© Springer International Publishing Switzerland 2015Katie E. Cherry (ed.)Traumatic Stress and Long-Term Recovery10.1007/978-3-319-18866-9_19
19. Trauma, Religion, and Spirituality: Pathways to Healing
Department of Psychology and Counseling, Southern Nazarene University, 429 Don Beaver Science Building, Bethany, OK 73008, USA
KeywordsReligionSpiritualityCopingTraumaPosttraumatic growthPosttraumatic stressDisastersPsycho-spiritual interventions
When disaster strikes, religion and spirituality are commonly brought to the forefront of peoples’ lives. Consider the following poignant examples:
People talked about ghosts, especially in the beginning…or, people [could] smell the one they lost. Then, people go to the temple and give donations in [the victim’s] name. It happened with me with my sister’s “smell”—it only happened in the first few weeks, and I could smell her body decomposing. I would feel so badly, and it reminded me of her, but I was really busy. It still reminded me to go to the temple.
Buddhist health-care provider in the Phang Nga Province of Thailand, after the 2004 Indonesian earthquake and tsunami (Varley, Isaranuwatchai, & Coyte, 2012, p. 665) .
Where is this peace and this evenness in my life coming from? Well, it is coming from God . It was coming from him ministering to me and helping me each day to cope with it [cancer] and live through it and heal, not just physically, but to heal spiritually as well.
Cancer survivor (Denney, Aten, & Leavell, 2011, p. 379) .
“I really haven’t found any meaning in my son’s death. I don’t understand it or accept it. I still get angry at times. I still cry frequently.”
Bereaved parent, 5 years after the tragic death of a child (Murphy, Johnson, & Lohan, 2003, p. 396) .
As these quotations exemplify, traumatic experiences can have deeply spiritual consequences. The first statement illustrates one way in which a calamity may be interpreted through a religious or spiritual lens. The second statement describes the healing a cancer survivor achieved through the use of spiritual resources, while the third statement captures a bereaved parent’s enduring spiritual struggles.
For better or worse, people often draw upon religion and spirituality in the wake of traumatic events. For example, a national survey about stress reactions to the September 11, 2011, terrorist attacks found that 90 % of American adults reportedly turned to “prayer, religion, or spiritual feelings” in order to cope during the week after the attacks (Schuster et al., 2001, p. 1510) . In a qualitative study of older adults who had been displaced by Hurricane Katrina, interview responses revealed that approximately 37 % of the participants pursued active religious coping methods (i.e., praying, meditating, spiritual singing, scripture reading, exercising trust in God , participating in church-related activities), 29 % relied on maintaining attitudes of hopefulness, thankfulness, and/or gratitude (frequently directed toward God), and 13 % reappraised the situation in a positive existential light (i.e., focusing on being alive, seeking a posture of acceptance, holding a positive view about the event; Henderson, Roberto, & Kamo, 2010; see also Chap. 20, this volume) . These findings are not particularly surprising, given that according to 2013 national surveys, 90 % of Americans endorsed belief in God or a universal spirit, while 39 % reported attending a church or synagogue at least once in the past 7 days (Gallup, 2014). Across the globe, tragic events often stimulate religious and spiritual expressions. Among the coastal and island people of Bangladesh who are frequently devastated by cyclones, for example, qualitative field data reveal an increase in diverse religious and spiritual activities (e.g., prayer, religious obedience, ritual sacrifices) in the Muslim and Buddhist communities during the days when a storm is imminent (Alam & Collins, 2010) . The diversity of religious and spiritual responses to catastrophic events is striking; however, considerably more striking is the apparent ubiquity of religious and spiritual coping in the face of disaster.
In this chapter, we consider many ways in which religion and spirituality intersect with trauma. We focus on (a) the religious/spiritual facet of trauma, (b) religious and spiritual ways of coping with trauma, and (c) the outcomes of religious/spiritual coping with trauma. We end the chapter with a discussion of ways in which religion and spirituality can be integrated into the posttraumatic recovery process, with the goal of preventing enduring problems and enhancing lasting posttraumatic growth .
The Relationships Among Religion, Spirituality, and Trauma
As a prelude to this discussion, it is important to consider the meanings of religion and spirituality . Religion has been defined as “the search for significance that occurs within the context of established institutions that are designed to facilitate spirituality” (Pargament, Mahoney, Exline, Jones, & Shafranske, 2013b, p. 15) . Spirituality has been defined as “the search for the sacred” (Pargament, 2007). These definitions rest on the assumption that people have a yearning to discover, pursue, sustain, and at times transform a relationship with something they perceive as sacred in their lives. While the sacred often directly references God or a higher power , any aspect of life may be deemed as sacred if it is perceived to have divine-like qualities, such as transcendence, boundlessness, ultimate meaning, and perfection (Pargament & Mahoney, 2005). In the words of Jones (2002), “The sacred is not, necessarily, a unique and special object or domain split off from the rest of life, but is rather the world of ordinary objects experienced in a particular way” (p. 61). The “particular way” in which we experience sacred things, according to Paden (1992) , is the “immense role they play and the absolute priority they have in someone’s world” (p. 73).
Indeed, people report making exceptional investments in the pursuit, maintenance, and transformation of special aspects of life they experience as sacred. For example, adults tend to invest more time, energy, and personal resources into work (Wrzesniewski, McCauley, Rozin, & Schwartz, 1997) and personal strivings (e.g., self-development, physical health, existential concerns; Mahoney et al., 2005b) when these domains of life are perceived to have sacred qualities. Likewise, the attribution of divine significance to aspects of the material world has been associated with greater personal investment, including greater care for one’s body (Mahoney et al., 2005a) and the natural environment (Tarakeshwar, Swank, Pargament, & Mahoney, 2001) . Furthermore, people who describe relational aspects of life as sacred exhibit similar patterns of increased personal investment in the domains of parenting (Dumas & Nissley-Tsiopinis, 2006; Murray-Swank, Mahoney, & Pargament, 2006; Volling, Mahoney, & Rauer, 2009) , marriage (DeMaris, Mahoney, & Pargament, 2010; Lichter & Carmalt, 2009; Mahoney et al., 1999; Mahoney, Pargament, & DeMaris, 2009) , and sexuality (Murray-Swank, Pargament, & Mahoney, 2005) . The aforementioned list is certainly not exhaustive. As Durkheim (1915) stated, “By sacred things one must not understand simply those personal beings which are called gods or spirits; a rock, a tree, a pebble, a piece of wood, a house, in a word anything can be sacred” (p. 52).
Each person’s search for the sacred is facilitated by a complex and dynamic system of beliefs, feelings, values, relationships, experiences, and practices that direct the person along spiritual pathways and toward spiritual destinations (Pargament, 2007) . For many, religious institutions provide guidance regarding which spiritual pathways and destinations are of primary importance. While both religion and spirituality involve the sacred as a valued destination, religion can also be directed toward a variety of other goals, including psychological, physical, and social functions. Thus, religion and spirituality constitute overlapping yet distinct processes that are relevant to many peoples’ experiences in times of crisis.
Traumatic events span multiple domains of life, including the interpersonal (e.g., violence, sexual assault, physical abuse, emotional maltreatment, neglect, death, separation), medical (e.g., physical injury, illness), ecological (e.g., natural disaster, man-made industrial accident), and political (e.g., war, terrorism, forced displacement). A holistic understanding of trauma must incorporate religion and spirituality because humans are complex beings with interrelated physical, psychological, social, and spiritual capacities. Traumatic events do not merely endanger a person’s physical, psychological, and social well-being but can also have potent implications for spiritual well-being, to the extent that these upheavals threaten or damage aspects of life that have been deemed as sacred.
The spiritual impact of negative life events was illustrated when adults in a Midwestern community sample were asked to describe the most significant personal crisis that took place in the past 2 years (Pargament, Magyar, Benore, & Mahoney, 2005) . These participants reported a variety of events, including the death or serious illness/injury of a loved one, parenting or family relationship difficulty, job loss, personal illness, and divorce/separation. Over 38 % of the sample appraised the event as a sacred loss , meaning that something once viewed as a manifestation of God or imbued with sacred qualities was perceived as lost. Nearly 25 % of the sample perceived the event as involving a desecration , or the violation of a sacred aspect of life by someone or something. Those who appraised the event more as a sacred loss reported greater intrusive thoughts and depression, while those who appraised the event more as a desecration reported greater intrusive thoughts and anger after the event.
In another study, college students living in the Midwest and New York City who reported greater desecration appraisals (e.g., “This event was both an offense against me and against God,” endorsed by over 50 % of the sample) of the September 11, 2001, terrorist attacks reported higher levels of posttraumatic anxiety and depressive symptoms, as well as stronger approval of extreme forms of retaliation against the perpetrators (Mahoney et al., 2002) . On the other hand, a qualitative study of Hurricane Katrina survivors found that many participants gained a greater appreciation for life and for the people in their lives, a greater sense of wholeness with family and community , and an enhanced sense of personal and spiritual strength (Tuason, Güss, & Carroll, 2012; see Chap. 21, this volume) . These and other research findings have supported the notion that even seemingly secular aspects of life can be connected to the divine and that events that disrupt sacred aspects of life can have a significant impact on posttraumatic recovery, for better or worse.
Religious and Spiritual Coping with Trauma
Religion and spirituality do not only bear on peoples’ perceptions of critical life events and their initial appraisals of traumatic incidents but also on the coping methods they select, the functions of coping methods, and the outcomes of coping. Efforts to measure posttraumatic coping often overlook religious and spiritual domains, and, when religion/spirituality is taken into account, it is often assessed by only a few items. A research study on the impact of the 2004 Indian Ocean tsunami found that religious affiliation alone did not predict Thai citizens’ collective efficacy to cope with future natural catastrophes (Paton et al., 2008) . This finding illustrates the importance of gaining a rich, fully dimensionalized picture of how religion and spirituality manifest during times of crisis. Because religion and spirituality are multifaceted and nuanced, it is important to go beyond broad measures of these constructs to gain specific information regarding how they are involved in coping, including who (e.g., clergy, congregation members, God) and what (e.g., prayer, reading sacred scriptures) is included in coping, when (e.g., acute stressors, chronic stressors) , and where (e.g., privately, communally) coping occurs, and why (e.g., to find meaning, to gain control, to foster closeness and comfort) particular coping methods are pursued (Pargament, Falb, Ano, & Wachholtz, 2013a) .
Theory and research arising from Lazarus and Folkman’s (1984) influential account of stress and coping suggest that the outcomes of coping are not dependent solely on qualities of the traumatic event itself but also on personal reactions to the event (see Folkman & Moskowitz, 2004, for an overview of the history of coping theory and research) . These personal reactions include primary cognitive appraisals (i.e., “What are the potential consequences of this event? Is it a challenge, a threat, or a loss?”) and secondary cognitive appraisals (i.e., “Do I have the resources necessary to successfully handle this stressor?”) of a stressful event, accompanied by an assortment of cognitive, behavioral, and relational coping strategies employed to deal with the stressor . Thus, religious and spiritual coping involves the use of cognitive appraisals and cognitive/behavioral/relational coping methods that promote the pursuit of the sacred . Pargament (1997) has described religious/spiritual coping as the intersection of the “search for significance in ways related to the sacred” (p. 32) with the “search for significance in times of stress” (p. 90). This search includes “the use of religious beliefs or behaviors to facilitate problem-solving to prevent or alleviate the negative emotional consequences of stressful life circumstances” (Koenig, Pargament, & Nielsen, 1998, p. 513) . Religious and spiritual coping can take many forms. They may have a divine , intrapersonal, and/or interpersonal focus (Mahoney, Krumrei, & Pargament, 2008). In the divine realm, people may focus their coping efforts on countering threats to their thoughts, feelings, and general relationship with God or a Higher Power . In the intrapersonal realm, coping may center on resolving internal questions, doubts, and uncertainties about sacred aspects of life. In the interpersonal realm, coping may concentrate on relieving relational tensions and conflicts over spiritual matters. A relational, medical, ecological, or political disaster may conceivably trigger the need for religious/spiritual coping in all three of the aforementioned domains.
As with secular coping methods (Folkman & Lazarus, 1988) , the effectiveness of a specific religious/spiritual coping strategy relies on how well the particular method fits the individual and his or her context. Across studies, however, two primary patterns of religious/spiritual coping have been identified: positive religious/spiritual coping and negative religious/spiritual coping (Pargament, Koenig, & Perez, 2000; Pargament, Smith, Koenig, & Perez, 1998). Positive religious/spiritual coping methods (also referred to as positive religious/spiritual resources) generally reflect a secure connection with the divine, oneself, and others, while negative religious/spiritual coping methods (also referred to as religious/spiritual struggles) are generally associated with conflicts with the divine , oneself, and others about sacred matters (Exline, 2013; Pargament, Falb, et al., 2013a).
Positive Patterns of Religious and Spiritual Coping
Positive patterns of religious and spiritual coping address five key coping functions: (1) finding meaning, (2) gaining mastery and control, (3) increasing comfort and closeness to God, (4) enhancing intimacy with others and closeness to God, and (5) achieving life transformation (Pargament et al., 2000). In the upcoming sections, we provide empirical examples to illustrate some of the ways in which these coping functions manifest in the lives of people healing from traumatic experiences.
In order to find meaning after a traumatic event, a person may attempt to redefine the stressor through a benevolent spiritual lens (Park, 2013). In a longitudinal qualitative study of 29 families in Louisiana who had survived Hurricane Katrina, 38 % of the respondents made sense of the storm by referencing “God” or “the Lord” (Garrison & Sasser, 2009) . For example, one 25-year-old man explained, “I believe He (referring to God) has his reason and it is not for us to understand, it is for us to accept” (p. 120). Trauma is commonly perceived as serving a higher purpose or as evidence of God’s perfect, mysterious will. This type of reappraisal is exemplified by the response of a person who experienced a paralyzing accident, “There must be some reason for it. Could be that He had a reason for it. Maybe somebody else needs my legs more than I do” (Bulman & Wortman, 1977, p. 358) . Tragic events may also be reappraised as blessings in disguise or opportunities for spiritual growth and transformation . In a qualitative study of adults who had survived Hurricanes Katrina and Rita, one man stated:
A lot of things are [not that important]…[the hurricane gets you] re-evaluating where you are in your life, what you’re doing, what is important to you…. I am Christian …but I would think that even the atheist, after Hurricane Katrina, would have to sit down and…not suddenly believe in God, but they would have to sit back and re-evaluate where they are in life and realize how precious life is. (Marks, Cherry, & Silva, 2009, p. 201)
For some, disasters may be interpreted as spiritual challenges or tests of devotion to God. The following passage from the Hilali-Khan translation of the Qur’an provides an interpretation that believers will be rewarded for patience and devotion through trials and calamities:
And certainly, We shall test you with something of fear, hunger, loss of wealth, lives and fruits, but give glad tidings to As-Sâbirin (the patient ones, etc.). Who, when afflicted with calamity, say: “Truly! To Allâh we belong and truly, to Him we shall return.” They are those on whom are the Salawât (i.e. blessings, etc.) (i.e. who are blessed and will be forgiven) from their Lord, and (they are those who) receive His Mercy, and it is they who are the guided-ones. (Al-Baqarah 2: 155–157)
Mastery and Control
To gain mastery and control in response to calamity, a person may pursue a collaborative problem-solving partnership with God. As one female breast cancer survivor stated, “God would help me but I had to do my part too, that was expected of me by the Providence to which I trusted my life” (Gall & Cornblat, 2002, p. 528) . Others may cope by actively surrendering uncontrollable aspects of the situation. A Hindu , for example, may find encouragement from Valmiki’s Ramayana to accept unalterable circumstances: “Every man suffers the three pairs of opposites; hunger and thirst, pleasure and pain, life and death. Do not permit thyself to grieve for that which cannot be avoided” (2.77.23). A Christian may similarly find inspiration in the words of Jesus:
Therefore I tell you, do not worry about your life, what you will eat or drink; or about your body, what you will wear. Is not life more than food, and the body more than clothes? Look at the birds of the air; they do not sow or reap or store away in barns, and yet your heavenly Father feeds them. Are you not much more valuable than they? Can any one of you by worrying add a single hour to your life? (Matthew 6:25–27 New International Version)
Comfort and Closeness to God
To achieve comfort and closeness to God in the midst of grief, a person may seek connectedness with transcendent forces or pursue connection and support from God. As David recorded after he was delivered from the hand of his enemies in the Hebrew scriptures:
I called to the Lord, who is worthy of praise,
and have been saved from my enemies.
The waves of death swirled about me;
the torrents of destruction overwhelmed me.
The cords of the grave coiled around me;
the snares of death confronted me.
In my distress I called to the Lord;
I called out to my God.
From his temple he heard my voice;
my cry came to his ears. (2 Samuel 22: 4–7)
Sometimes people seek comfort and closeness to God by creating and adhering to helpful religious boundaries, engaging in spiritual cleansing rituals, seeking forgiveness for transgressions, or engaging in religious activities to shift the focus from the stressor . In another example from the Hebrew Scriptures, Job responds to a rapid series of calamities (i.e., raiding enemies, natural disasters) that strip him of his family and possessions with worship and a mourning ritual, saying, “Naked I came from my mother’s womb, and naked I will depart. The Lord gave and the Lord has taken away; may the name of the Lord be praised” (Job 1: 21).
Intimacy with Others and Closeness to God
In an effort to increase intimacy with others and closeness to God after disaster strikes, a person may seek support and reassurance from clergy, congregation members, and others in the community who share one’s religious or spiritual faith. In a qualitative study of Hurricane Katrina survivors, participants who decided not to evacuate emphasized interdependence and connection with others in their community, strength, and faith in God as important factors in their decision to stay in the area (Tuason et al., 2012) . Another way people may cope with disaster is to attempt to provide spiritual support and comfort to others. One Hurricane Katrina survivor recalled an encounter in which she had been emotionally and spiritually helped by others who had lost more in the storm than she had:
I just vividly [remember] in my mind…a family from one of the hardest hit areas outside of Grand Isle…. They came…about a week or two after the hurricane and sang at our church…. [T]hey lost everything. I mean they lost every picture…everything…. Still to this day, [I remember thinking that day], “You are here and you lost everything and you are singing praises to the Lord.” (Silva, Marks, & Cherry, 2009, p. 234)
For a breast cancer survivor, the power of spiritual intimacy with others was found within a support group: “I began to see that many had this same spiritual quest and experience, regardless of religion or no religion…. Here we support each other in our living and dying…[we created]…communities of spiritual seekers” (Gall & Cornblat, 2002, p. 529) .
Sometimes people seek life transformation in the face of adversity. To achieve this, a person may offer forgiveness as a way to shift from a posture of anger and blame to one of peace, look to religion to find a new life direction, seek spiritual guidance, or pursue a radical religious or spiritual conversion. One individual who had suffered a paralyzing spinal cord injury explained that the event was a spiritual turning point:
I see the accident as the best thing that could have happened ’cause I was forced to decide my faith, whereas there would have been the possibility that I would have lived and never made a decision—been lost the rest of my life. ’Cause an individual, they don’t know how lost they are without faith…. (Bulman & Wortman, 1977, p. 359)
A Buddhist who turns to the following passage from Ṭhānissaro Bhikkhu’s translation of the Dhammapada would find a different path toward spiritual transformation during times of crisis—to eschew mundane attachments:
be done with conceit,
get beyond every fetter.
When for name & form
you have no attachment
–Have nothing at all—
no sufferings, no stresses, invade. (17: 221)
Taken together, these examples of positive religious/spiritual coping highlight the powerful capacity for religion and spirituality to facilitate the search for posttraumatic meaning, control, comfort, intimacy, and transformation. However, for some people, the search for the sacred also has a dark side. We now turn our attention to negative posttraumatic religious/spiritual coping.
Negative Patterns of Religious and Spiritual Coping
Negative patterns of religious and spiritual coping attempt to address the five coping functions described earlier, although these strategies typically exacerbate posttraumatic distress (Pargament et al., 2000). In the next sections, we share empirical examples to illustrate some of the ways in which these five coping functions manifest in the form of posttraumatic religious/spiritual struggles .
In the search for meaning after a traumatic event, a person may interpret the stressor as an act of evil forces, as a grandfather of two children killed in the Oklahoma City bombing exclaimed: “A year ago this week, Satan drove up Fifth Street in a Ryder truck. He blew my babies up. He may have looked like a normal man, but he was Satan” (Bragg, 1996) . More often, people perceive traumatic events as punishment from God. A news report after the 2004 Indian Ocean earthquake and Indonesian tsunami described religious beliefs as coloring appraisals of the disaster; specifically, some Muslim survivors perceived the tsunami as punishment from Allah, some Israeli and Christian religious leaders interpreted it as God’s wrath, some Buddhists believed the sea gods must have been angered, and some with beliefs rooted in Hinduism and Buddhism cited karma as the reason for the tragic deaths (Broadway, 2005) . When calamity hits, the existential “problem of suffering” often arises: How could a loving, all-powerful God allow terrible things to happen? When faced with suffering, people often respond by (a) questioning God’s love, or (b) questioning God’s power (see Chap. 20, this volume, for related discussion). John Piper, an influential American evangelical Christian Protestant minister, has grappled with reconciling the concepts of God’s power and love, as in his statement after the 2004 Indonesian earthquake and tsunami: “Destructive calamities in this world mingle judgment and mercy…. They are both punishment and purification. Suffering, and even death, can be both judgment and mercy at the same time” (Piper, 2004, section 3) . However, for some, the problem of suffering is not as easily resolved. In a qualitative study of women who had battled breast cancer, one woman stated, “[I am] not sure if I will ever believe that God loves me again,” while another woman fluctuated between attributing blame to God for her cancer and questioning the existence of God (Gall & Cornblat, 2002, p. 528) .