How the “Not Religious” Experience and Witness Suffering and Death: Case Studies

ABSTRACT

This article is based on a subset of a multi-site (8), multi-year (4) research study that explored the cultural construction of dying and death in long-term care facilities. In open-ended interviews with residents and staff members, we learned how four individuals who describe themselves as “not religious” respond to queries about the meaning of suffering and death while working and living in long-term care.

We present case studies of two residents and two staff members from one of the sites–a secular, for-profit nursing home–who described themselves as not religious. We offer a brief history of their lives and daily activities, and present their responses to our queries about dying and death.

A finding of this article is that the nonreligious residents and staff members discussed here found significance in personal meaning systems developed through past, positive life events and present uncertainty about suffering and death. The self-described “not religious” provide another perspective on facing the end of life.     

POETRY

ABSTRACT

This article presents a pilot project in which reminiscence group members read mystics from several religious traditions to select imagery about the mystical theme of an unconditionally accepted “Core Self.” The perspective from “Core Self,” in turn, reframes unforgiving judgments some members have made about their personal history, ameliorates meager levels of self-esteem through which they have reviewed their life, and draws from their reminiscences more functional ways of managing current issues. The article concludes with examples of members offering additional insights into the life review of three colleagues that enhance the benefits of the project.     

The Spiritual Dimension of Caring: Applying a Model for Spiritual Tasks of Ageing

SUMMARY

This chapter describes a spiritual dimension of ageing using themes and a model for spiritual tasks of ageing, developed as a part of doctoral studies that examined spirituality amongst a group of independent-living older adults in Canberra and NSW. This model has been tested further and the model was confirmed through in-depth interviews of residents of nursing homes in the ACT. The first study identified six major spiritual themes from participant interviews. These were: ultimate meaning in life for each person, the way they responded to meaning, self-sufficiency versus despair, moving from provisional to final life meanings, relationship versus isolation in ageing and hope versus despair.     

The Importance of Religious Orientation and Purpose in Life for Dying Well: Evidence from Three Case Studies

ABSTRACT

As older adults approach the end of their lives, it is not uncommon to find a decrease in subjective well-being. However, a number of studies have indicated that elders with an intrinsic rather than extrinsic religious orientation often are able to keep a high level of subjective well-being even if they are close to death. In a previous quantitative study, only intrinsic religiosity was indirectly and positively related to subjective well-being in a sample of 103 relatively healthy older adults and 19 hospice patients (aged 61 +), mediated by shared spiritual activities and purpose in life. Extrinsic religiosity, by contrast, was indirectly and negatively related to subjective well-being. To explore in greater depth how religious orientation might influence subjective well-being at the end of life, we used the method of objective hermeneutics to examine semi-structured qualitative interviews with three older male hospice patients (aged 79, 80, and 98) on religion/spirituality and attitudes about death and dying. Results of the analyses revealed that the intrinsically religious respondent maintained his sense of cosmic purpose in life, which continued to be a source of satisfaction for him, unaffected by his terminal illness. The two extrinsically religious respondents, however, did not find solace in their religion and, hence, were unable to cope with their physical and emotional dependence and vulnerability. The findings suggest that an intrinsic religious orientation is most likely to be related to a cosmic sense of purpose in life, which facilitates subjective well-being even in the face of death.     

Dementia and Suffering in Nursing Homes

SUMMARY

This paper uses case studies of challenging behaviour associated with dementia to demonstrate, firstly, that disturbed behaviour is often a manifestation of suffering caused by multiple phenomena such as medical problems or the care environment. Addressing these causes instead of simplistically ‘treating the behaviour’ usually reduces the behaviour. Secondly, staff distress with a particular difficult resident is often caused by more general fundamental problems such as a lack of support or knowledge. Addressing these problems reduces staff distress. Finally, results from a Swedish intervention study are presented. They show that suffering for both staff and residents can be reduced, and quality of life improved, by providing increased autonomy for hands-on staff, systematic emotional support, and collaboratively developing care plans based on each resident's emotional and physical needs, rather than the problems they present.     

Religiosity and Church-Based Assistance Among Chronically Ill African-American and White Elderly

ABSTRACT

This study examines religion and church-based assistance among 127 chronically ill African-American and white elderly persons hospitalized for congestive heart failure and discharged to home. Elders reported high levels of religiosity and prayer behavior; they reported low levels of church help received. Controlling for living arrangement, gender, social class and health in probit regression analyses, race was not a significant predictor of subjective religiosity, frequency of prayer, or level of church help received. Findings indicated a significant race-by-health interaction. Subjective religiosity was positively associated with health for whites but no relationship was found between religiosity and health for African-Americans. Further research is called for that replicates study findings on other elders with chronic illness.     

Development and Initial Psychometric Evaluation of the Transgender Adaptation and Integration Measure (TG AIM)

ABSTRACT

Transgender individuals have a gender identity or expression that is not congruent with their anatomy (Bullough, 2000). Limited empirical data are available regarding the mental health and general well-being of the transgender population. In addition, few standardized measures have been developed specifically for transgender individuals. The main purpose of this study was item and scale development of a measure of adjustment for transgender adults, as well as the assessment of the internal consistency and validity of the measure. Responses to the Transgender Adaptation and Integration Measure (TG AIM) were collected from a sample of 108 self-identified male-to-female transsexual adults. Standardized measures of quality of life and self-esteem were also administered to participants in order to assess construct-related validity. Factor analysis of the measure identified four factors: Gender-Related Fears, Psychosocial Impact of Gender Status, Coping and Gender Reorientation Efforts, and Gender Locus of Control. Internal consistency for each of the four factors ranged from r = .59 to r = .81. Psychosocial Impact of Gender Status and Gender-Related Fears were positively correlated with self-esteem and quality of life. Coping and Gender Reorientation Efforts were significantly correlated to both Psychosocial Impact of Gender Status and Gender-Related Fears. Preliminary psychometric analysis resulted in a 15 item, multidimensional measure with three reliable and valid subscales for use with male to female (MtF) transsexual adults. Further psychometric evaluation of the measure for use with other segments of the transgender population is needed.     

Validation of the Internet-Administered Quality of Life Inventory (QOLI) in Different Psychiatric Conditions

The Quality of Life Inventory (QOLI) is an established rating scale of self-perceived quality of life across 16 domains. Norms for different psychiatric conditions when rated via the Internet, responsiveness to change following treatment, and the clinical impact of importance-weighting items have yet to be examined. To investigate these unanswered questions, important for the continued and expanded use of the QOLI, we compiled archival screening and post-treatment data from 20 studies featuring Internet-delivered psychological interventions for seven different psychiatric conditions and an undergraduate sample, totalling over 4000 participants. Disorder-specific norms were indicated by between-group analyses and are reported here, item-by-item. The QOLI showed adequate responsiveness to change and construct validity. Discrepancies were found when conducting between-group analyses with and without weighted items (more significant differences when items were not weighted) on both the screening and post-treatment data, suggesting that weighting is a procedure that is likely to have an impact when analysing QOLI results. Limitations and the needs for future research are discussed.     

The Effect of d-Cycloserine on Subliminal Cue Exposure in Spider Fearful Individuals

Research on d-cycloserine (DCS) has demonstrated a significant effect on symptom reduction in human studies that utilized conventional exposure-based approaches. Recent studies have offered promising results for targeting fears through subliminal paradigms. In this double-blind, randomized placebo-controlled study, 45 spider fearful individuals received DCS or placebo pills prior to completing a subliminal cue exposure task to images of spiders. Participants completed self-report questionnaires and a behavioral approach task to a live caged tarantula. After repeated exposure to subliminal spider cues, participants in the DCS group reported a greater reduction in disgust than individuals in the placebo group. No difference was observed in fear ratings. These findings suggest that DCS augments the reduction in disgust in spider fearful subjects after subliminal exposure to spider cues.     

社会支持与主观幸福感关系的元分析

研究目的是探讨基于社会支持评定量表的社会支持与主观幸福感的相关,并探讨影响二者关系的研究特征.纳入元分析86篇原始研究,产生了89个独立样本,样本总量为32948.结果显示,主观支持、客观支持和支持利用度,与主观幸福感总体、生活满意度、积极情感之间存在中等程度的显著正相关,与消极情感之间呈中等程度的显著负相关.二者之间的相关受被试群体类型的调节,即在不同被试群体中二者的相关大小不同.