STUDY OF RELIGION

și Folkman postulează că după ce este inițiat copingul, persoanele reevaluează situația în care

se află și își modifică strategia de coping în consecință. Astfel, pe măsură ce numărul

evenimentelor negative crește semnificativ, este posibil că persoanele religioase vor reevalua

viziunea asupra Lui Dumnezeu. Acest fapt poate să conducă și la utilizarea mai frecvență a

copingului religios negativ, de exemplu: reaprecierea iubirii și suportului Lui Dumnezeu sau

reinterpretarea evenimentului negativ ca și pedeapsă dată de El. Similar, Caplan (1964)

argumentează faptul că indivizii care se confruntă cu un stresor vor utiliza la început copingul

lor habitual. Dacă stresul continuă să crească, indivizi vor căuta noi strategii de coping, prin

încercare și eroare. În privința copingului religios față de un singur eveniment, strategiile

pozitive sunt comune, iar cele negative nu sunt comune (e.g., Pargament et al. 1998), primele

sunt mai habituale, în timp ce ultimele sunt mai neobișnuite.

Așadar, prima ipoteză a studiului este: copingul religios ca răspuns la evenimentele

negative este mai degrabă pozitiv decât negativ. A doua: odată ce evenimentele negative sunt

mai numeroase, copingul religios negativ va fi utilizat cu o frecvență mai mare decât cel

pozitiv. A treia: copingul religios negativ corelează cu intensificarea distresului, în timp ce

copingul religios pozitiv corelează cu diminuarea distresului. (Pargament et al. 1998; Koenig,

Pargament, and Nielsen 1998). A patra: vor fi replicate corelațiile tradiționale dintre

evenimentele negative de viață și funcționarea psihologică. Ultima ipoteză: copingul religios

pozitiv diminuează efectele intensificării evenimentelor negative.

METODA

Procedura

Acest studiu a făcut parte dintr-un proiect mai vast (de ex., Fiala, Bjorck, şi Gorsuch

2002) care a utilizat un eşantion de convenienţă. Cu acordul conducătorilor bisericilor, au fost

selectate aleator 400 de nume din fiecare dintre cele trei mari biserici Protestante din sudul

Californiei (N> 1,200). Una dintre congregaţii (Misionară Baptistă) era predominant Afro-

Americană, celelalte două biserici (nondenominaţională şi respectiv Conferinţa Creştină

Congregaţională Conservativă) erau mixte din punct de vedere etnic. Membrilor bisericilor li

s-au trimis prin poştă pachete cu chestionare, inclusiv un plic timbrat autoadresat. Participarea

a fost voluntară şi confidenţială. După două săptămâni au fost trimise cărţi poştale de

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reamintire. S-au primit 337 de răspunsuri (27,1 %), dintre care unul a fost respins, deoarece

era incomplet.

Participanţii

Respondenţii (197 de femei, 139 de bărbaţi; M = 38.87 ani, SD = 12.12) erau albi

(39.3 %), Afro-Americani (28.0 %), Latino-Americani (13.7 %), Asiatic-Americani (11.0 %)

ş.a. (8.0 %). Participanţii erau căsătoriţi (46.1 %), necăsătoriţi (35.1 %), divorţaţi (13.7 %),

văduvi (3.9 %) ş.a. (1.2 %). Ultimul stadiu educaţional terminat era şcoala postliceală (67.9

%), liceu sau echivalent (26.2 %), 10-12 ani (5.7 %) şi 7-9 ani (0.3 %).

Măsurători

Prezentarea măsurătorilor a fost contrabalansată (pentru a controla efectele de ordine)

în pachetele distribuite aleatoriu. Participarea religioasă a fost evaluată pe două scale cu un

singur item: (a) participarea la slujbe religioase formale; şi (b) activităţi religioase informale

(de ex., lectura Bibliei, rugăciune, etc.).

Fiecare din acestea a fost cotată pe o scală cu 5 puncte (1 = o dată pe lună, 5 = de

patru sau mai multe ori pe săptămână).

Evenimentele de viaţă au fost cotate cu ajutorul scalei LES (70-event Life Experience

Survey; Sarason, Johnson, and Siegel 1978). Participanţii au indicat evenimentele

experienţiate în timpul ultimului an şi le-au cotat pe fiecare ca pozitiv, negativ sau neutru.

Numărul total al evenimentelor negative a servit ca măsurătoare a evenimentelor negative

(Cohen 1988). Alpha pentru această măsurătoare, pentru acest eşantion a fost 0.88.

Chestionarul Brief RCOPE cu 14 itemi (Pargament et al. 1998) include două subscale cu şapte

itemi, care evaluează coping-ul religios pozitiv respectiv pozitiv. Itemii pozitivi (de ex., „Am

căutat dragostea şi afecţiunea lui Dumnezeu”) includ reevaluări religioase benevole, coping

religios colaborativ, căutarea suportului spiritual, a conectării spirituale, a purificării

religioase, căutarea ajutorului din partea clerului sau a membrilor, ajutorul religios şi iertarea

religioasă. Itemii negativi (de ex., „ M-am îndoit de dragostea lui Dumnezeu pentru mine”)

includ reevaluări religioase punitive, reevaluări religioase demonice, reevaluări ale puterii lui

Dumnezeu, nemulţumire spirituală, coping religios centrat pe sine şi nemulţumire religioasă

interpersonală.

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Itemii sunt cotaţi pe o scală cu cinci puncte (1 = deloc, 5 = o mare parte din timp),

iar cei şapte itemi ai fiecărei subscale sunt adunaţi pentru a produce un scor de coping religios

pozitiv respectiv negativ.

În studiul curent, scala Brief RCOPE a urmat imediat după LES, iar instrucţiunile

RCOPE au fost alterate. În loc să se refere la un singur eveniment, participanţii au raportat

cum au făcut faţă la toate evenimentele negative din ultimul an. Cu această modificare, Alpha

pentru coping-ul pozitiv şi negative au fost 0.83 respectiv 0.79.

Funcţionarea psihologică a fost evaluată cu ajutorul Scalei SWLS (Satisfaction With

Life Scale; Diener et al. 1985) şi cu Scala CES-D (Center for Epidemiological Studies-

Depressed Mood Scale; Radloff 1977). SWLS măsoară starea de bine subiectivă generală

(overall subjective wellbeing), iar CES-D măsoară simptomele depresive doar din ultimele

şapte zile. Pentru a păstra consistenţa măsurătorilor, timpul pentru CES-D a fost schimbat în

“pe durata ultimului an”. În plus, pentru a îndeplini claritatea instrucţiunilor, itemii tuturor

măsurătorilor, înafară de LES, au fost transformaţi într-o gamă de răspunsuri cu cinci puncte.

Alpha pentru acest eşantion pentru SWLS şi CES-D au fost 0.82 respectiv 0.90.

REZULTATE

Media şi abaterea standard pentru variabilele de interes sunt prezentate în Tabelul 1.

Pentru a facilita interpretarea, toate scorurile scalelor (excepţie făcând evenimentele negative

pentru LES) au fost împărţite la numărul respectiv de itemi. Această operaţie a generat scoruri

totale de la 1 la 5, reprezentând ancora fiecărei scale. În sprijinul primei noastre ipoteze,

coping-ul religios pozitiv a fost utilizat mult mai frecvent decât coping-ul religios negativ, t

(1,335) = 44.06, p < 0.001.

Apoi au fost efectuate corelaţii de ordinul zero. Cum era de aşteptat, evenimentele

negative au fost corelate pozitiv atât cu pattern-urile de coping religios pozitiv cât şi negativ

(rs = 0.32 şi 0.11, respectiv ambele cu un ps < 0.05). A două ipoteză a noastră, că

evenimentele negative vor corela mai puternic cu coping religios negativ decât cu coping

religios pozitiv, a fost evaluată cu ajutorul testului t Hotelling pentru coeficienţi de corelaţie

corelaţi (Hotelling, cum este citat în Guilford 1965:190). Cum am prezis, prima corelaţie (r =

0.32) a fost semnificativ mai puternică decât cea mai târzie (r = 0.11), t Hotelling (333) =

2.99, p < 0.01). În sprijinul celei de a treia ipoteze, coping-ul religios negativ a fost corelat cu

depresie crescută (r = 0.51, p <0.001), şi satisfacţie în viaţă (life satisfaction) scăzută (r = -

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0.27, p < 0.001), dar, surprinzător, coping-ul religios pozitiv nu a fost relaţionat semnificativ

cu niciuna dintre ele.

Ipoteza a patra a fost sprijinită de corelaţiile semnificative între evenimentele

negative şi creşterea depresiei (r = 0.41, p < 0.001), dar şi cu scăderea satisfacţiei de viaţă (r =

-0.26, p < 0.001).

Mai departe, am efectuat analize canonice ierarhice, evaluând numai varianţa unică

pentru a: (a) examina interacţiunea prevăzută şi (b) a testa ulterior corelaţiile de mai sus în

timp ce sunt controlate covariatele relevante. Întâi, însă, depresia şi satsifacţia de viaţă au fost

ortogonalizate (Gorsuch 1991) datorită intercorelaţiei lor semnificative (r = -0.50). Ca şi în

studiile precedente (de ex., Bjorck et al. 2001; Fiala, Bjorck şi Gorsuch 2002; Maynard,

Gorsuch şi Bjorck 2001), această tehnică a produs corelaţii pozitive puternice între variabilele

originale (adică depresia şi satisfacţia de viaţă) şi noii lor factorii (ambii rs = 0.97).

Prima analiză canonică ierarhică omnibus a înregistrat ordinul chestionarului şi

participarea religioasă (atât la slujbe cât şi activităţi) ca covariate, urmate de evenimente

negative ca predictor şi coping religios pozitiv şi negativ ca set de criterii. Analiza a fost

semnificativă, F (8,662) = 7.47, p < 0.001. Analiza univariată a arătat că, chiar după controlul

ordinii, al serviciilor şi activităţilor religioase şi al pattern-ului alternativ de coping religios,

evenimentele negative tot erau relaţionate cu creşteri atât în coping religios pozitiv, F (1,662)

= 5.54, r = 0.13, p < 0.05 şi coping religios negativ, F (1,662) = 32.99, r = 0.30, p < 0.001.

O a doua analiză ierarhică omnibuz a examinat efectele evenimentelor negative,

coping-ul religios şi interacţiunea acestora cu funcţionarea psihică. Ordinea chestionarelor1 şi

participarea religioasă (slujbe şi activităţi) au fost din nou covariate. Mai departe,

evenimentele negative au fost introduse, urmate de setul de coping religios pozitiv şi negativ.

Apoi a fost introdus setul celor două interacţiuni între evenimentele negative şi cele două

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pattern-uri de coping religios, având ca criterii depresia şi satisfacţia de viaţă. Analiza globală

a fost semnificativă, F (16,654) = 9.36, p < 0.001. Aceeaşi analiză (vezi Tabelul 2) a scos la

iveală un efect principal semnificativ al evenimentelor negative asupra depresiei şi a

satisfacţiei de viaţă. În plus, s-au găsit efecte esenţiale semnificative pentru setul celor două

scoruri pentru coping religios asupra depresiei şi a satisfacţiei de viaţă. În sprijinul celei de a

treia ipoteze, analizele univariate ale varianţei unice au arătat că, coping-ul religios pozitiv

este corelat negativ cu depresia şi pozitiv cu satisfacţia de viaţă, F (1,654) ≥ 3.74, ambele ps ≤

0.05. Invers, coping-ul religios negativ a fost corelat pozitiv cu depresia şi negativ cu

satisfacţia de viaţă, F (1,654) ≥ 4.32, ambele ps < 0.05.

În final, aceeaşi analiză (vezi Tabelul 2) a arătat că setul celor două tipuri de coping

religios x interacţiunile evenimentelor negative au fost semnificative cu privire la depresie dar

nu şi cu privire la satisfacţia de viaţă. O analiză univariată a varianţei unice a arătat că acest

efect asupra depresiei este datorat unei interacţiuni semnificative între coping-ul religios

pozitiv şi evenimentele negative, în sprijinul ultimei noastre ipoteze, F (1,654) = 4.90, p <

0.05. Figura 1 arată că, pentru persoanele care raportează coping religios pozitiv ridicat,

impactul evenimentelor negative asupra depresiei a fost scăzut, comparat cu cei care

raportează coping religios pozitiv scăzut.

DISCUŢII

În trecut au fost identificate pattern-uri de coping religios pozitiv şi negativ şi s-a

descoperit că corelează cu rezultate diferenţiale cu privire la evenimente stresante specifice

(de ex., Koenig, Pargament şi Nielsen 1998; Pargament et al. 1998). Studiul de faţă arată ca

astfel de diferenţă se aplică la evenimente negative în general şi demonstrează relevanţa

coping-ului religios în paradigma evenimentelor de viaţă stresante (adică, cu privire la toţi

stresorii negativi experienţaţi în ultimul an). Numeroase ipoteze au fost sprijinite.

Aşa cum s-a prezis, participanţii au utilizat mai mult coping religios pozitiv decât

negativ ca răspuns la stresul general. De asemenea, cum era de aşteptat, evenimentele

negative crescute au fost relaţionate cu creşteri atât în coping-ul pozitiv, cât şi în cel negativ,

iar aceste constatări au rămas robuste chiar şi după controlul participării religioase. Cercetări

anterioare au arătat cum un singur stresor, cum ar fi o vizită la spital, bombardarea oraşului

Oklahoma sau orice eveniment singular poate cauza atât răspunsuri de coping religios pozitiv

şi negativ. Totuşi, stresorii nu vin, în mod tipic, singuri, ci în perechi sau în grupuri.

Constatările actuale sugerează că, odată cu acumularea evenimentelor negative, membrii

bisericii Protestante nu numai că îşi menţin, ci îşi şi intensifică strategiile de coping religios,

atât pozitiv, cât şi negativ.

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Bazându-ne pe teoria de criză a lui Caplan (1964) şi pe conceptul de reevaluare al lui

Lazarus şi Folkman (1984), am prezis de asemenea faptul că coping-ul religios negativ va

creşte în intensitate mai mult decât cel pozitiv, ca răspuns la creşterea intensităţii

evenimentelor negative. A doua ipoteză a fost sprijinită şi este asemănătoare cu raportul lui

Koenig, Pargament şi Nielsen (1998), cum că între pacienţii unui spital, „relaţii semnificative

cu starea de sănătate proastă… erau atât mai frecvente cât şi mai puternice pentru activităţile

de coping religios negativ decât pentru cel pozitiv” (1998:517). Având în vedere acumularea

evenimentelor negative, rezultatele noastre sugerează că, atunci când Protestanţii

experienţează evenimente mai normative, şi mai puţine, ei se bazează în primul rând pe

strategii de coping religios pozitiv habitual, pe care le-au învăţat ca fiind adaptative în situaţii

tipice (Caplan). Atunci când evenimentele negative cresc, în ciuda coping-ului religios

pozitiv, aceste persoane pot totuşi să îşi reevalueze viziunea asupra lui Dumnezeu în faţa

stresului continuu (Lazarus şi Folkman). Aceste reevaluări negative, care sunt în sine o formă

de coping religios negativ, ar putea determina un nou şir de strategii de coping încercare-

eroare (Caplan), inclusiv o creştere în coping religios negativ2.

Această creştere în coping religios negativ este contraproductivă, având în vedere

legătura între astfel de strategii negative şi funcţionare psihologică mai proastă. Într-adevăr, în

conformitate cu a treia noastră ipoteză, coping-ul religios negativ, ca răspuns la evenimentele

negative întâmpinate în ultimul an, a fost relaţionat cu creşterea depresiei şi scăderea

satisfacţiei de viaţă, chiar după controlul participării religioase, evenimentelor negative şi a

coping-ului religios pozitiv. Invers, după introducerea participării religioase, a evenimentelor

negative şi a coping-ului religios negativ ca covariate, coping-ul religios pozitiv a fost

relaţionat negativ cu depresia şi pozitiv corelat cu satisfacţia de viaţă, aşa cum era de aşteptat3.

Împreună, aceste constatări sugerează faptul că impactul diferenţial asupra coping-ului

religios pozitiv versus negativ generalizează dincolo de evenimente singulare (Koenig,

Pargament, and Nielsen 1998; Pargament et al. 1998) şi se aplică la stresul adunat ale

evenimentelor negative în general.

Ca o ultimă ipoteză, ne-am aşteptat ca coping-ul religios pozitiv să amortizeze

efectele evenimentelor negative asupra funcţionării, în lumina rolului general de amortizor de

stres al religiei (Hood et al. 1996). Acest efect a apărut într-adevăr cu privire la depresie. În

cazul persoanelor care au reportat coping religios pozitiv crescut, depresia a crescut mai puţin

ca răspuns la evenimente negative, decât în cazul persoanelor care au raportat un coping

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religos pozitiv mai mic. Această sugerează faptul că coping-ul religios pozitiv ajută la

atenuarea impactului acumulării evenimentelor asupra depresiei. Aceasta ar putea fi adevărat

în măsura în care un astfel de coping accentuează o relaţie colaborativă, afectivă cu un

Dumnezeu personal.

De asemenea există posibilitatea ca membrii bisericii protestante să considere

evenimentele negative ca provocări, pe care Dumnezeu le permite, pentru a le întări credinţa.

(Park, Cohen şi Herb 1990). În consonanţă cu aceasta, există un item de coping religios

pozitiv precum: “să văd cum Dumnezeu vrea să mă întărească în această încercare".

(Pargament et al. 1998:718). O asemenea viziune îi poate face pe protestanţi să caute

aspectele pozitive ale oricărui stresor, ceea ce duce la creşterea speranţei şi la simptome

depresive reduse. De partea cealaltă, coping-ul religios negativ nu interacţionează cu

evenimente negative în ceea ce priveşte funcţionarea psihologică.

Cu toate acestea, luând în considerare efectele puternice ale coping-ului negativ, se

poate infera că acest tip de strategii sunt legate de o adaptare şi mai proastă, indiferent de

cantitatea de stresori. Prin urmare, constatările noastre la adresa protestanţilor, indică faptul că

este la fel de important, sau chiar mai mult, să atenuăm coping-ul religios negativ, decât să

maximizăm coping-ul religios pozitiv. Rezultatele actuale trebuie totuşi interpretate în lumina

variilor limitări metodologice. Mai întâi, studiul este transversal, limitând inferenţele de ordin

cauzal. Apoi, deoarece au fost investigaţi numai protestanţii, a existat riscul de a studia

comportamentele de coping în cazul unei tradiţii religioase particulare, ceea ce poate duce la

reducerea abilităţii de a generaliza rezultatele şi în cazul altor religii.

O altă limitare se referă la utilizarea evocării de tip retrospectiv din ultimul an, dat

fiind faptul că participanţilor li s-a cerut să facă o medie a coping-ului religios folosit în mai

multe evenimente. Fără îndoială, o asemenea strategie este ţinta multor erori şi biasări în ceea

ce priveşte procesul de evocare. Într-adevăr, deoarece unii din participanţi au raportat un

coping religios pozitiv, nu este ieşit din comun ca distibuţia eşantionului actual să fie

îngustată puternic negativ, sugerându-se posibilitatea unei supraraportări a copingului religios

pozitiv. În ciuda acestor limitări, studiul de faţă procură un sprijin serios pentru evaluarea

importanţei coping-ului religios şi pentru distincţia dintre strategii pozitive şi negative când

este vorba de stresul acumulat de-a lungul timpului (versus un eveniment specific).

Pattern-uri pozitive de coping religios pot fi eficiente în combaterea efectelor

negative de viaţă. Astfel de circumstanţe stresante aduc cu ele şi un risc crescut de utilizare a

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coping-ului religios negativ, care este legat inevitabil de funcţionare proastă. Prin urmare,

rafinarea distincţiei dintre coping-ul religios negativ şi cel pozitiv, poate constitui o resursă

preţioasă pentru cercetătorii din psihologia religiei, pentru comunitatea psihologilor, consilieri

pastorali şi clinicieni care tratează clienţi religioşi.

NOTE

1. Ambele analize ierarhice omnibus au fost repetate, adaugându-se variabilele

demografice (gen, etnie, statut marital, educaţie şi vârstă), la covariatele existente (ordinea

măsurătorilor, participarea la serviciul religios, participarea la activitati religioase). Toate

rezultatele găsite au rămas semnificative chiar şi după controlul celor 8 covariate, cu o singură

excepţie. Întrucât relaţia pozitivă a coping-ului religios negativ cu depresia a rămas

semnificativă, relaţia negativă cu satisfacţia de viaţă s-a redus. (p = 0,11).

2. Dată fiind includerea unor itemi - întrebări, unii ar putea crede că măsurarea

coping-ului religios negativ a lui Pargament şi a colaboratorilor săi evaluează orientarea

religioasă şi nu coping-ul religios per se. Este important de notat că această căutare nu este

văzută ca şi o nemulţumire sau neconvergenţă cu convingerile oamenilor, ci mai degrabă,

"implică a face faţă cu onestitate întrebărilor existenţiale... în timp ce opui rezistenţă...

răspunsurilor potrivite... (cu conştiinţa că) nu ştii şi probabil nici nu vei afla adevărul final..."

(1991:417). Din contră, scala de itemi pentru coping-ul religios negativ a lui Pargamant,

reflectă în mod consistent sentimente negative (abandon, pedeapsă, rănirea de catre diavol,

etc.), care converge cu natura maladaptativă ale acestor evaluari de coping.

3. Coping-ul religios pozitiv a fost corelat semnificativ cu variabilele funcţionării

după introducerea covariatelor, însă corelaţiile de ordin zero nu au fost semnificative. Acest

lucru sugerează că trăsăturile coping-ului religios pozitiv cele mai tipice în ceea ce priveşte

despresia şi satisfacţia de viaţă, sunt acele aspecte care nu sunt legate de covariate. De

exemplu, s-ar putea ca comportamentele de coping religios pozitiv axate pe căutarea

ajutorului si iubirii lui Dumnezeu să fie mai relevante pentru funcţionarea psihologică decât

comportamentul de coping, care poate reprezenta pur şi simplu participarea religioasă (una

dintre covariate), precum rugăciunea şi slava.

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Tradus de:

Costache Roxana Elena

Costaș Meda

Brumă Valeria

Facultatea de Psihologie și Științe ale Educației, Anul al II-lea. 2010

Journal of Psychology and Theology

2001, Vol. 29, No. 3, 201-211

Copyright 2001 by Rosemead School of Psychology

Biola University, 0091-6471/410-730

201

We reply to Gassin’s (2001) valuable description ofan Eastern Orthodox perspective on interpersonalforgiveness by discussing some socio-cultural issuesrelated to eastern and western construals of forgive-ness and humility. Differences in the social functionof humility and forgiveness are outlined based on dif-fering cultural contexts. Crysdale’s (1999) theologicalmodel of the cross and resurrection is utilized fordeveloping an integrative perspective on forgivenessand empowerment.

tion of Eastern Orthodoxy. Instead, we will engagesome socio-cultural issues related to eastern and west-ern construals of forgiveness. Gassin focused mostlyon theological and psychological differences betweeneastern and western models with some mention of cul-tural differences. We believe differences in socio-cul-tural contexts strongly influence the theological andpsychological differences in how forgiveness andhumility are construed. We will outline some differ-ences in the social function of humility and forgivenessbased on differing cultural contexts and conclude bydescribing Cynthia Crysdale’s (1999) integrative theo-logical model of forgiveness and empowerment.

THE SOCIAL FUNCTION OF

FORGIVENESS

Gassin (2001) pointed out several key differencesbetween Eastern Orthodox and western psychologi-cal perspectives on interpersonal forgiveness. Forexample, she suggested that Eastern Orthodox writ-ers tend to blur the distinction between interperson-al forgiveness and reconciliation, whereas westernpsychological models of forgiveness tend to empha-size the difference (e.g., Freedman, 1998). She alsocontrasted Eastern Orthodox emphases on humility,the sinfulness of anger, forgiveness rituals, and rela-tional selfhood with western emphases on self-esteem, the legitimation of anger, self-forgiveness,and personal boundaries. We argue that these differ-ing emphases in the social function of forgivenessreflect core differences between individualistic andcollectivistic worldviews. Eastern Orthodoxy is prac-ticed primarily in collectivistic cultural contexts and,of course, western psychology arises from individual-istic cultural contexts. We will consider the socialfunction of forgiveness from individualistic and col-lectivistic worldviews, as well as some of the dynam-ics related to social justice in those contexts.

CONTEXTUALIZING MODELS OF

HUMILITY AND FORGIVENESS:A REPLY TO GASSIN

STEPHEN J. SANDAGE and TINA WATSON WIENS

Bethel Theological Seminary

We wish to thank Cynthia Crysdale, Carla Dahl, Samantha Mor-gan O’Rourke, and Gloria Metz for helping us with thismanuscript. Correspondence concerning this article may be sentto Steven J. Sandage, PhD, Bethel Theological Seminary, 3949Bethel Dr., St. Paul, MN 55112. Electronic mail may be sent tos-sandage@bethel.edu

Gassin (2001) has made an extremely impor-tant contribution to integrative literatureon interpersonal forgiveness. The growing

body of theoretical and empirical research on thepsychology of forgiveness has been promising. Butintegrative dialogue on forgiveness requires morecontributions like Gassin’s that offer sophisticatedtheological perspectives on forgiveness rooted inparticular traditions, like Eastern Orthodoxy. Fur-thermore, Gassin has richly described a theologicaland cultural tradition that has been largely neglectedby western Christians, and she has brought that tra-dition into dialogue with western psychology. Weneed a diverse array of such contextualized modelsof forgiveness to deepen our understanding of howconstructs like forgiveness can be shaped by theo-logical traditions, spiritual practices, psychologicalmodels, and cultural systems.

We also appreciated Gassin’s (2001) articlebecause we have personally been so uninformedabout Eastern Orthodox theology. This means we lackthe expertise to reply to the accuracy of her descrip-

202 CONTEXTUALIZING HUMILITY AND FORGIVENESS

Individualism and Collectivism

Individualism and collectivism have been definedin many ways but basically refer to differing culturalor social patterns that are rooted in differing world-views (Triandis, 1995; on the related constructs ofindependent and interdependent self-construals, seeMarkus & Kitayama, 1991). According to Triandis(1995), individualism is a social pattern that: (a)involves individuals perceiving themselves as relative-ly independent of others; (b) emphasizes individualneeds, rights, contracts, and attitudes; (c) gives prior-ity to personal goals and boundaries over groupgoals and social identity; and, (d) encourage rationalcost-benefit analyses of social relationships. In con-trast, collectivism is a social pattern that: (a) involvesindividuals perceiving themselves as interdependentwith others; (b) emphasizes social norms, obliga-tions, and duties; (c) gives priority to family or groupgoals over personal goals; and (d) values social con-nectedness and commitment even when it is disad-vantageous to individuals. These differences in cul-tural worldviews influence the ways cultural orreligious groups construe interpersonal forgiveness.

At the risk of over-simplifying some complex cul-tural and worldview issues, we will outline the con-tours of these two contrasting cultural worldviews(i.e., individualism and collectivism) as they mightinfluence models of forgiveness (see Table 1). This isintended to provide a general heuristic that is usefulfor the discussion of models of forgiveness rather

than the depiction of dichotomous categoriesbecause there are many versions of individualismand collectivism (Triandis, 1995). Individuals with abicultural identity might even fluidly shift betweenfacets of both individualistic and collectivistic world-views depending upon the immediate context.Admittedly, these proposed cultural differencesrelated to forgiveness are mostly hypothetical andbased on theory rather than empirical data.

Views of the self. The view of the self from anindividualistic worldview is one of a bounded selfdefined by one’s bodily boundaries (Cushman,1995). The individualistic (or “modern”) self is root-ed in the Cartesian tradition of self-reflexivity, or theability to autonomously objectify and reflect on one-self. The individualistic self is understood to needliberation through freedom from social ties or con-straints, and the healthy self establishes indepen-dence from others (Markus & Kitayama, 1991). Incontrast, the self from a collectivistic worldview isirreducibly social and relational. From a collectivisticperspective, the healthy self is interdependent. Fromthe Eastern Orthodox perspective, loving your“neighbor” and your “self” is the same thing (seeGassin, 2001, p. 20), which is consistent with a col-lectivistic view of the self.

These differing cultural views of selfhood willobviously influence the relationship between forgive-ness and reconciliation, a difference pointed out byGassin (2001). Western psychological models of for-

Table 1The Contours of Individualistic and Collectivistic Worldviews in Relation to Forgiveness

Individualistic1 CollectivisticWorldview Worldview

View of the Self2 Independent InterdependentSelf-Reflexive Social, Relational

View of Relationships3 Exchange/Contractual Communal/Covenantal

Primary Face Concern4 Self-Face Other-Face and Self-Face

Self-Forgiveness Vital Implausible

Forms of forgiveness Personal Insights & Skills Communal Narratives,Professional Techniques Rituals, and Symbols

1See Triandis (1996).2See Cushman (1995); Markus & Kitayama (1991); Triandis (1995)3See Bromley & Busching (1988)4See Triandis (1995)

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giveness tend to be more individualistic and make asharp distinction between forgiveness and reconcili-ation, with the latter being unnecessary, cautionedagainst, or simply optional for healing (e.g., seeFreedman, 1998; McCullough, Sandage, & Wor-thington, 1997). In an individualistic culture, forgive-ness might frequently be construed as a pathway toself-heal from relational injuries without necessitat-ing the communal reconciliation that is so counter tothe prevailing individualistic social scripts. Forgive-ness might even be framed as a unilateral method ofdisembedding oneself from painful relationships(Augsburger, 1997).2 In collectivistic cultures, for-giveness and reconciliation will be much more close-ly related (Augsburger, 1992, 1997), as depicted byGassin in Eastern Orthodoxy’s emphasis on reconcil-iation. Collectivistic cultures are so strongly orientedtoward preserving group and familial cohesion thatmutual forgiveness will tend to be viewed as a path-way toward reconciliation (Augsburger, 1997).

People living in the ancient Mediterranean socialcontext of the New Testament would have certainlyconstrued the self in a more collectivistic or interde-pendent fashion (Malina, 1993a). Forgiveness and rec-onciliation are, therefore, probably more closely relat-ed in the New Testament than in contemporarywestern psychological models of forgiveness (Jones,1995). Gassin (2001) makes the point that “theChurch” (p. 41) (i.e., presumably the contemporarychurch) should be communal rather than individualis-tic in cultural orientation. We would certainly agreethat the Church should be a community that embod-ies many of the interpersonal values of communal orcollectivistic worldviews, especially if the goal is corre-spondence to the New Testament vision. Western psy-chologists and therapists interested in Christian inte-gration would be wise to give greater attention toconnections between forgiveness and reconciliation(Sandage, 1999; Worthington & Drinkard, 2000).However, it seems realistic to acknowledge that thecontemporary social context of highly urbanized andindustrialized western countries is far different fromthat of both the New Testament context and many

contemporary collectivistic contexts. Moreover, wewould argue that extreme forms of both collectivismand individualism have weaknesses. Therefore, thechallenge for Christian integration involves develop-ing culturally-contextualized models of forgivenessthat weave together biblical theology and spiritualitywith quality psychological science.

Social relations. The view of social relations froman individualistic worldview is one of contractualexchange (Bromley & Busching, 1988; Triandis,1995). Relational commitment is based on a mutual-ly-satisfying contract or exchange that meets oneanother’s felt needs (Bellah, Madsen, Sullivan, Swi-dler, & Tipton, 1985). Relationships that do notmeet one’s personal needs tend to be viewed asunnecessary or expendable.

The view of social relations from a collectivisticworldview is more communal and covenantal thanthe view of social relations from an individualisticworldview. Collectivistic relationships are basedupon making and keeping vows or covenants, whichrequire greater consideration of the needs and well-being of the group or community. Forgiveness in col-lectivistic cultures is more likely to be framed as asocial duty that preserves social harmony rather thana personal decision or attitude. The Eastern Ortho-dox respect for martyr-like attempts at reconciliationonly make sense from a collectivistic worldview, notan individualistic one.

Face concern. Interpersonal conflict creates crisesof social face. “Social face” refers to a person’s senseof social worth or dignity. A “loss of face” involves ashameful or humiliating experience of being dishon-ored before others (Goffman, 1967). Efforts to saveface can be directed at saving one’s own face (i.e.,self-face concern) or saving the face of others (i.e.,other-face concern) (Triandis, 1995). Individualisticcultures promote self-face concern while collectivisticcultures promote both other- and self-face concern.

Again, Eastern Orthodoxy as described byGassin (2001) is consistent with a collectivisticworldview by encouraging the practice of “victims”seeking forgiveness from their offenders. In socio-logical categories, this practice demonstrates a valu-ing of other-face concern. The tremendous empha-sis in contemporary western psychological literatureon forgiving others and the relative paucity of litera-ture on seeking forgiveness from others (seeSandage, Worthington, Hight, & Berry, 2000) high-lights the western emphasis on self-face concernabove other-face concern.

2 It is noteworthy that some research on forgiveness even in thelargely individualistic context of the U.S. suggests that, in actualpractice, forgiveness and reconciliation are quite closely related(McCullough et al., 1998). That is, people tend to be more forgiv-ing toward those they are close to prior to an offense, and for-giveness predicts closeness following an offense. Forgivenesswithout reconciliation might be relatively rare outside of psy-chotherapy.

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Self-forgiveness. Gassin (2001) suggested that thewestern concept of self-forgiveness finds “no place inthe Orthodox tradition” (p. 19). This is probablyrelated to the differing construals of the selfdescribed above with self-forgiveness being poten-tially vital from an individualistic worldview andpotentially implausible from a collectivistic world-view. Some historical context can shed light on thesecultural differences regarding self-forgiveness.

Taylor (1989) has traced the historical develop-ment of modern western notion of the self, and heemphasizes the pivotal role of Descartes. Descartesconsidered the exercise of rational control over thematerial world as the epitome of the human endeav-or. The instrumental exercise of control requires amotivational source, and Descartes transformed theseventeenth century virtue of “generosity” into thatmotivational source. Generosity was the crowningvirtue that promoted honor or a willingness to con-quer one’s fears in order to accomplish heroic mili-tary feats or other acts of public service. The mean-ing of “generosity” could be translated as a sense ofdignity, worth, or honor. According to Taylor,Descartes transferred this virtue from the publicsphere, where it was conferred by others in honor-shame cultures, to make generosity toward oneselfthe internalized “motor of virtue” (p.154). This ideaof self-generosity may be an ideological root of mod-ern psychological notions of self-esteem, andDescartes called this sense of self-worth “the key ofall other virtues, and a general remedy for all disor-ders of the passions” (as quoted in Taylor, 1989, p.155). This may in part explain the historical develop-ment of the uniquely modern and western conceptof self-forgiveness.

Taylor (1989) goes on to suggest that the individ-ualistic self of modern western cultures is disembed-ded from all social identity and social connectionsand, therefore, lacks internalized “moral sources” ofidentity. In a similar fashion, Cushman (1995) arguesthat the modern, individualistic Cartesian selfstripped of relational or moral ties to community isreally an “empty self” waiting to be filled by a con-sumer society (also, see McCullough et al., 1997).According to Cushman, the source of moral authori-ty for the modern, individualistic self is the individu-al’s own self-constructed attitudes. In contrast, col-lectivistic cultures identify the source of moralauthority as a spiritual and/or social community.This community is generally responsible for the tra-ditions and narratives that illustrate the moral virtues

to which the individual should strive (MacIntyre,1984). Those living in contemporary individualisticcultures who find themselves disembedded fromsuch communal moral sources and traditions mayfeel the need to engage in radical self-reflexivity toconfer forgiveness upon the self. This individualisticself-forgiveness can then be viewed as providing thefoundation of self-healing and self-esteem thatencourages the generosity to forgive others. Self-for-giveness would seem to be a potentially implausibleconstruct from a collectivistic worldview becauseforgiveness is mediated through relationships in col-lectivistic cultures (Augsburger, 1992; Braithwaite,1989). To “forgive oneself” could imply an inappro-priate independence from communal sources or ritu-als of forgiveness.

Forms of forgiveness. These differing culturalviews on self-forgiveness are related to the differingforms of forgiveness. Gassin (2001) described someof the rich Eastern Orthodox rituals for encouragingforgiveness. Collectivistic cultures will be more likelythan highly individualistic cultures to retain the cohe-siveness of communal rituals, stories, and symbolsthat narrate forgiveness. Individualistic cultures willtend to rely on what Rieff (1966) called “analytictherapies,” which provide individuals with informa-tion, skills, or personal insights for privatized healingrather than employing the use of more public ritualsor symbols. According to Rieff, most forms of mod-ern western psychotherapy would qualify as “analytictherapies.” Western psychological models of “thera-peutic forgiveness” (Jones, 1995) might be viewed asa type of analytic therapy that relies upon personalinsights or skills rather than communal rituals, narra-tives, and practices.

This issue of the differing forms of forgiveness iscentral to some of the critiques of therapeutic for-giveness (Augsburger, 1997; Jones, 1995) and the de-contextualizing of forgiveness as simply a “tech-nique” removed from any historical or communalcontext (McMinn, 1996; Meek & McMinn, 1997).Individualistic models of forgiveness do seem at riskof lacking cultural richness and historical depth.Conversely, Foucault (1993) argued that communalinstitutions (e.g., churches) are capable of imple-menting oppressive rituals that subjugate rather thanempower members. Communal rituals carry tremen-dous power for good or evil. Therapeutic approach-es to forgiveness might be particularly relevant forindividuals who are disconnected or estranged fromtraditional forms of community. Foucault’s analysis

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also raises questions about the relationship betweenmodels of forgiveness and social justice.

Social Justice

The social function of forgiveness involves how acultural group or society approaches issues of socialjustice (Braithwaite, 1989). Gassin (2001) points outthat western psychologists might strongly object tothe Eastern Orthodox practice of encouraging vic-tims to apologize to offenders. This is probably true.Western psychological models of forgiveness havearisen in a professional therapeutic context that hasinvolved grappling with the realities of abuse and theinjustice of blaming victims for that abuse (McMinn,1996). We are curious how Eastern Orthodox clergyand church leaders approach issues of abuse and thedynamics of social justice. Young (2000) describedthe Eastern Orthodox church as generally maintain-ing a “very conservative or traditional moral system”(p. 97). This does not imply a lack of concern forsocial justice in Orthodoxy, but it could translateinto less focus on violations of individual rights andindividual liberation than promoted by westernmodels of psychotherapy.

These issues of social justice are related to thesocial function of anger, as well. Gassin (2001)described the general lack of support for interper-sonal anger in Eastern Orthodoxy, which isassumed to be a “result of our fallen nature” (p. 9).The Orthodox tradition seems to suggest thatanger is better directed against the self. As Gassinsuggests, western psychologists do put moreemphasis on the legitimacy of interpersonal angerand the dangers of self-directed anger, probablydue to many cultural and worldview factors. Forexample, the social cost of interpersonal anger andconfronting abuse might be greater in collectivisticcultures than in individualistic cultures. The theo-logical and spiritual legitimacy of anger involvescomplex issues beyond the scope of this paper. Wedo resist an assumption that all interpersonal angerresults from our fallen nature (see Jones, 1995;Volf, 1996). Such a view would seem to offer nolegitimation for anger against injustice.

THE SOCIAL FUNCTION OF HUMILITY

Gassin’s (2001) article raises important issuesabout the social function of humility, as well as for-giveness. We will briefly consider biblical and con-temporary psychological views on humility.

Biblical Views of Humility

Gassin (2001) provided a helpful challenge toSandage’s (1999) attempt to connect his definitionof ego-humility with two biblical passages (Rom12:3; Phil 2:3). Sandage (1999) defined ego-humilityas “a realistic self-orientation that includes a willing-ness to acknowledge one’s strengths and face one’slimitations” (p. 261). Building on the work ofRoberts (1982), he further suggested that an inter-personal correlate of such humility is a tendency to“view others as one’s equal” (p. 261). Gassin pointedout that Paul actually exhorts the readers at Philippito humility and to “consider others better than your-selves” (Phil 2:3; New International Version), sug-gesting that Sandage’s egalitarian construal of humil-ity might not be fully consistent with this biblicaltext. Gassin also questioned an egalitarian implica-tion to Paul’s exhortation in Romans 12:3 to notthink of oneself “more highly than you ought.” Theseare points well-taken and serve to highlight some ofthe first author’s contemporary egalitarian social val-ues. This calls for an examination of the New Testa-ment meaning of humility, as well as the social func-tion of humility in that ancient context.

At the same time, we will argue that the contextof both passages suggests Paul is primarily con-cerned with a humility that promotes the unity of theChristian community within the diversity of mem-bers. In Romans 12:3-8, Paul moves directly fromcalling for sober self-assessment to a discussion ofthe differing gifts within the body of Christ with eachmember’s gifts being important to the overall body.His point is that each member has a place of belong-ing within the community.

In Philippians 2:1-4, Paul is also calling the commu-nity at Philippi to a spirit of unity through humility(e.g., verse 3 says, “in humility consider others betterthan yourselves”). The Greek word for “humility” inverse 3 ( ) implies a “lowliness ofmind” (Fee, 1995). Humility was generally not consid-ered a virtue in the Greco-Roman world, whichregarded humility as a form of servility and weakness(Bockmuehl, 1998; Fee, 1995). Paul sets humility incontrast to “selfish ambition” and “vain conceit” (verse3), giving humility a connotation of unselfishness(Grundmann, 1972) that counters the grandiosetemptation to that “strangely addictive and debasingcocktail of vanity and public opinion” (Bockmuehl,1998, p. 110).

It appears that the Philippian church was at risk for

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experiencing division due to some “selfish ambition”or what Fee (1995) calls “posturing” (p. 33). It is possi-ble that the social values of the prominent Romancolony of Philippi were influencing some members inthis posturing. Paul holds out the sacrificial exampleof Christ’s humility in going to the cross (Phil 2:5-8) asan alternative to selfish ambition and vain conceit.This raises several questions about the meaning of bib-lical humility. First, does humility mean consideringeveryone better than oneself? If so, this would seemto create a tremendous burden of social comparisonthat would be contrary to the values of most contem-porary western psychologists and therapists. Second,is self-disparagement or abasement a central feature ofhumility? Again, this would make humility contradic-tory to most contemporary western models of healthyhuman development.

Social comparison. Interpreting Paul’s exhorta-tion to “in humility consider others better than your-selves” (Phil 2:3) requires understanding the occa-sion of the letter to the Philippians. Paul does notuse the more serious language of “division” or “strife”in this letter as he does in First Corinthians (1 Cor1:10-12). This suggests the tensions Paul has in mindat Philippi, such as that of Euodia and Syntyche (Phil4:2), are basically between friends within the Chris-tian community (Fee, 1995). Therefore, Paul is notcommending an attitude of considering oppressiveor abusive people morally better than oneself. Infact, he does not even seem to be encouraging thePhilippians to consider everyone better than them-selves because he refers to a certain group he consid-ers to be destructive “enemies” (Phil 3:18). Paulseems to be encouraging a capacity to consider somepeople “better than” oneself while still being able tocritique the character and values of some otherdestructive persons.

Self-disparagement. We must also determine theprecise meaning of humility in Philippians 2:3 andwhether humility requires self-denigration. Severalbiblical scholars have argued that the kind of humili-ty Paul is encouraging is not one of self-disparage-ment, abasement, nor low self-esteem (Bockmuehl,1998; Fee, 1995; Grundmann, 1972; Hawthorne,1987). Fee (1995) explains the meaning of humilityin Philippians 2:3 in this way:Humility is not to be confused with false modesty, or with thatkind of abject servility that only repulses, wherein the “humbleone” by obsequiousness gains more self-serving attention thanhe or she could do otherwise. Rather, it has to do with a prop-er estimation of oneself, the stance of the creature before the

Creator, utterly dependent and trusting. Here one is wellaware both of one’s weaknesses and of one’s glory (we are inhis image, after all) but makes neither too much nor too littleof either. True humility is therefore not self-focused at all, butrather, defined by Paul in v.4, “looks not to one’s own con-cerns but to those of others.” (p. 188)

Rather than social comparison or self-denigra-tion, Paul is encouraging the Philippians to humblycare for others and to put their concerns ahead oftheir own. The goal is one of mutual love and honor-ing others in a Mediterranean cultural context wherehonor and shame were the core social values (Mali-na, 1993). The Greek word for “better” in verse 3( ) can also be translated “surpassing”and does not suggest a comparative evaluation of theworth of others (i.e., “consider others more worthythan yourselves”) (Fee, 1995). Instead, we concurwith Fee’s (1995) interpretation that Paul is saying“consider the needs of others in the community assurpassing your own and care for them.” Bockmuehl(1998) points out that the central social dynamic thatdistinguishes the Christian view of humility from theGreek is the “non-hierarchical intent [of Christianhumility]: it governs relations between people whoare in principle equals, and is not a cliche for exces-sive deference to superiors” (p. 111). Thus, it appearsthat the biblical view of humility, at least as devel-oped by Paul in Philippians, is consistent with anegalitarian social ethic. Christian humility involvesthe willingness to take a humble relational posture(when appropriate) by surrendering the motives ofselfish ambition and grandiosity while consideringthe needs of others above one’s own. This is qualita-tively different from the false humility of perpetualself-denigration or a need for self-abasement. Thisunderstanding counters the position of Nietzsche(1886/1989), who despised both Christianity humili-ty because he believed it did represent a false defer-ence that masked true motives (see Roberts, 1982).

Contemporary Western PsychologicalViews of Humility

How might contemporary western psychologyview this biblical understanding of humility?1

Gassin is correct that there has been very limitedconsideration of humility in contemporary westernpsychology (for reviews, see Exline, Campbell,Baumeister, Joiner, & Krueger, 2000; Emmons,

1This is not to imply a uniformity in contemporary western psy-chology but simply a way of framing some general differences.

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2000; Tangney, 2000), so there are no well-devel-oped psychological theories of humility. Neverthe-less, we will outline a few areas of potential disso-nance and rapprochement between EasternOrthodox and biblical views of humility and con-temporary western psychology.

First, contemporary psychologists in the westwould probably advocate for more emphasis onself-care and personal boundaries than is evident ineither Eastern Orthodoxy or New Testament litera-ture. Even if Paul’s exhortation in Philippians 2:3to “consider others better than yourselves” is notuniversal and does not mean self-denigration, itdoes run counter to the individualistic cultural val-ues that dominate parts of the United States (U.S.)and some other western nations. Many cliniciansin the U. S. could probably quickly think of clientswhose problems involve a self-defeating proclivityto view others “as better than themselves.” This dis-crepancy can be mitigated by realizing that Paul isnot prohibiting what contemporary psychologistswould call “self-care” even if it is given much lessemphasis than in our contemporary therapeuticculture. Jesus himself practiced a form of spiritualself-care that placed limits on the amount of ser-vice he offered to those in need (Mark 1:35-38).Self-care and humility actually form a healthydialectic that represents spiritual and emotionalmaturity. Self-care practices (e.g., prayer, sleep,nutrition, exercise) contribute to the energy need-ed to humbly care for others, and humility con-tributes to the dynamics of a healthy communitythat benefit both self and others.

Second, contemporary western psychologistswould probably be eager to have humility distin-guished from low self-esteem or shame-proneness(Exline et al., 2000; McMinn, 1996; Means, Wilson,Sturm, Bion, & Bach, 1990; Tangney, 2000).Emmons (2000) explains:To be humble is not to have a low opinion of oneself; it is tohave an opinion of oneself that is no better or worse thanthe opinion one holds of others. It is the ability to keep one’stalents and accomplishments in perspective . . . to have asense of self-acceptance, an understanding of one’s imper-fections, and to be free from arrogance and low self-esteem.” (pp. 164-165)

Tangney (2000) likewise defines humility asincluding an accurate self-assessment and relativelylow self-focus. Humility involves an ability to viewoneself from a broader perspective (Exline et al.,2000). Conversely, shame and low self-esteem

restrict the self, and they can actually increase thekinds of self-consciousness and interpersonaldefensiveness that prohibit caring for others(McMinn, 1996; Tangney, 1995). A shame-pronefragile sense of self can lead to defensive narcissism(Sandage, 1999; Tangney, 2000), and narcissism iscertainly contrary to humility, empathy, and forgive-ness (Emmons, 2000; Exline et al., 2000; Tangney,Fee, Reinsmith, Boone, & Lee, 1999). Empathymay be a vital dimension of humility or at least aclosely related virtue (Emmons, 2000; Means et al.,1990; Sandage, 1999). Empathic humility involvesthe ability to accurately perceive the needs of oth-ers (cf. Phil 2:3), as well as the ability to forgive byviewing oneself as morally similar to offenders(Exline et al., 2000).

Contemporary psychologists might also be con-cerned to distinguish mature humility from the kindsof pathological shame and self-abasement that canbecome ego-syntonic. Simone Weil (1951/1973), asocial philosopher and spiritual writer, described thepotential dark side of shame-proneness that differsfrom genuine humility by suggesting “consciousnessof sin gives us the feeling that we are evil, and kind ofpride sometimes finds its place in it” (p. 109). Weilsuccinctly captures the irony of how self-satisfactionin false humility or even one’s own need for forgiv-ingness can be a way of assuming “the moral highground” in relationships.

Millon (1996) describes masochistic personalitydisorder as involving self-denigration and abase-ment that is ego-syntonic. Individuals with suchself-defeating personalities usually have painful rela-tional histories of abuse or neglect (or both), andMillon suggests that they can be unconsciouslymotivated toward an excessive self-sacrifice thatobligates or shames others. It is important to distin-guish humility from such self-destructive masochis-tic propensities. The Eastern Orthodox practice ofencouraging victims to apologize for the sins oftheir offenders, as described by Gassin, seems high-ly questionable in this regard. A core fear of manyvictims of abuse is that they are either culpable forthe abuse or capable of becoming abusive them-selves. These fears would seem to be exacerbatedby a practice of victims apologizing for the sins oftheir offenders. On the other hand, the culturalcontext and religious rituals of Eastern Orthodoxymight prevent such practices from producing thesame psychological consequences as would occurin western individualistic contexts.

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CRYSDALE’S INTEGRATIVE MODEL

Cynthia Crysdale (1999) has developed an inte-grative theological model of the cross and the resur-rection in her book, Embracing Travail: Retriev-ing the Cross Today, which weaves togetherfeminist, evangelical, and liberationist theologicalperspectives. Crysdale records some of her ownjourney of wrestling with how to personally and the-ologically reconcile her evangelical background withthe truth she has found in feminist and liberationistChristianity. Her work is integrative at several levels.For example, she integrates theories from both the-ology and the social sciences, and she is well-attunedto the spiritual struggles of both individuals andsocial systems. What makes her model particularlyrelevant to our discussion is her integration of for-giveness and empowerment. We suggest that hermodel goes beyond many traditional Christian theo-logical views of the cross and offers a sound and justtheological foundation for understanding the socialdynamics related to humility and forgiveness.

Crysdale’s (1999) major thesis is that Christianscan affirm “two sides” to the cross and resurrection(see Figure 1). Traditional orthodoxy has empha-sized the gospel’s promise of forgiveness of sins forthose who are humbled by the cross into repentance.This side of the cross speaks most directly to thosewho come from a place of privilege and socialpower. Crysdale suggests that the other side of thecross is primarily for those whose social location

involves oppression. Along with many liberation andfeminist theologians, Crysdale argues that the gospelspeaks to disempowered victims of oppression of aloving God who identifies with innocent victimiza-tion yet overcomes evil with good (also, see Volf,1996). For the oppressed, the gospel first offers heal-ing for the wounds of social shame (Jewett, 1997)and an affirmation of selfhood and voice (also, seeCone, 1991; Jones, 1995).

One of the unique dimensions of Crysdale’s(1999) contribution is her suggestion that both sidesof the cross (i.e., the healing of wounds and the for-giveness of sins) are ultimately relevant to every per-son in order to break the victim-perpetrator cycle.Social location influences the side of the cross thatrepresents a person’s primary initial need. A victimof oppression needs the empowerment of voice, buteventually that person also needs to experiencerepentance and the forgiveness of sins. A personfrom a position of social privilege needs to experi-ence the humility of repentance and the grace ofbeing forgiven, but eventually that person also needsto grow into the empowerment of true voice. Itseems to us that western psychotherapists have tend-ed to focus on the side of the cross that involves thehealing of shame and woundedness and the empow-erment of voice without necessarily using the theo-logical language. Evangelical Christian churches havefocused on the side of the cross that invites humility,repentance, and offers the forgiveness of sins. Basedon Gassin’s description, Eastern Orthodoxy also

Figure 1.

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appears to focus on humility, repentance, and theforgiveness of sins. However, much is lost wheneither side of the cross is neglected.

We will briefly highlight three theological themesfrom Crysdale’s model that are relevant to anapproach to forgiveness that integrates both sides ofthe cross . These themes include suffering, sin, andsalvation.

Suffering

The title of Crysdale’s book, Embracing Travail(1999), is the major motif for her model. Embracingtravail is likened to the process of giving birth, and itspeaks to the centeredness of being that is open tonew life including both the pain and the responsibili-ties involved. She suggests grief and suffering areoften pathways to healing (and probably forgiveness,see Augsburger, 1997; Layton, 1998), yet she is con-cerned about a theology that over-valorizes sufferingor martyrdom. Over-valorizing suffering can be aninsidious way of maintaining social hierarchies andkeeping power from those who are oppressed.While some project evil onto others to justify domi-nation, others have been socialized to introject evilinto themselves, resulting in a theology of self-deni-gration and self-defeating shame. In contrast, Crys-dale points out that Jesus refused to project or intro-ject evil. Crysdale’s work challenges us to considerhow we socialize people into the sacrificial virtue offorgiveness and whether issues of voice, power, andboundaries are also part of that socialization. AChristian integrative model of forgiveness andempowerment should suggest the importance ofhelping people overcome tendencies to either pro-ject or introject evil.

Sin

Sin has been traditionally viewed as pride, arro-gant ambition, or narcissism by many Christian the-ologians (Crysdale, 1999; Volf, 1996), and prideseems to be a dominant sin motif in Eastern Ortho-doxy (Gassin, 2001). But Crysdale (1999) effectivelyargues that narcissism is not the universal coredynamic of sin. Other themes and metaphors for sinare needed in order to generate contextualized mod-els of forgiveness and reconciliation. For example,Volf (1996) suggests exclusion of those we find dif-ferent, strange, or “outgroup” is an important dynam-ic of sin that wars against forgiveness and reconcilia-tion. Crysdale suggests that sin can take the form of

denigration or accepting “too much limitation” (pp.128-129) among oppressed groups of people. Shewarns that an over-emphasis on humility can exacer-bate this problem for people who already strugglewith self-denigration (also, see McMinn, 1996).

A call to name one’s victimization is part of over-coming the effects of evil and sin. Crysdale (1999)writes,” ‘Confess your sins’ and ‘embrace yourwounds’ are both true” (p. xii). The redemptivedrama of the bible describes a God who sees inno-cent blood crying out from the ground (Gen 4; seeVolf, 1996) and promises to bring ultimate justice.Integrative models of forgiveness will need to givemuch greater attention to the relationshipsbetween interpersonal forgiveness, systemic sin,and social justice.

Salvation

Crysdale (1999) argues that salvation involvesboth sides of the cross (forgiveness of sins and heal-ing of wounds), and both sides are eventually impor-tant for everyone. She explains, “Sooner or later, insome form or other, one must discover oneself asboth a crucifier and a victim. The failure to do thiscan lead to self-righteousness on the one hand orself-immolation on the other” (p. 20). Salvation leadsto a process of transformation or sanctification thatmeans “completing the circle: victims discoveringresponsibility and perpetrators embracing wounds... the cycle becomes not victim-perpetrator-victim,but healed-forgiven-healed” (pp. 23-24). The EasternOrthodox theology that Gassin describes might res-onate with Crysdale’s process-oriented view of salva-tion and sanctification, though the contextualizedsocio-political dimensions of Crysdale’s model donot seem to find any parallel in Gassin’s account ofEastern Orthodoxy. Also, the concern about self-immolation and the need to discover healing forone’s victimhood might run counter to the world-view of persons from an Eastern Orthodox tradition.

Crysdale (1999) goes on to develop her view ofsalvation by suggesting that the resurrection calls forthe risk of voice, telling the story, and the discoveryof discovery. Again, she integrates the spiritual andthe socio-political in her use of the resurrection as asalvific motif by explaining,”Some people inherit apresumption of voice and the confidence to knowthey are knowers. Others are socialized into silenceand are carefully ‘protected’ from discovering thatthey can make discoveries” (p. 76). Western litera-

210 CONTEXTUALIZING HUMILITY AND FORGIVENESS

ture on the psychology of forgiveness has given littleattention to the relationship between forgivenessand social power (Fincham, 2000; Madanes, 1991;Sandage, 1999). This has contributed to the chasmbetween therapeutic models that emphasize empow-erment, agency, and voice for the disempowered(e.g., feminist therapies) and those models thatdescribe the healing potential of forgiveness. Wewould like to see greater integration of forgivenessand empowerment in therapeutic approaches, andCrysdale’s model offers a theological foundation forChristian integration. Therapeutic approaches willalways need to be contextualized, however, andclients from hierarchical collectivistic cultures mighthave greater difficulty identifying with themes ofempowerment and voice than clients from individu-alistic cultures.

CONCLUSION

Models of forgiveness are embedded in culturalworldviews. Social location provides a powerfulinfluence that should be considered in contextualiz-ing models of humility and forgiveness. It is impor-tant to assess what these constructs mean for a clientwith respect to issues of gender, race, culture, andreligiosity. Gassin (2001) has provided a helpfuldescription of an Eastern Orthodox perspective oninterpersonal forgiveness and ways forgivenessmight need to be contextualized for clients from thattradition. Considering a cultural and theological tra-dition different than our own has offered the oppor-tunity to gain self-awareness of our own culturalworldview and to reconsider our theological and ide-ological assumptions. Following Crysdale (1999), wehave suggested that attending to both sides of thecross could provide an integrative theological modelthat values both forgiveness and empowerment.

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AUTHORS

SANDAGE, STEVEN J. Address: Bethel Theological Seminary,3949 Bethel Dr., St. Paul, MN 55112. Title: Associate Professor;Licensed Psychologist. Degrees: BS, Psychology, Iowa State Uni-versity; MDiv, Trinity Evangelical Divinity School; MS, PhD,Counseling Psychology, Virginia Commonwealth University.Specializations: forgiveness, couples and family therapy, psy-chology and religion.

WIENS, TINA R. WATSON. Address: 1525 Albert St. N., St.Paul, MN 55108. Title : Marriage and Family Therapist.Degrees: BS, Business, Northwestern College; MA, Marriageand Family Therapy, Bethel Theological Seminary. Specializa-tions: Collaborative and interdisciplinary health care, sexualhealth, adolescents.

Deconectare, Depresie si spiritualitate: Un stiudiu despre rolul

spiritualitatii si sensului in vietile indivizilor cu depresie severa

Abstract Acest studiu calitatitativ exploreaza rolul spiritualitatii si al

sensului printre 15 participanti care sufera de depresie severa.In timplul desfasurarii acestui studiu participantii ,erau sub tratament in Loma Linda University Behaviorial Medicine Center.Temele abordate sunt :(1) Depresia creaza o deconectare spirituala.Pacientii au raportat ca se simt separati ,"de-conectati" de Dumnezeu de comunitate, si de ei insisi.(2) Spiritualitatea joaca un rol important in copiingul activat dealungul durerii din depresie ;(3) Exista o dorinta arzatoare pentru sens si semnificatie si o zabatere pentru a descifra sensul durerii; si (4) Faptul de a ajunge la o impacare cu circumstantele personale si depresia , la un anumit nivel faciliteaza procesul de vindecare.

Cuvinte cheie: Spiritualitate. Sens. Depresie. Deconectare.

Acceptare.

Introducere

Acest studiu isi propune sa inteleaga rolul spiritualitatii si al sensului in viata al indivizilor care se lupta cu depresia severa.Potrivit Instutului National de Sanatate Mentala(2003) aproximativ 2 din 35 de milioane de adulti americani avand varsta de 65 de ani si peste 65 de ani sufera de o anumita forma sau alta de depresie.Doolittle si Farell(2004) au raportat faptul ca :"depresia este un diagnostic comun in practica ingrijirii primare numarand de la 6% la 20% dintre toate vizitele pacientilor"(p. 114).Ryan(2005) a confirmat ca rata la care indivizii ajung in depresie in ultimele cateva decenii se prezinta ca fiind in crestere comparate cu primele decade ale secolului 20. Cu toate acestea , numeroase studii au confirmat eferctele pozitive ale spiritualitatii asupra depresiei .(Cotton et al. 2005; McCoubrie& Davies 2006;Dalmida 2006;).Cel mai important motiv al acestui studiu este de a examina efectele perspectivei religioase asupra durerii provocate de depresie .Prevalenta depresiei nu este doar o provocare pentre comunitatea medicala.Depresia intuneca sufletul , indeparteaza speranta din locul ei , creaza un sentiment de goliciune sau ceea ce William James denumea intr-un fel edificator :"sufletul bolnav", care ii ia locul.Trece dincolo de minte . Si in timp ce mintea poate sa construiasca strategii care sa lupte cu conceptiiile gresite , poate sa vindece boala sufletelor?

Pentru cei dintre noi , a caror chemare este sa aiba grija de suflete , ingrijorarea ultima etse sa obtimem descrieri narative din partea sufletelor care s-au confruntat sever cu melancolia , cautand un sens al rolului spiritualitatii si al locului sensului in propriile vieti.Cum afecteaza depresia spiritualitatea ?

Poate spiritualitatea sa functioneze ca un mecanism de coping in vederea contracararii depresiei?Cum defineste cineva sensul in viata in prezenta melancoliei?Acest stiudiu cauta sa raspunda catorva dintre aceste intrebari fundamentale prin a asculta indivizii care se lupta existential cu depresia cronica.

Spiritualitatea

Conceptul de spiritualitate a generat un fel de dezbatere printre cercetatori(Mohr 2006).

Spiritualitatea este adesea perceputa ca fiind cu o sfera mai larga de cuprindere decat religia , si este adesea definita ca o relatie personala cu o putere superioara sau transcendenta(Dalmida 2006).

Religia , pe de alta parte , a fost descrisa ca fiind ca un sistem organizat de credinte, ghidata de valori ,ritualuri sau un cod de conduita (Mohr 2006). Se afirma ca spiritualitatea este independenta de religie pentru ca sunt unii care considera ca cineva poate sa fie spiritual fara ca sa apartina de o comunitate religioasa cu credinte organizate.(Hodges 2002) , Totusi, anumiti cercetatori (eg. Mueller et al. 2001) au indicat factori specifici care deosebesc spiritualitatea de religie , cum ar fi actelle de compasiune , altruismul, exprienta unei paci interioare , dreptate, o cautare a sensului si un sens al scopului.

Cu toate acestea , un efort considerabil a fost depus pentru a distinge spiritualitatea de religie , numerosi cercetatori si studenti au acceptat o anumita legatura intre cele doua. Puchalski(1999) s-a referit la religie ca fiind :"o expresie a spiritualitatii" (p.1) si Mohr(2006) a afirmat ca :"Religia este platforma pentru expresia spiritualitatii".(p.18).Bazat pe experienta , Mueller et al.(2001) a explicat , ca desi spiritualitatea este un concept mai vast ca domeniu decat religia , cele doua se suprapun. Acesti cercetatori au accentuat ca o cautare a sensului , o putere superioara , sentimentul conectarii si al valorii sunt terenuri comune in care deopotriva religia si spiritualitatea opereaza.

Spiritualitate si depresie

Dolittle si Farrell(2004) -utilizand scala de depresie Zung si scala de masurarea a implicarii spiritualitatii si a credintelor(SIBS)., o scala iudeo-crestina neexclusiva , pentru a determina asocierea intre depresie si spiritualitate la pacienti din medii urbane -a pus in evidenta faptul ca pacientii care au obtinut scoruri mari la evaluarea spiritualitatii au avut mai putine simptome depresive .Ei au explicat , pentru populatia lor de cercetare,ca participarea la serviciile religioase nu are un impact semificativ asupra simptomelor religioase .Mai degraba ,credinta intr-o putere superioara, rugaciunea , si faptul de a avea o relatie cu o putere transcendenta , a fost luate in considerare pentru a face diferenta intre non-depresivi si depresivi.

Printre alte rezultate ale ale cercetarii lor asupra "spiritualitatii si distresului in ingrijirea paliativa " Hills et al.(2005) a descoperit ca acei pacienti care au exprimat furie la adresa Lui Dumnezeu sau l-au pus la indoiala pe Dumnezeu si biserica (considerate ca fiind mecanisme de coping religios negativ) erau mai stresati ,confuzi , si depresivi. Deasemea calitatea vietii lor au fost afectata in mod negativ. Hills et al. (2005) a pretins ca rezultatele lor la

sustin e cele ale lui Koenig et al. (1988) ,a carui studiu a pus in evidenta faptul ca pacientii internati care ai dovedit un coping religios negativ in special cei care au fost furiosi pe Dumnezeu , au recuperat activitatile independente din viata de zi cu zi mult mai greu.

Sensul vietii si depresia

O alta arie ce cercetare care primeste o cantitate insemnata de publicatii este rolul sensului vietii la pacientii cu depresie.Numeroase studii au pus in evidenta o asociere pozitiva intre sens si depresie..Deasemenea , anumite studii ca si cel al lui Wink et al.(2005) si Frick et al. (2006) au subliniat legatura dintre sens si spiritualitate/religie.

Ca si in cazul spiritualitatii definitiile sensului vietii variaza. Este normal printre cercetatori care investigheaza asocierea dintre sens, spiritualitate/religie , si depresie ca clasifice sensul ca fiind pe de o parte sens spiritual sau sens personal/existential.Sensul personal/existential este utilizat uneori intersanjabil cu sensul vietii.Sensul spiritual este definit de catre Mascaro si Rosen (2006) ca :"Avand un sens al scopului sau al chemarii derivat din credinte despre fortele spirituale care planeaza asupra vietii."(p.184) .Puchalski (1999) , aderand la ideea ca sensul nu poate fi despartit de spiritualitate ,sugereaza ca vietile oamenilor ajung sa fie bogate in sens si scop in masura in care relationeaza cu transcendentul.

Hodges(2002) analizand diferite studii care abordau problema sensului vietii si a depresiei a raportat doua rezultate diferite .El a indicat ca studii ca si acelea ale lui Wright et al. (1993) si Olszewski(1995) au stabilit o legatura pozitiva intre sensul vietii si depresie .Al doilea rezultat care s-a bazat pe un rezumat a lui Beck(1967) si Selingman(1990) a relevat o relatie negativa intre conceptul de sens la vietii si depresie .Hodges a conluzionat ca sensul trascendent ar putea avea un impct pozitiv asupra dezvoltarii in viata si poate deasemenea sa sustina in acelesi timp o criza.Metoda cea mai buna care se potriveste pentru a clarifica semantismele sensului discutate in literatura de specialitate este calitativa , aceasta cercetare a utilizat interviuri semi-structurate ,care sunt parte a metodelor calitative.

Această cercetare calitativă utilizată interviuri semi-structurate pentru a explora rolul de spiritualitate şi sensul vieţii între indivizii depresivi admişi la Universitatea Loma Linda Behavioral Centrul de Medicină. Cincisprezece participanti diagnosticati cu depresie care au participat la tratamentul parţial la LLUBMC au fost recrutaţi prin intermediul unui terapeut, asistentă medicală. Din cei 15 participanţi, au fost 12 femei şi trei bărbaţi. Unul din criteriile de selecţie a participanţilor a fost un minim de 2 săptămâni de tratament la LLUBMC.Această cercetare vizează descoperirea impactului depresiei avut asupra spiritualităţii şi sensului vietii şi, în acelaşi timp rolul spiritualitaţii jucat în procesul de recuperare a pacienţilor depresivi. Ea a încercat să înţeleagă cum fiecare îşi explică evenimentul negativ din viaţă prin intermediul întrebărilor deschise pentru a vedea perspectiva lor din care privesc lucrurile.

Întrebările folosite în interviuri urmăresc scopul de a argumenta, de a aprofunda, şi a clarifica semnificaţia răspunsurilor participanţilor. Participanţii au fost rugaţi sa răspundă următoarelor întrebări:

1. Vă rugăm să descrieţi experienţa dvs. cu depresia. (Argumente

pentru ce fel de durere, cât timp au suferit, şi modul în care a intrat durerea în viaţa lor.) 2. Cum a afectat depresia viaţa ta? (Argumente pentru modul în care a

observat şi a răspuns la modificări, şi cum au observat alţii aceast răspuns.) 3. Cum a-i descrie rolul spiritualitaţii în viaţa ta? (Argumente pentru

cea ce semnifica spiritualul in viata lor - include asta si o viziune a lui Dumnezeu? Dacă

da, ce fel?) 4. Cum afectează depresia, sensul si scopul în viaţă? 5. Ne puteţi descrie nivelul de depresie, înainte de programul de

reabilitare, precum şi în timpul şi după finalizarea programului?

Interviurile au fost realizate de către Siroj Sorajjakool, doctor, profesor de religie, Loma Linda University. Înainte de interviu, a fost dat pacienţilor un formular de consimţământ pentru a se asigura de voluntariat asupra participării pacienţilor ". Conversaţia a fost înregistrată, transcrisă şi codificate în conformitate cu metodele propuse de Anselm Strauss şi Corbin Julieta. Primul nivel de analiză a inceput cu deschiderea codificarii -etichetare linie cu linie despre "ceea ce se întâmplă aici." Următorul nivel de analiză implică crearea unor categorii bazate pe descrieri a ceea ce s-a întâmplat. Această cercetare a folosit o metodă de "comparare constanta" pentru a examina modul în care un nou răspuns a fost sau nu intr-o categorie anterioare. Nivelul final de analiză legată categoriile emergente împreună într-un mod care a explicat de datele. Această explicaţie a fost "teoria de baza", care inglobeaza varietaţile de răspunsuri. Cum aceste ipoteze s-au dezvoltat, cercetătorii s-au întors la interviuri pentru a vedea dacă analiza a explicat fiecare caz. Atunci când nu s-a explicat fiecare caz, analiza a fost revizuit. Revizuirile implicate redenumirea categoriilor, dezvoltarea de noi categorii, precum şi identificarea căilor alternative sau procese.

Curs de tratament Toţi participanţii au avut un program: de luni până vineri, de la 9:00 la

15:00, 20-25 zile pe o perioadă de 4 până la 6 săptămâni.Aportul lor iniţial de evaluare a fost efectuată de către o asistentă medicală care a verificat dacă toţi au avut gânduri si dorinţa de a muri. Acest lucru a fost urmată de o evaluare psihosocială detaliată şi a planului de tratament realizată de către un terapeut clinic (Terapeut de familii si căsnicii, asistent social, psiholog). În plus, pacientul a fost evaluate şi văzut săptămânal de către un psihiatru pentru gestionarea medicaţie.

Curriculum-ului a constat în cinci grupuri de zi cu zi cu durata de o oră. Cursurile de coping si managementul stresului l-au invatat pe pacient cum sa aiba un regim alimentar sanatos, sa urmeze un program de exercitii, sa faca afirmatii pozitive despre ei si sa comunice asertiv si respectuos.

Grupurile de educatia sanatatii mentale le-au oferit informatii despre diagnosticele lor, simptomele lor si folosirea adecvata a medicamentelor.

Grupul de terapie zilnică a abordat problemele profunde care stau la baza pierderilor nerezolvate şi durere, furie, şi stima de sine scazuta rezultate

dintr-o copilărie plina de abuzuri. Această sesiune de 2 ore de terapie cognitiv explora, de asemenea, problemele de ruşine şi un nivel scazut al valorii de sine

(self-worth) Ei au fost învăţaţi sa înlocuiască punctul lor de vedere negativ despre sine cu unul care a fost mai realist şi pozitiv, printr-un proces de învăţare, intensiv de zece paşi . Pentru a completa această metoda, ei au făcut o medie de 2 - 5 ore pe săptămână de auto-ajutor lucrând pe

The Feeling Good Handbook de David Burns. Au învăţat să utilizeze o analiză cost-beneficiu la o greutate de argumente pro şi contra stimei de sine scazută si corectarea gândurilor lor negre cu starea de spirit activa.

În plus, un capelan se întâlnea cu grupul pentru a explora nevoile spirituale, 2 ore pe săptămână. Deoarece Programul a fost realizat într-o instituţie Adventista de ziua a şaptea, partea spirituală a fost integrata în întregul program, terapeuţi şi pacienţi deopotrivă simţindu-se liberi să împărtăşească practicile credinţei personale (nu doctrinele), în toate grupurile, pentru a cita Scriptura, şi a se ruga pentru nevoile apărute.

Teme comune

Această secţiune va prezenta teme comune emergente care se referă la

trei aspecte principale ridicate în timpul interviului, şi anume, spiritualitate, sensul vieţii, şi de acceptare.

Studiul a descoperit ca persoanele cele mai deprimate au indicat faptul că depresia face să se simtă deconectate de partea spirituală. În acelaşi timp, spiritualitate a acţionat, de asemenea, ca sursă de puterea în mijlocul depresiei. În al doilea rând, nevoia de a avea un sens in viata a fost o temă dominantă între participanţi, iar sentimentului de sens al vietii a fost asociat în cea mai mare parte cu relaţie cu Dumnezeu, care indică faptul că a existat un motiv pentru depresie lor. In continuare, pentru toti participantii, sensul l-au capatat facand servicii celorlalti. Tipul serviciului in care ei se vedeau angajati era deseori relationat de experienta lor cu depresia.

În cele din urmă, procesul de vindecare a fost in cea mai mare parte legată de capacitatea lor de a se împăca cu propria depresie.

Spiritualitatea

În explorarea locului spiritualităţii între participanţii depresivi, trei

întrebări au fost întrebaţi. În primul rând, participanţii au fost rugaţi să definească înţelegerea lor de spiritualitate. În al doilea rând, au fost întrebaţi despre impactul pe care depresia l-a avut asupra spiritualităţii lor. În cele din urmă, acestea au fost întrebaţi cum spiritualitatea lor a afectat luptele lor cu depresie. Este interesant de notat faptul că toţi cei 15 participanţi au recunoscut rolul spiritualitaţii în lupta lor cu depresie. Această secţiune va analiza modul în care indivizii depresivi definesc spiritualitate, efectul de depresie in spiritualitate, iar impactul spiritualului asupra depresiei.

Definirea spiritualităţii

Definiţia cea mai comună de spiritualitate este: a avea o relaţie cu Dumnezeu. "Văd spiritualitate cu adevărat ca relaţie a ta personală cu Dumnezeu ", a declarat un participant de sex feminin. Un participant de sex

masculin care a trecut prin multe perioade de spitalizare definea spiritualitatea ca "O relaţie în care trăiesc cu Dumnezeu ... este aducerea lui Dumnezeu în tot ce se întâmplă." O tânărîă participantă, cu o istorie de abuz sexual a descris spiritualitatea ca un sentiment de confort, un sentiment că există Cineva acolo sus care veghează asupra ei.

Un tanar participant care urma sa obtina o diploma in muzica a folosit termenul de intregire pentru a defini spiritualitatea: „ A fi intreg...e mai mult decat intelectual sau emotional... e a fi intreg ca si Moise, Iisus si Ghandi. Oameni care pot relationa cu viata. Nu trebuie sa fii cel mai de succes. E vorba de a fi conectat”

Accentul pus pe relaţie a fost semnificativ, mai ales având în vedere experienţa lor cu depresia şi impactul depresiei asupra relaţiei şi a sentimentului de conexiune.

Impactul depresiei in spiritualitate

Majoritatea participanţilor au raportat că depresia îi face sa se simta deconectati de la spiritualitatea lor. Aceştia au arătat că s-au simţit foarte deconectati de la ei înşişi, de la Dumnezeu, şi de la comunitate. “ Mi-a fot foarte greu emotional sa ma conectez la Dumnezeu în timpul acestor cinci ani” a raportat un participant. Un participant de sex feminin care au luptat cu depresia de cand era tanara, a afirmat: “ E doar o luptă. Aş spune că sigur .... inima mea este foarte protejata şi rece.” O studenta absolventa a indicat faptul că ea "se simte rece" in inima ei si nu merita dragostea lui Dumnezeu. Acest simtamant al deconectarii, pentru multi, a survenit din furie. Ei au experimentat furie pentru ca simteau ca si cum Dumnezeu i-ar fi parasit. O alta participanta ce traia in depresie de cand avea 12 ani spunea: „Chiar acum, simt furie fata de Dumnezeu, sunt furioasa pentru ca El nu da atentie nevoii mele in special pentru ca sunt vulnerabila. El nu mi-a demonstrat ca e acolo si ma asculta....El nu e acolo”. Apoi a continuat, “Uneori a fost in viata mea, dar de cele mai multe ori nu pot sa-L vad...pentru ca de cele mai multe ori am fost in depresie si aveam gandul sinuciderii.” Un participant, care tocmai trecuse printr-un divort, a indicat ca e foarte furios pe Dumnezeu. El s-a rugat ca Dumnezeu sa ii aduca inapoi sotia, dar nu Dumnezeu nu a adus-o. Iar un motiv important pentru care sotia l-a parasit a fost depresia lui.Prin urmare, el a refuzat sa mai mearga la biserica. Un numar de participanti au impartasit aceasta experienta.Din cauza depresiei si a furiei catre Dumnezeu, ei au incetat sa mai citeasca Biblia, sa mearga la biserica si sa aiba regulat un timp acordat lui Dumnezeu. Impactul spiritualitatii in depresie

În timp ce starea de spirit generală a acestor participanţi în timpul depresiei a fost cea de deconectare din spiritualitatea lor, spiritualitatea a jucat încă un rol în ajutarea multor sa facă faţă acestora stari întunecoase. Toti cei 15 participanţi au recunoscut spiritualitatea ca una dintre metodele lor de coping. Când întrebati despre cum se confruntă cu depresie, termenul de "Dumnezeu" a fost prezent în rândul tuturor participanţilor. Din cei 15, o fata a simţit că Dumnezeu a abandonat-o, dar a indicat, în acelaşi timp că pe ea spiritualitatea ei a împiedicat-o de la sinucidere. "Uneori, eu vreau doar să merg acolo repede la Dumnezeu. Şi cred că singurul lucru care mi-a ţinut să facă aceasta este faptul că mi-au spus ca o să ard în iad ", a spus ea. Două persoane au crezut în posibilitatea ca

spiritualitatea ar putea aduce vindecare, dar a trebuit încă să-l aduca aceasta experienţă în viaţa lor. Un participant a indicat, "Eu caut pentru că eu cred. Şi aş vrea să pot simţi. Aş vrea să pot simţi căci eu cred ...rugăciunile mele private sunt pentru a-mi deschide inima ". Restul., într-o măsură variabilă, au recunoscut spiritualitatii rolul pozitiv jucat în viaţa lor. Un participant care a luptat cu durere cronica a descris rolul jucat de spiritualitate: Prima dată când m-am dus înapoi la biserica a fost la începutul lunii februarie şi a fost prima oară când am simţit pacea în peste un an. Nu am simţit durerea mea (in biserica). Vreau să ma sinucid, dar apoi speranta venea înapoi, atunci când am imi citeam Biblia... este ca un fel de furnicături, senzatia care trece prin corpul meu. Eu nu pot explica, dar este pace, bucurie, şi dragoste. Toate într-un mod necondiţionat .... Uneori am, de asemenea, acest sentiment coplesitor, şi ştiu că există, fie cineva acolo care se uita la mine, fie este îngerul meu pazitor sau un înger .... Începe prin stomacul meu sau prin umeri. Este un sentiment ca si cum am fost atins. Este ca şi cum cineva pe care il iubesti vine sa te atinga. Un alt participant a declarat, "Când mă gândesc la asta [o putere mai mare], chiar şi numai gândind despre asta, ma face sa ma simt mai bine". Un participant de sex masculin care a fost spitalizat de mai multe ori, a raportat: "Nu m-am simţit sinucidal într-o perioadă lungă, doar în depresie, şi cred că motivul pentru care aspectul suicidare nu a venit e spiritualitatea". Un alt participant a împărtăşit o experienţă similară: "Aceasta nu mă lasă să mă omor oricât de mult am încercat [să ma sinucid], deoarece nu vreau să merg în iad ... depresia te face să te simţi deconectat de la alţii, dar simţi că Dumnezeu este mereu cu tine, indiferent cât de greu este. " În timp ce depresia a dus la un sentiment de deconectarea de la spiritualitatea lor, deoarece starea de întuneric data de depresie i-a făcut să se simtă deconectati şi îi împiedica să se angajeze în frecventarea bisericii regulate şi devotament personal, spiritualitatea a rămas modul esenţial cu care ei faceau fata depresiei. Acesta a oferit speranţă, a adus confort si a împiedicat suicidul. Sensul

Problema sensului este adesea conceptualizat în ceea ce priveşte scopul în viaţă. Scopul poate fi obţinute din ataşamentul fata de oameni, cum ar fi prietenii şi familia sau implicarea în anumite activităţi, cum ar fi cariera sau de recreere. Scopul poate fi, de asemenea, exprimat prin explicaţii teologice sau teoretice pentru lupta existenţiala a persoanelor. Intenţia acestui studiu a fost de a lăsa deschisă întrebarea astfel încât participanţii au putut să răspundă în conformitate cu înţelegerea lor actuală a termenului "sensul". Pentru majoritatea dintre participanţii la acest studiu, sensul a constat în capacitatea lor de a explica situaţia traumatică în care s-au găsit ei înşişi. Este interesant de observat că 13 din cei 15 participanti au văzut o legătură strânsă între spiritualitate si sensul vietii. Ceilalţi doi participanţi, deşi nu în mod explicit au facut o conexiune a sensului cu spiritualitatea, cred în Dumnezeu. Unul dintre cei doi participanţi defineste spiritualitatea ca având o relaţie cu Dumnezeu şi s-a crezut că sensul este atins atunci când el este conectat. Sensul, pentru acest participant, a fost legat de capacitatea de a găsi o explicaţie pentru evenimentul lui traumatic. Cum se reflectă în descrieri ale participanţilor la acest studiu, persoanele cu depresie au o dorinta intensa de a face sens din experienţa lor cu depresie. Ei vor sa stie de ce trebuie să treacă printr-o astfel de experienţă şi au nevoie sa inteleaga că această suferinţă nu este în zadar, că există un anumit scop ataşat la aceasta. Treisprezece de 15 participanţi au exprimat aceasta dorinta de a face sens al experienţei lor cu depresia. O tanara participanta a declarat:

L-am întrebat pe Dumnezeu de ce atunci când am fost abuzata sexual de către tatăl meu. Am ajuns la concluzia ca poate că acest lucru imi poate permite sa-i ajut pe alţii. Dar când am fost abuzata a doua oară de [fratele meu], nu avea sens ... lucru pe care m-am lupta cu este, de ce a trebuit să se întâmple de două ori? De ce a fost fratele meu un pic ca tatal meu? Intotdeauna am crezut că totul se întâmplă pentru un motiv, că fiecare situaţie nu poate fi doar pozitiva. Dar ce scoti din ea poate fi pozitiv şi asta este ceea cu ce ma lupt eu acum. S-a întâmplat o dată şi trec prin chestiile astea, dar de ce de două ori ...de ce... Cred că depresia mi-a deschis cu adevarat ochii la spectrul de durere şi de suferinţă care cred că sunt importante în viaţă. Că nu poţi pe deplin experienta fericire, până când pe deplin nu experientezi durerea. Tu nu stii fericirea până când nu ştii durerea. Un student la muzică descrise căutarea pentru înţelegerea de sine prin explorarea credinţele religioase din diferitele tradiţii religioase, cum ar fi hinduism, budism, Zen şi altele. "Depresia ma face sa ma cine sunt eu si nu voi fi asa cum sunt fara ea. Odată ce iesi din depresie, poti realiza modul în care aceasta vă ajută cu perspectiva in viata. " O altă încercare comuna de a face sens din depresia acestora în raport cu Dumnezeu a fost de a spune "Dumnezeu ma pune aici cu un scop. Nu ştiu acum. Chiar acum am nevoie pentru a găsi scopul. Sunt disperat dupa scopul meu. Ştiu că Dumnezeu are unul pentru mine, dar eu nu stiu care este". În timp ce unii ar putea să nu ştie de ce a trebuit să mearga prin depresie, au existat câţiva care au crezut ca depresia sa întâmplat, pentru a-i aduce înapoi la Dumnezeu. "Am cam simtit ca depresia trebuie să fi fost ca o bataie la uşa mea de la Dumnezeu să mă trezesc". Sau cum a declarat o alta participanta care s-a afiliat cu Cruciada Campusului: "Simt ca acest lucru este tot o parte din mine pentru a-L cunoaşte pe Dumnezeu mai bine ... Eu mă vad în cele din urmă apropiindu-ma, ştiindu-L mai bine". Pentru cei mai multi participanti., depresia a fost instrumentul care le-a permis de a servi mai bine altora. "Cred ca singurul lucru pe care într-adevăr il urmaresc cu nerăbdare în restul vietii mele este doar posibilitatea de a ajuta alţi oameni ...pe care este mai bine să-i ajute mult cineva care a fost deja prin foc sau iad". În conformitate cu o participanta, "Cred ca depresia, probabil ma ajută să ma facă mai sensibila sau conştienta de ceea ce oamenii trec prin atunci când sunt în acest tip de situaţie". Un participant a declarat." Eu cred că suferinţa noastră este pentru binele altora. " Din 15 participanţi, unul a ataşat sensul cu familia sa. Trei au văzut depresia ca o parte din planul lui Dumnezeu pentru a-i aduce mai aproape de Dumnezeu. Restul au crezut ca depresia i-a făcut mai plini de compasiune şi le-a permis să fie mai capabili de a ajunge la alţii si a-i intelege. Aceptarea

O altă temă interesantă a fost locul acceptarii în viaţă în ceea ce priveşte situaţia lor sau experienta de depresie. Conceptul de acceptare articulat de către participanţi părea să fie strâns legat de speranţa lor pentru viitor şi sentimentul lor de vindecare. Din cei 15 participanţi, 12 s-au descris ca vin la termeni oarecum cu situaţia lor de viata. Unul dintre acesti 12 a recunoscut importanţa renuntarii, cu toate că a admis că ea nu este la acelnivel în viaţa ei. Ceilalti trei nu au prezentat nici o indicaţie a faptului că au ajuns la un acord cu starea lor. Prezenţa de luptă a fost evidentă la acesti trei. Această temă de acceptare a fost exprimat în mod curent în două forme: acceptarea situaţiile neplăcute din viaţa lor sau de acceptare a depresiei lor (recunoaşterea faptului că aceştia va trebui să continue să trăiască cu depresie la un anumit nivel).

Acceptarea circumstantelor vietii

Un număr de participanţi a vorbit despre aceste proces gradual de a se impaca cu circumstanţele vieţii lor. Un bărbat divorţat care a încercat din greu pentru a o câştiga înapoi pe soţia, a vorbit despre furia iniţială fata de Dumnezeu pentru a nu-l ajuta, dar în cele din urmă a fost in pace cu el însuşi şi a ajuns la credinta că poate Dumnezeu a avut un plan mai bun şi că era bine să fie acolo unde era. Un participant de sex feminin, care a fost crescut intr-o casa perfecţionista în care valoarea ei ca o persoana a fost bazat pe abilitatea ei de a ajunge la performante, a ajuns la concluzia ca "toti avem valoare ca fiinţe umane". Ea a spus în continuare,"Se pare că nu există nici o soluţie pentru o mulţime de lucruri pe care le putem face noi înşine. Şi, încercand să rezolvam vom ajunge la concluzia că există cineva acolo care ne pot sustine prin această perioadă dificilă in care nu există speranţă". Un alt participant de sex feminin a ajuns la concluzia că viaţa nu este corecta. Este dificil, dar este realitatea cu care noi toţi trebuie să ne impacam. Acceptarea depresiei

Pentru cei mai multi participanti cu depresie, impacarea cu depresia lor a fost un pas important în procesul de vindecare. Un participant a clarificat frecventele interpretari gresite a vindecarii în înţelegerea ei: "având depresie nu înseamnă că nu sunteţi vindecat". Pentru alţii, a fost despre posibilitatea că încă ar putea exista viaţă cu depresie. "Cred că am început să constat că depresia nu este, probabil, cel mai rău lucru din lume care se poate intampla". Un alt participant a declarat: "Obişnuiam să cred că depresia este ceva ce se poate evita, dar acum am înţeles că nu este aşa. Este ceva că se întâmplă cu oameni diferiti pentru diferite motive. Acesta nu este ca si cum aveţi o alegere. Eu nu cred că va disparea pentru totdeauna". Acceptarea de depresie pot fi, de asemenea, reflectata în capacitatea de a accepta negativ emotii. Un participant dintr-o familie abuzivă a declarat: „Sunt un pic deprimat acum. Voi trece peste asta, dar înainte, niciodată n-am crezut că, da, este ok să ma simt trist. Înainte când am fost într-un fel de etapă de negare, era ok ca sunt trist, dar eu nu ar trebui să am sentimentul trist acum, deoarece nu sa intamplat nimic, nu este mare lucru şi lucruri de genul asta. Dar acum ştii ce, sunt trist ... Eu pot plânge,eu pot trece prin asta”. Aceasta capacitatea de a imbratisa depresia a fost, de asemenea, exprimate în raport cu spiritualitatea. Un participantul credea că a avea o relaţie cu Dumnezeu însemna "aducerea lui Dumnezeu în tot ce se întâmplă. Ea poate fi durere. Ea poate fi nimic. Dacă este durere, te duci la Dumnezeu în durerea aceea, şi dacă este bucurie, acelaşi lucru. Eu încerc întotdeauna să fac tot posibilul să-l accepte de acum. Poate ca, de asemenea, conceptul spiritual poate aduce predarea". În final, dacă a fost acceptarea circumstantelor vietii sau a depresiei, vindecarea a avut de a face cu una din doua. Reflecţii teologice

Această secţiune reflectă teologic la temele bazate pe relatări de la participanţii care continuă să se lupte cu melancolia. Sub discuţia Sufletului Bolnav asa cum e prezentat intr-o serie de experiente religioase, William James a utilizat frecvent termenul "melancolie" pentru a se referi la "depresie", cei doi termeni sunt folositi aici ca sinonime. Aceste trei teme sunt sentimentul de deconectare spirituala, căutarea sensului, şi procesul de acceptare. Există vreo perspectivă teologică care sa poata oferi o explicaţie a inter-relaţiei de deconectare, sens, şi acceptare?

Sentimentul de deconectare exprimat în mod curent de acesti participanţi este o amintire a luptei personale lui Tolstoi cu depresia şi cu idei suicidare, când a simţit ca viaţa lui a fost complet lipsită de sens. Comentând pe această experienţă, William James subliniază că în timp ce Tolstoi a căutat sfarsitul vieţii, a existat, în cea mai adâncă parte din el, setea de Dumnezeu.

Concluzii

Majoritatea participanţilor a indicat faptul că depresia ii face sa se simta deconectati de Dumnezeu, de alţii, şi de ei înşişi. În acelaşi timp, acestia au recunoscut că spiritualitatea a jucat un rol semnificativ în cautarea lor de a face fata depresiei. Depresia a fost, de asemenea, un factor important în creşterea întrebările referitoare la sensul vietii pentru aceste participanţi. Ei credeau că a existat un motiv pentru depresia lor; ca depresia a fost oarecum în cadrul proiectului Divin pentru destinul lor. În cele din urmă, sensul vindecarii a fost cel mai adesea legate de capacitatea lor de a se impaca cu depresia lor. Capacitatea de a ajunge la o înţelegere, prin urmare, poate fi un important factor care ne-ar putea indica o conexiune între vindecare si spiritualitate. În timp ce aceasta nu poate fi foarte acurat de zis, pe baza experienţelor acestor 15 participanţi în acest studiu, ca ei au realizat o reînnoire în spiritul lor, un sentiment de armonie totală cu ei însisi, a fost posibil să se demonstreze că majoritatea participanţilor au avut intuiţii mari în procesul lor, prin acceptare. La un anumit nivel, ei au venit pentru a vedea realitatea lor ca una care a inclus "răul natural", durerea şi pierderea. Poate că a fost prin acesta realitate, după cum se indică în a treia temă, care le-a ajutat sa recapete un sentiment de conexiune, un sentiment de armonie în interiorul lor sau, din perspectiva lui William James, "a doua naştere". Cum a declarat unul dintre participanţi: "Invăţ să accept .... cuvântul care se apropie de mine acum este predare. Cred că o parte din tine te accepta. La un anumit nivel toata lumea are nevoie să se predea şi să accepte unele situaţii, trecutul, cat si ca viata continua".