Spirituality and religion (S/R) often play a central role in post-loss meaning-making processes (Lichtenthal, Neimeyer, Currier, Roberts, & Jordan, 2013; Marrone, 1999). While S/R-related assumptions (e.g., benevolent and just world) can provide great com- fort to the bereaved, loss can challenge these assumptions, further complicating one’s grief response. To examine the nuances of the associations between religious identity, meaning-making, and prolonged grief, this preliminary study examined these variables in a sample of parents bereaved by cancer.

In addition to S/R, meaning may be found through evocative experiences, which have been described as experiences that evoke either a visual or auditory sense of a person who died that provide a way of remaining connected to the deceased and are heavily influenced by spiritual beliefs (Wiener, Alkin, Gibbons, & Hirschfeld, 1996). However, research on evocative experiences is limited. Thus, a secondary goal of this study was to explore evocative experiences described in qualitative interviews with bereaved parents in our sample.

Parents (n = 114; 86 percent religiously-identified) who lost a 6- to 25-year-old child to cancer between 6 months and 6 years ago were recruited from two major cancer treatment facilities to complete a battery of self-report questionnaires. These included the PG-13, a measure of prolonged grief symptoms (Prigerson et al., 2008); the LAP-R, a measure of meaning in life and attitudes toward death (Reker, 1992); and the PTGI, a measure perceived changes in self, relationships, and philosophy of life following a traumatic event (Tedeschi & Calhoun, 1996). A subset of parents (n = 8; 75% religiously-identified) with both elevated (n = 7) and lower levels of PGD (n = 1) participated in qualitative in-depth interviews that were recorded, transcribed, and analyzed using thematic content analysis.

The survey findings indicated a largely positive impact of S/R on bereavement out- comes. Religiously-identified parents reported significantly lower levels of PGD symptoms (p = .04) than those who did not identify with a religion. They also demonstrated a significantly greater sense of purpose (p = .02), personal meaning (p = .01), life coherence (p = .02), positive spiritual changes (p = .01), and an increased ability to relate to others (p = .04) since their loss.

While qualitative analyses also suggested S/R played a generally positive role in parents’ coping and meaning-making processes, interviews also revealed parents’ conflicting views of S/R as it related to their child’s death (e.g., some expressed a belief that God had a purpose for the child’s death but they were challenged to understand what that was). Most of the 6 parents in the qualitative subsample who identified with a religion struggled because their child’s death challenged their S/R assumptions. Six out of 8 parents also described evocative experiences; though these parents varied in religious identity and in their process of meaning-making, they seemed to demonstrate a spiritual bond with their child through these experiences.

Overall this study confirmed findings from prior studies demonstrating the positive effect S/R can have on meaning-making in bereavement (Lichtenthal, Burke & Neimeyer, 2011; Lichtenthal, Currier, Neimeyer, & Kessee, 2010). However, this study also found that parents struggle with meaning-making when S/R beliefs are challenged by their loss experience, particularly when they have witnessed their child’s suffering from cancer and its treatment. This struggle may reflect complicated spiritual grief (Neimeyer & Burke, 2011) and warrants further study. Finally, evocative experiences appeared to play a significant role in meaning-making and continuing bonds with the deceased child and thus their role in bereavement adaptation should be further explored. This preliminary study was limited by a relatively small qualitative sample size and a lack of diversity with respect to religion and race. Future studies should examine more diverse samples to identify unique themes associated with other faiths and investigate the influence of strength of religiosity in addition to religious identification.

About the Author

Kailey Roberts is a doctoral student in clinical psychology at the New School for Social Research. Her research interests include bereavement, psycho-oncology, spirituality and religion, and existential psychotherapy. Currently, Kailey is engaged in research on cancer-related bereavement at Memorial Sloan- Kettering Cancer Center where she is supported by an NIH pre-doctoral training grant.

References

Lichtenthal, W. G., Burke, L.A., Neimeyer, R. A. (2011). Religious coping and meaning-making following the loss of a loved one. Counseling and Spirituality, 30, 113–136.

Lichtenthal, W. G., Currier, J. M., Neimeyer, R. A. & Kessee, N. J. (2010). Sense and significance: A mixed methods examination of meaning making after the loss of one’s child. Journal of Clinical Psychology, 66, 791–812.

Lichtenthal, W. G., Neimeyer, R. A., Currier, J. M., Roberts, K., & Jordan, N. (2013). Cause of death and the quest for meaning after the loss of a child. Death Studies, 37, 311–342.

Marrone, R. (1999). Dying, mourning, and spirituality: A psychological perspective. Death Studies, 23, 495–519.

Neimeyer, R. A. & Burke, L.A. (2011). Complicated grief in the aftermath of homicide: Spiritual crisis and distress in an African American sample. Religions, 2, 145–164.

Prigerson, H.G., Horowitz, M.J., Jacobs, S.C., Parkes, C.M., Aslan, M., Goodkin, K., et al. (2009). Prolonged grief disorder: Psychometric validation of criteria proposed for DSM-V and ICD-11. PLoS Med, 6, e1000121.

Prigerson, H. G., Vanderwerker, L.C., & Maciejewski, P. K. (2008). A case for inclusion of prolonged grief disorder in DSM-V. In M. S. Stroebe, R. Hansson, H. Schut and W. Stroebe (Eds), Handbook of Bereavement Research and Practice: Advances in Theory and Intervention (pp. 165–186). Washington, DC: American Psychological Association.

Reker, G. T. (1992) Manual of the Life Attitude Profile-Revised (LAP-R). Peterborough, ON: Student Psychologists Press.

Tedeschi, R. G. & Calhoun, L. (1996). The Post Traumatic Growth Inventory: Measuring the positive legacy of trauma. Journal of Traumatic Stress, 9, 455–471.

Wiener, L., Alkin, A., Gibbons, M. B., & Hirschfeld, S. (1996). Visions of those who left too soon. American Journal of Nursing, 96, 57–61.