Meaning-making Methods for Coping with Serious Illness

Fereshteh Ahmadi, Nader Ahmadi

• Publisher: Routledge
• Year: 2018
• eBook ISBN: 9781351578882
• Topic: Social Sciences
• Subtopic: Social Work
• Index: Social Sciences

This book provides an alternative, complementary approach to the existing conventional approaches to religious and spiritually oriented coping. By focusing on the role of culture, the authors take into account the methods employed by a vast number of people who do not directly identify themselves as religious. The empirical data used in this book derive from studies conducted in several countries; Sweden, China, South Korea, Turkey and Malaysia, across which religion plays a different role in the social and cultural life of individuals. This approach and these empirical data are unique and allow comparisons to be made between different cultural settings.

By introducing the concept of meaning-making coping, the authors explore the influence of culture on choice of coping methods, be they purely religious, spiritual or existential. The term "existential meaning-making coping" is used to describe coping methods that are related to existential questions; these methods include religious, spiritual and existential coping methods.

Meaning-making Methods for Coping with Serious Illness contributes to new approaches and theoretical models of coping. As such it is an invaluable resource for health care, medical, public health and sociology students and researchers. It will also be of interest to educators and policy-makers working in the area of health.

1 Introduction

Each year, millions of people die of cancer. WHO estimates that by 2030 the cause of death for one in five men and one in six women will be cancer. It is, thus, not surprising that cancer causes tremendous feelings of anxiety, fear, despair, and powerlessness among those hit by these disease. Patients, all around the world, grab hold of what is within their reach to lessen the burden they are carrying and to cope with cancer. Depending on the historic, socioeconomic, and cultural contexts in which they live, individuals choose or adhere to different coping methods.

Although there is a large body of literature examining how people cope with different serious illnesses, the effects of contextual parameters, among others culture, have largely been neglected. This lack of attention exists despite a strong body of research studying the effect of religious attitudes and beliefs, as well as spiritual feelings, on help-seeking behavior. Traditionally, researchers have found significant relations (both negative and positive) between religious and spiritual variables and mental health. Some researchers have showed greater sensitivity to, and integration of religion and spirituality in their research. Much of this research, however, has been conducted in the United States, where religion is an integrated part of a large number of individuals’ lives. Studies on religious and spiritually oriented coping in other countries have also mainly been conducted among religious people. There are, however, many individuals who are either non-believers or, if believers, do not consider themselves religious people, i.e., religion is not an important part of their life. We also find societies in which the dominant culture and ways of thinking do not leave much scope for religion to play an important role in people’s lives. This issue is rarely taken into consideration in the research area focused on coping. An important question to pose here is, thus: What role does culture play in coping? And what is the role of culture and ways of thinking in the choice of religious and spiritually oriented coping methods? To answer these questions, there is a need for sociologically and clinically relevant theoretical frameworks to advance research in this area by focusing on the cultural perspective. This book attempts, within the framework of a sociological study, to meet such a need.

The fact that individuals cope with different illnesses in a number of different ways has been a major topic of interest in health research during recent decades. This book will hopefully promote a clearer understanding of the roles culture and social context play in the coping process. In addition, the study may help us better understand the needs and challenges faced by ailing people and provide creative ideas concerning how their psychological well-being can be enhanced. What we are facing is the lack of a cultural approach to the study of religious and spiritual coping. This has paved the way for an increased tendency toward generalization of results obtained from research conducted among religious people, especially in the United States, to other people. To get beyond the above-mentioned problem, we have turned our focus to studying the meaning-making coping methods (religious, spiritual, and secular existential coping methods) used by people facing a serious crisis.

Objectives and the scope of the book

This book, thus proceeding from a contextual approach to coping and health, is based on an international research project aimed at identifying culturally bound coping methods used by cancer patients in several different countries, namely Sweden, China, South Korea, Malaysia, and Turkey. The empirical data for the book were collected using both qualitative (semi-structured and in-depth interviews) and quantitative (surveys) methods.

In our studies, we have tried to answer the following questions: What role do religion and spirituality play in coping when non-theists or non-religious people face difficult life events? Are there other coping methods that focus on existential questions, but that are not related to the religious and spiritual coping methods usually called RCOPE?¹ And what is the role of culture and ways of thinking in the choice of religious and spiritually oriented coping methods?

One important aim of the international project “Meaning-Making Coping and Culture” has been to conduct international studies on meaning-making coping (i.e., existential secular, spiritual, and religious) among people who have been affected by cancer and who live in a secular society. In this respect, studies have been conducted in South Korea (qualitative) and China (qualitative) as well as in Sweden (both qualitative and quantitative). Turkey and Malaysia were studied to help us discover possible variations in coping strategies in religious countries. In most of the previous studies on coping, the dominant religions were Christianity and/or Buddhism. For this reason, we have looked in particular at two Islamic countries, because Islamic culture is completely different from Christian and Buddhist culture regarding views on health and disease. The cancer patients’ socialization in either an individual or collectivist cultural setting was another factor in choosing these countries.

The structure of the book

Chapter1: In Chapter 1, the background, objectives and the structure of the book are presented.

Chapter 2: Because the book focuses on meaning-making coping, which includes religious and spiritually oriented coping methods, and against the background of existing controversies and disagreements surrounding definitions in the field of health, religion, and spirituality, we present our own working definition of the terms religion and spirituality in the first part of Chapter 2. Later on in this chapter, we deepen the definition to include notions of religiosity, inwardly and outwardly oriented transcendence, coping and coping strategies, RCOPE and, finally, we present our notion of meaning-making coping. According to our definition, meaning-making coping goes beyond the scope of religious and spirituality oriented coping and embraces other coping strategies, e.g., connectedness to nature, connectedness to the Self and to others. These kinds of coping strategies are all related to individuals’ search for meaning without any correspondence whatsoever to religion or religious symbols. Rather, these strategies concern individuals’ endeavors to find a source – in nature, in themselves or in others to help them cope with problems that have caused an existential vacuum – a disorder that requires elaboration of the old order into a new order and that, thus, helps them fill this vacuum. This means that we define meaning, not in relation to the “divine,” but as something of cognitive origin. According to this perspective, if individuals are to avoid falling into meaninglessness, they should find some kind of contrasting rational (meaning) that can play an essential role in restructuring their “worldview.” These new experiences are then assimilated, and life becomes more comprehensible and predictable, and thus filled with trust. We conclude therefore that using the term “meaning-making coping” prevents the misunderstandings found in the previously predominant definitions focused on religious coping and semi-/non-religious coping methods. Meaning-making coping is thus used in this book, and in all parts of our international project, to address the entire spectrum of religious, spiritual, and existential secular meaning-making coping methods.

Chapter 3: In Chapter 3, we present two sociological studies on individuals stricken by cancer in Sweden – a society where religion is not an integrated part of the social life of individuals. In these studies, we aimed to examine meaning-making coping with cancer from a cultural perspective. One of the studies was carried out using a qualitative and the other a quantitative research methodology. The first study investigated the assumed prevalence of religious and spiritually oriented coping methods among cancer patients in Sweden. It showed, however, the existence of a strong tendency among Swedes to rely primarily on themselves for solving problems related to their disease, rather than on other sources, such as God. Another important finding of this study was that nature-related coping methods were prevalent among participants, illustrating the impact of culture on coping. The subsequent quantitative study examined the extent to which the results obtained in the qualitative study among cancer patients were applicable to a wider population of cancer patients in Sweden. The results showed that the three most important coping methods used by the informants were related to nature.

The study showed that, in a given community, some dominant cultural traits may affect how patients deal with difficult diseases. In other words, although the choice of coping strategies is undeniably individual, it is influenced by the culture in which the person has been socialized. For instance, research on religion and health has shown that the negative or positive impact of religion on older people’s well-being, as well as the matter of using religion as a coping strategy, may depend on factors such as gender, ethnicity, culture, income, education level and marital status. Chapter 3 illustrates the effect of culture on meaning-making coping methods among people who had been hit by cancer and had been socialized in Sweden and Swedish culture, with its Protestant background, although this does not imply that the informants were necessarily Christians. None of the informants was chosen based on their interest or lack of interest in religion or spirituality. One of the main conclusions presented in this chapter is that the value system of the people in the Protestant northern European countries (including Sweden) is marked by a high degree of secular-rational rationality as well as a postmodern view on individual identity and integrity. Some results from the study underlying this chapter reveal that nature has replaced the church and, likewise, that oneness with nature has replaced unity with the holy. Thus, the chapter maintains that the possibilities for coping that spending time in and relating to nature offer cancer patients should be taken more seriously by healthcare providers, particularly by therapists trying to address the psychological problems cancer patients face in different phases, such as diagnosis, treatment, and post-treatment. Generally speaking, there should be more focus on developing less conventional therapeutic methods, such as creating opportunities for patients to come into contact with nature. For example, well-designed, health-promoting gardens within clinics would allow patients to engage in gardening, meditation, or just give them an opportunity to feel the earth.

Chapter 4: This chapter focuses on the characteristics of coping with cancer in secular societies and non-religious segments of the populations, e.g., patients who either are uninterested in institutional religiosity, but have their own individual approaches to spirituality, or who express no interest in spirituality and religiosity. China, South Korea, and Japan were selected as the sites for this study, because according to WIN-Gallup International 2015 – in Scandinavia and East Asia, particularly in China – atheists and non-religious people make up the majority. In South Korea and China, the majority of people do not self-identify as religious, but instead spirituality (what some researchers call “secular spirituality”) is prevalent among the populations.

We discuss in this chapter the four coping resources most frequently employed by the Korean informants: belief in the healing power of nature; mind-body connection; relying on a transcendent power; finding oneself in relationships with others. Furthermore, we observed one shared meaning derived from the Korean experiences, namely cancer as “a turning point in life.” Fighting cancer had been a great ordeal for all of them, but the outcome of their struggles included positive aspects. Experiences of struggling with cancer gave the Korean participants a chance to appreciate the small things in life, to stop worrying about what others think, to realize the futility of petty arguments, and to find themselves in relationships with family and friends they love.

The study in China also showed no use of any religious coping methods besides visiting church and praying. Regarding “spiritual” coping methods, none of the conventional spiritual meaning-making coping methods could be found among our Chinese informants, despite the fact that some reported believing to some extent in a mysterious spiritual power, without being able to explain this belief clearly. The existential secular meaning-making coping methods were, as it seems, prevalent among the informants. These methods are family, inner peace, and listening to music to ease the pain.

When it comes to family relationships, there is a considerable difference between Chinese and Korean society. Although participants in both countries were afraid of death and worried about family members who would be left behind, the Korean participants had a more critical attitude toward their relation to family.

The studies in the two East Asian countries indicated that the relation between body and soul has an impact on the use of meaning-making coping strategies among cancer patients. Development of the idea of body-mind-spirit in the ways of thinking of people in East Asia is primarily influenced by a holistic system of thought advocated by Eastern philosophers, particularly the Chinese. Chinese civilization has greatly influenced other cultures in East Asia, including Japan and Korea as well as Southern Asia. Use of various body-mind-spirit techniques to ease pain or to cope with illnesses is an old traditional cultural practice among people in East Asia. Among both Chinese and Korean informants, we found the use of meaning-making coping methods related to the doctrine of a body-mind-spirit relation: inner peace among the Chinese and peaceful mental attitude among South Koreans.

Chapter 5: This chapter presents the results of the studies carried out in Turkey and Malaysia. In Turkey, despite the important role played by religion in social and cultural life, many people do not self-identify as religious. In fact, Turkish society has strong features of both religiosity and secularism that affect social as well as cultural life. In addition, most people have been socialized into a society where Islam is the dominant religion. Malaysia provides an example of a Muslim country where ethnicity and religion coincide; it is a multi-religious society. In Malaysia, there are different ethnic groups, especially Chinese and Indians, whose cultures have historically strongly influenced the social and cultural life of people in Malaysia. People in Malaysia are strongly influenced by the characteristics of the pre-Islamic cultures of Shamanism, Hinduism, and Buddhism. Many customs, the dress code, and the language bear witness to the fact that people in Malaysia have been greatly influenced by the Indian/Hindu and Chinese cultures. Even after conversion to Islam in the 14th century, many of these influences on their culture still remain; this may explain why although Islam is widely practiced in Malaysia, its presence is subtler and more downplayed in everyday life compared to in Turkey, where Islam plays a greater role in society.

In Chapter 5, our point of departure was that Islamic culture is completely different from Christian and Buddhist culture regarding views on health and disease. Two Muslim countries in very different cultural contexts, namely Turkey and Malaysia, were chosen for this part of our international study. The Turkish study reveals that several religious coping methods found to be prevalent in other countries – such as Spiritual Discontent, Seeking Support from Clergy or Members, Punishing God Reappraisal, and Demonic Reappraisal or Self-Directing Religious Coping – were not applied by the Turkish informants. Nor were the non-religious coping methods highly prevalent among these informants. The most important coping methods used by cancer patients in Turkey were the RCOPE methods, especially Spiritual Connection, Active Religious Surrender, Passive Religious Deferral, and Pleading for Direct Intercession. The Malaysian study indicates that informants used several RCOPE methods, both passive and active. It also shows that shamanism – although it is in opposition to the religion of our informants (all of whom were Muslims) – played a role in how they coped with cancer. The study highlights the important role of culture in the choice of coping methods. It is convenient to maintain that the reason people in Turkey and Malaysia turn to religion in times of crisis is that religion has a prominent position in people’s ways of thinking. Yet there are certain differences between the two countries.

Furthermore, based on results from the studies in Turkey and Malaysia, the chapter concludes that, in both countries, the notion of being patient (Sabr) was important among the informants when they were coping with the psychological problems caused by cancer. The notion of Sabr implies that the problems of this world are meant to test people and the thought of having patience is highly influential among people in Muslim countries, including Turkey and Malaysia.

Chapter 6: Focusing on the relation between religious, spiritual, and existential secular meaning-making coping, in Chapter 6, we discuss globalization, health, and culture and underline the importance of taking cultural differences into consideration when studying the meaning-making coping methods used by people who are facing a serious crisis. We emphasize that culture affects the selection of strategies that an individual uses in any given situation. Cancer patients use a multitude of meaning-making coping methods, be they spiritual, religious, or existential. The strategies people employ when they are stricken by disease, accidents, misfortune, etc., are cultural and historical constructions. When discussing the issue of health and culture, we should remember that we are not talking solely about different cultural settings that are geographically separate. These settings are not islands. In a world that is becoming more and more linked to international trade, immigration, and electronic communication, health issues are increasingly affected by both global and local forces and cultures are becoming more and more connected. In many societies, the populace consists of people with different cultural and ethnic backgrounds. Therefore, healthcare systems should take into consideration the distinct cultural characteristics of the population they serve.

Regardless of the employed strategies or the secular or religious characteristics of these strategies, coping is about consoling. The ...

Table of contents

• Cover
• Title
• Copyright
• Contents
• List of figures
• List of tables
• Contributor
• Foreword
• Acknowledgments
• 1 Introduction
• 2 Theoretical framework
• 3 Western Protestant culture Swedish culture and coping
• 4 The study in East Asia
• 5 The study in Muslim countries
• 6 The relationship between culture and health
• Index