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April 2005 Article of the Month
This month's article selection is by Chaplain John Ehman,
University of Pennsylvania Medical Center-Presbyterian, Philadelphia PA.


McClain-Jacobson, C., Rosenfeld, B., Kosinski, A., Pessin, H., Cimino, J. E. and Breitbart, W. "Belief in an afterlife, spiritual well-being and end-of-life despair in patients with advanced cancer." General Hospital Psychiatry 26, no. 6 (November-December 2004): 484-486.


COMMENT AND SUMMARY: Gallup polls since the 1940s have indicated that 75-85% of Americans believe "there is a life after death"--a belief that recent sociological research suggests may be on the rise [--see pp. 814-815 of Greeley & Hout, in Related Items of Interest, below]. Moreover, belief in an afterlife is famously connected to motivation and behavior. As Colleen McDannell and Bernard Lang observe in their fascinating book, Heaven: A History, "In the hope of reaching heaven and its rewards, people have endured poverty and exploitation, trials, and suffering, even persecution and martyrdom," and many people hope to meet not only God but loved ones there [--see pp. x and 309 of McDannell & Lang, in Related Items of Interest, below]. Of course, an afterlife could also mean a hell as well as a heaven. Chaplains deal frequently with questions of life after death, as people share their hopes and anxieties, but remarkably little research has been conducted about the effects of afterlife beliefs on people in health crises, especially at the end of life. This month's featured article is, in the words of its authors, "one of the first systematic analyses of afterlife beliefs in terminally ill patients" [p. 486].

McClain-Jacobson and her colleagues enlisted the participation of 276 people who were "newly admitted to a palliative care hospital for terminally ill cancer patients in the New York City area" [p. 485]. Participants were asked if they believed in an afterlife and whether their beliefs were comforting or distressing to them. They were also given several self-report measures, including the FACIT-Sp-12 [--see the February 2004 Article-of-the-Month page for more on this instrument]. A total of 63.4% reported a belief in an afterlife, 19.6% reported no belief in an afterlife, and 19.6% said they were unsure about their beliefs. Belief in an afterlife was reported by 72% of those who were Catholic, 64% of those who were Protestant, and 46% of those who were Jewish. While 64.8% of all participants indicated that they found comfort in their beliefs, 7.6% said that their beliefs were distressing; and "there were no differences across the three groups [i.e., belief, nonbelief, and unsure] with respect to whether their beliefs were distressing to them" [p. 485].

Analysis of the measures used showed "no significant difference in anxiety or depression across the three afterlife groups; however, ...patients who reported belief in an afterlife were less hopeless, had less desire for hastened death and [had] less suicidal ideation than those who did not believe in an afterlife or those who were unsure about their beliefs" [p. 485]. Nevertheless, when spiritual well-being was considered (in a general linear model) as a covariate with afterlife belief, the effect on hopelessness, desire for hastened death, and suicidal ideation was no longer significant, but the "spiritual well-being level accounted for a large effect" [pp. 485-486]. The authors conclude that "spirituality [as indicated here by spiritual well-being] has a much more powerful effect on psychological functioning than beliefs held about an afterlife" [p. 486].

In spite of the fact that McClain-Jacobson, et al. found belief in life after death to be less significant than spirituality/spiritual well-being in accounting for the results of the various measures included in the study, there is surely cause for more study of the role of afterlife beliefs in the lives of patients. Chaplains may be well suited for further research, by virtue of their experience in pastoral visitation, and qualitative methodology--with which chaplains are often comfortable--may be a productive alternative for discerning such things as the ways that afterlife beliefs become salient for people in health crises, influence their coping with illness, and possibly affect end-of-life decision-making; and paving the way for further quantitative work in this area.


Suggestions for the Use of the Article for Discussion in CPE: 

Students should be able to read this article quickly, though it contains some statistical language that may require explanation. It would serve as a good entree to the general subject of afterlife beliefs as they arise in pastoral visitation. Students could be challenged to think about how they see afterlife beliefs being important to patients and/or family members, and they could discuss how they handle the subject in various circumstances. For a discussion session, this brief article could be paired with one of the Related Items of Interest, listed below.


Related Items of Interest: 

Alvarado, K. A., Templer, D. I., Bresler, C. and Thomas-Dobson, S. "The relationship of religious variables to death depression and death anxiety." Journal of Clinical Psychology 51, no. 2 (March 1995): 202-204. [This study of 200 persons from a general population--the first study, according to the authors, to correlate religious variables with death depression--found a positive correlation between lower death depression and belief in an afterlife. However, people with lower death depression were also "less likely to say that the most important aspect of religion is that it offers the possibility of life after death" (p. 202, abstract). The authors also discuss previous research that associated religious belief with death anxiety more than religious practice.]

Buckley, J. and Herth, K. "Fostering hope in terminally ill patients." Nursing Standard 19, no. 10 (November 17-23, 2004): 33-41. [In this British study--a replication of a 1990 American study by Herth--16 adults receiving palliative care were interviewed on the subject of hope. Life after death was identified as a sub-theme in the hope-fostering category of "spirituality/having faith."]

Dossey, L. "Immortality." Alternative Therapies in Health and Medicine 6, no. 3 (May 2000): 12-17 and 108-115. [This is an essay on the idea of immortality and its relation to science and medicine from one of the leading voices in recent years in the dialogue about spirituality and health. While not a report of research, it is the sort of writing that may stir creative thinking about issues and topics for future studies.]

Greeley, A. M. and Hout, M. "Americans' increasing belief in life after death: religious competition and acculturation." American Sociological Review 64, no. 6 (December 1999): 813- 835. [This analysis of General Social Survey data indicates that between the 1970s and the 1990s there was a rise in the number of Americans reporting a belief in an afterlife. While the number of Protestants reporting such a belief remained essentially unchanged at about 85%, the number of Catholics, Jews, and persons with no religious affiliation reporting such beliefs seems to have risen markedly--a trend even more noticeable when cohort data is extended back to 1900. The authors address possible reasons for these changes.]

Marrone, R. "Dying, mourning, and spirituality: a psychological perspective." Death Studies 23, no. 6 (September 1999): 495-519. [This review "examines the cognitive basis of the spiritual experience and the use of cognitive assimilation, accommodation strategies during the process of mourning the death of a loved one, as well as during the process of living our own dying" (p. 495, abstract). The author notes research that suggests that people's capacity to engage in a process for rediscovering meaning in their lives after loss may be more important than specific belief content. (This article is cited by McClain-Jacobson, et al.)]

McDannell, C. and Lang, B. Heaven: A History. New Haven, Conn.: Yale University Press, 1988. [This is a social and cultural history of the idea of heaven in Christianity. It contains numerous illustrations and 39 pages of notes. A second edition has been published by Yale University Press (2001), including a substantially expanded preface.]

Niemeyer, R. A., Moser, R. P. and Wittkowski, J. "Assessing attitudes toward dying and death: psychometric considerations." Omega: Journal of Death and Dying 47, no. 1 (2003): 45-76. [Chaplains interested in thanatological research--especially regarding death anxiety--may find this recent review of methodology and particular measures helpful. The Fear of Personal Death Scale and the Death Attitude Profile-Revised (see pp. 58-60) touch on afterlife beliefs. The article does not address religious issues per se.]

Rose , B. M. and O'Sullivan, M. J. "Afterlife beliefs and death anxiety: an exploration of the relationship between afterlife expectations and fear of death in an undergraduate population." Omega: Journal of Death and Dying 45, no. 3 (2002): 229-243. [This psychological study of an undergraduate student population found no correlation between belief in an afterlife and death anxiety, but it did find that afterlife beliefs could revolve around expectations of judgment/punishment as well as around expectations of reward. The authors therefore caution against assumptions in some of the literature that afterlife beliefs are necessarily comforting.]


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