December 2016 Article of the Month
This month's article selection is highlighted by John Ehman,
University of Pennsylvania Medical Center-Penn Presbyterian, Philadelphia PA.
Johnson, S. K. and Armour, M. P. "Finding strength, comfort, and purpose in spirituality after homicide." Psychology of Religion & Spirituality 8, no. 4 (November 2016): 277-288.
SUMMARY and COMMENT: Homicide is connected to the experience of a significant percentage of people, and may be a part of their emotional and spiritual journey that comes out during pastoral visitation. A national Rasmussen poll has found that 25% of all adults in the US know someone who has been murdered (--see the 2013 poll report). Our featured article this month points out that for every one of the roughly 17,000 homicides in the US each year, there are an estimated 7-10 close family members who must cope with the experience, in addition to the friends, neighbors, and co-workers who are affected. Nevertheless, "little...research has considered the needs of the surviving
loved ones of homicide victims" [p. 277], and "little has been done to explore how the specific dimension of spiritual/religious [S/R] meaning making functions in the lives of this population" [p. 286]. In response, "This study addresses gaps in the research by providing a theory of the role of S/R in the process of healing among homicide survivors, and by examining the specific role of spiritual/religious meaning making in this process" [p. 286].
Qualitative analysis was applied to data from an earlier mixed-methods project by one of the co-authors [--see Items of Related Interest, §I, below], that from 1992-2007 followed survivors of murders occurring in Texas and Minnesota for which the offender had received the "ultimate penal sanction" [--see pp. 279, plus 280, 285 and 286]. "Semistructured, in person interviews were conducted between
2008 and 2010" [p. 280]. The final sample of 38 individuals was evenly divided between the two states, was 80% female, and with roughly 80% White/Caucasian and 10% Black/African American. "Most participants reported that they had been raised as Christian"; though "One participant was raised in a Hindu tradition" [p. 280]. The present study took a grounded theory approach but "did not involve theoretical sampling" (--usually key to the grounded theory process, guiding data collection based upon evolving theory), because "data collection was conducted as part of the original study and was not guided by evolving theory" [p. 280]. The article offers in good detail a description of the method of analysis [--see p. 280].
The data suggest an emerging, mid-range theory of trajectories of coping with homicide that could be the focus of future research. Survivors appeared to go through three or four stages and break out into three groups, which the authors diagram (Figure 1, p. 281) and describe:
News of the murder spurred a crisis of meaning that propelled one into the first stage of a four-stage healing process. Stage 1 was comprised of wrestling with God about the murder (e.g., Why did it happen?; What was God's role in its occurrence?). Stage 2 involved a decision about whether one could trust God and marked the end of the initial wrestling period. Stage 3 consisted of settling into a long term healing process and learning to continue with life after the homicide. A fourth stage, living with paradox, was comprised of experiencing unexpected benefits amid tragedy.
The stages and groups, as well as constituent dynamics of the process of healing, are each addressed in turn, with illustrations from the interviews [--see pp. 281-285], making for the heart of the article.
Participants divided into three groups that were distinguished by the nature of one's relationship with God. The role of S/R in healing was different for each group.... Group 1…was comprised of participants who, usually after the initial wrestling period (Stage 1), made the decision to trust God (Stage 2). Group 2…was comprised of participants who also experienced the wrestling period (Stage 1), but at Stage 2 found that they were unable to or chose not to trust God. Group 3…was comprised of individuals who had a neutral reaction to God. Data was sparse for this group, and it was not possible to assess the role of S/R in their lives. Thus, Stages 1 and 2 apply to Groups 1 and 2 only….
In Stage 3, Group 1 settled into a long term healing process characterized by positive relationship with God, whereas Group 2 participants continued to wrestle with God indefinitely. For participants in Group 3, S/R was not particularly relevant to long term healing. Stage 4 emerged only for Group 1 participants, who often described experiencing paradoxical benefits after the murder. [p. 281]
Beyond proposing the mid-range theory, the article also notes four ways that this research may have "critical implications for the study of homicide survivorship" [p. 286]. First, "[t]he fact that most participants had a predominantly positive experience of S/R suggests that S/R may play a positive role in healing for many homicide survivors, regardless of racial/ethnic background..." [p. 286]. Second, the pivotal importance of trust in the posthomicide healing process emerged as a key finding…," with "decisions about trust creating different processes in the healing trajectory" [p. 286, italics added]. The authors state: "This is a critically important finding for practitioners, as it suggests that this deciding point may be where intervention is needed" [p. 286]. Third, "[t]his study provided an initial glimpse at survivors' navigation of the tension between anger and a perceived obligation to forgive, a process that, to the authors' knowledge, has not been characterized in previous studies" [p. 286]. Relevant here was one's "interactive relationship with God" and factors of blame and forgiveness. And fourth, the study "provide[s] valuable insight into the experiences of a specific subgroup of homicide survivors (i.e., those in cases in which the offender received the ultimate penal
sanction)" which is a "starkly underresearched, highly vulnerable group...whose loved ones were murdered in the most gruesome and horrifying of manners and whose dealings with the legal system and media are likely to be the most drawn out and stressful of any group of homicide survivors" [p. 286].
Limits of the research include the aforementioned inability to pursue grounded theory analysis through theoretical sampling, but also the religious/cultural demographics of the sample and the small sizes of the groupings, especially Group 3 whose members had little to say about God and for whom spirituality/religion was not reported to be important to their healing process. The authors set up a number of avenues for further research, such as the need to understand better the role of positive and negative religious coping in bereavement of violent death [--see p. 279], "the impact of the tension between blame and forgiveness on well-being among homicide survivors" [p. 286], and "changes in spirituality and spiritual beliefs, both among homicide survivors who experience spiritual growth, and among those who experience spiritual struggle" [p. 278], plus the experience of those survivors for whom spirituality/religion did not become important to their healing. The entire evolving model that's proposed here calls for further testing and refinement, and study samples that concentrate on non-Christians could be enlightening [--see p. 286]. This article presents a rare call for more qualitative study to compliment and extend quantitative study. The bibliography holds good leads for further reading [--see Items of Related Interest, §II, below].
Three final comments: First, the authors use the language of decision to characterize the process by which survivors come to trust or not trust God (at Stage 2). That language made this reader wonder just how cognitive and intentional was the response of trusting or not trusting in God for people in such a complicated life situation. Second, this reader found especially interesting and valuable the various themes explicated for Groups 1 & 2 at Stages 3 & 4. For instance, Group 1's Stage 3 (Continuing Life after Homicide) was marked by Learning, Receiving, Straddling, and Changing; and their Stage 4 was marked by expressing gratitude and praise in the midst of tragedy, finding purpose and inspiration in the aftermath of loss, and forgiving and desiring salvation for the offender. These themes brought a deeper level of clarity to the presentation of the experience of the distinguished groups. And third, there is only one mention of a chaplain, in a quote from a participant [--see p. 282], but it illustrates the anger that chaplains can encounter in circumstances of extreme grief.
Suggestions for Use of the Article for Student Discussion:
The article should be engaging to any level of students, but those with experience with research may appreciate more the authors' contextualization of their work within the existing literature and their explanation of methodology. Discussion could begin by considering the students' sense of homicide as part of patients' and family members' life experiences from the past. CPE programs with Trauma Centers could explore whether students are aware of the pertinence of this topic to the general hospital population and not just to events in the Emergency Room/Trauma Resuscitation Bay. How does the diagram of the article's evolving theory strike them? How do they feel about religion/spirituality being described as a "meaning-making system" [--see esp. p. 278]. The authors bring up the concept of complicated grief and of Complicated Spiritual Grief (CSG) at various points. Students could think together about what makes grief "complicated." The description of the four-stage process [pp. 281-285] offers much to discuss, especially in light of the illustrative quotes. Students might look at how a theoretical model like the one proposed could on the one hand be helpful for making sense of what's happening for survivors but on the other hand could, if applied casually, risk pigeonholing people (--note the authors' point about the "fluidity" [p. 285] of the groups).
Related Items of Interest:
I. Co-author Marilyn P. Armour is the lead author of the study from which the data for our featured research was derived.
Armour, M. P. and Umbreit, M. S. "Assessing the impact of the ultimate penal sanction on homicide survivors: a two state comparison." Marquette Law Review 96, no. 1 (Fall 2012): article 3 (pp. 1-131); available online from the journal. [(Abstract:) Numerous studies have examined the psychological sequelae that result from the murder of a loved one. Except for the death penalty, however, sparse attention has been paid to the impact of the murderer's sentence on homicide survivors' well-being. Given the steadfastness of the public's opinion that the death penalty brings satisfaction and closure to survivors, it is surprising that there has been no systematic inquiry directly with survivors about whether obtaining the ultimate punishment affects their healing. This Study used in-person interviews with a randomly selected sample of survivors from four time periods to examine the totality of the ultimate penal sanction (UPS) process and its longitudinal impact on their lives. Moreover, it assessed the differential effect of two types of UPS by comparing survivors' experiences in Texas, a death penalty state, and Minnesota, a life without the possibility of parole (LWOP) state. Comparing states highlights differences primarily during the postconviction stage, specifically with respect to the appeals process and in regard to survivor well-being. In Minnesota, survivors of adjudicated cases show higher levels of physical, psychological, and behavioral health. This study's findings have implications for trial strategy and policy development.]
II. Our featured article has a strong bibliography, offering good leads for further reading, but see also these additional articles (including one older one from the pastoral care literature) about coping with homicide:
Blakley, T. L. "Murder and faith: a reflected case study of pastoral interventions in traumatic grief." Journal of Pastoral Care and Counseling 61, nos. 1-2 (Spring-Summer 2007): 59-69. [(Abstract:) Pastoral response to death in the family of a congregate is familiar terrain for most ministers. Pastors are often called upon to pray for the sick, comfort the bereaved, and preside at memorial services and graveside gatherings. While most get some orientation in the work of death and dying in seminary, few are pre- pared to minister effectively to church members who suffer traumatic bereavement caused by human-perpetrated violence. This paper describes the power of facilitated cathartic narrative, bearing witness, and reflective meaning-making in a case study involving a pastor, his wife, and the grief-stricken widow of a murdered comrade in ministry.]
Lichtenthal, W. G., Neimeyer, R. A., Currier, J. M., Roberts, K. and Jordan, N. "Cause of death and the quest for meaning after the loss of a child." Death Studies 37, no. 4 (Apr 2013): 311-342. [(Abstract:) This study examined patterns of making meaning among 155 parents whose children died from a variety of violent and non-violent causes. Findings indicated 53% of violent loss survivors could not make sense of their loss, as compared to 32% of non-violent loss survivors. Overall, there was overlap in sense-making strategies across different causes of death, with many parents invoking spiritual and religious meanings and the cultivation of empathy for the suffering of others. Nonetheless, violent loss survivors described the imperfection of the world and brevity of life more frequently in their narrative responses than parents who lost a child to natural causes, who in turn were more likely to find benefit in the loss in terms of personal growth. Violent loss survivors--and especially those losing a child to homicide--also reported enhanced appreciation of life more frequently than survivors of non-violent losses, and surviving a child's suicide was specifically associated with a change in priorities in the sample. Findings are discussed in terms of common and distinctive themes in meaning making that clinicians may encounter when working with parental bereavement, and the implications these carry for finding spiritual and secular significance in a traumatic loss.]
Mahat-Shamir, M. and Leichtentritt, R. D. "Israeli mothers' meaning reconstruction in the aftermath of homicide." American Journal of Orthopsychiatry 86, no. 4 (2016): 467-475. [(Abstract:) This study is the first to our knowledge to provide an in-depth account of the meanings reconstructed by bereaved Israeli mothers of homicide victims. Homicide survivors tend to receive little or no support from society; this is especially true in Israel, where homicide victims are a neglected population whose voice is socially muted. Constructivist theories have informed understanding of grief, emphasizing the role of meaning reconstruction in adaptation to bereavement, as well as the role of social support in the process of meaning reconstruction. We derived 3 prototypes of meaning from interviews of 12 bereaved mothers: the existential paradox; a bifurcated worldview; and oppression, mortification, and humiliation. Most informants used all 3 prototypes in the process of reconstructing meaning, describing changes in the perception of themselves, the world, and society. However, change was also accompanied by continuity, because participants did not abandon their former worldview while adopting a new one. The findings suggest that meaning reconstruction in the aftermath of homicide is a unique, multifaceted, and contradictory process. Implications for practice are outlined.]
Sharpe, T. L., Osteen, P., Frey, J. J. and Michalopoulos, L. M. "Coping with grief responses among African American family members of homicide victims." Violence and Victims 29, no. 2 (2014): 332-347. [(Abstract:) Research relevant to coping with grief for African American family members of homicide victims is limited. This retrospective study was conducted to determine the effects of gender, length of time since death, the traumatic impact of experiencing the homicide of a loved one, and the use of coping strategies to current grief reactions of African American family members of homicide victims (N = 44). Multiple regression analysis results suggest that gender and level of traumatic stress, related to posttraumatic stress symptomatology, predict current symptoms of grief. Women reported higher levels of current grief symptoms than men. Family members of homicide victims who reported higher levels of posttraumatic stress symptomology reported higher levels of current grief. Implications for research and recommendations for practitioners are discussed.]
Simmons, C. A., Duckworth, M. and Tyler, E. "Getting by after a loved one's death by homicide: the relationship between case status, trauma symptoms, life satisfaction, and coping." Violence and Victims 29, no. 3 (2014): 506-522. [(Abstract:) Covictims of homicide are the loved ones of people killed by homicide. As secondary victims, they experience trauma from the crime yet are not the focus of criminal justice system (CJS) processes. The current descriptive-exploratory study seeks to better understand this often hidden population by exploring the relationship between CJS case status, trauma symptoms, life satisfaction, and coping with a group of 137 covictims from the Mid-South region of the United States. Findings indicate that case closure does not resolve trauma symptoms, although symptoms do lessen. In addition, a broad range of helping services and coping strategies are used after the homicide. Some are associated with CJS case status, trauma symptoms, and life satisfaction whereas others are not. These findings highlight important areas for future research.]
Tuck, I., Baliko, B., Schubert, C. M. and Anderson, L. "A pilot study of a weekend retreat intervention for family survivors of homicide." Western Journal of Nursing Research 34, no. 6 (October 2012): 766-794. [(Abstract:) Homicide causes negative unintended consequences for family survivors. Family survivors face complicated grief and overwhelming loss with minimal support from others. The authors offered a retreat intervention as a way to ameliorate the effects of the homicidal death for family survivors of homicide. An exploratory longitudinal pilot study examined the feasibility and acceptability of the intervention and explored the impact of the TOZI(C) Healing intervention on participants' distress symptoms. Eight family members participated in the 2-day retreat and completed surveys at five time intervals over 30 months. Descriptive statistics and correlations were used to analyze the data. Although sample sizes were too small to achieve statistical significance, changes on selected holistic health outcomes, supported by overwhelmingly positive focus group responses to the intervention, affirm the need for further study.]
Wellman, A. R. "Faith without answers: the use of religion among cold case homicide survivors." Omega: Journal of Death and Dying 69, no. 1 (2014): 19-39. [(Abstract:) Through data gathered from interviews with cold case homicide survivors, this article reveals the important role of religion and faith in the aftermath of an unsolved murder. Using qualitative methodology, the author highlights the lived experiences and personal journeys of cold case homicide surviving family members, who are often a forgotten and an overlooked segment of victims. Qualitative data suggests that these cold case homicide survivors found religion to be critical in the aftermath of their loved one's murder. Specifically, survivors indicated their faith was fundamental in coping with the homicide and provided hope for anticipating a resolution in their cases. From these intimate, personal survivor accounts, scholars and practitioners can begin to develop future research and programs that are specifically designed to highlight the role of religion in moving forward after an unsolved murder.]
III. Our authors cite a number of articles by Robert A. Neimeyer and Laurie A. Burke, especially on Complicated Spiritual Grief, but see additionally:
Burke, L. A. and Neimeyer, R. A.
"The Inventory of Complicated Spiritual Grief: assessing spiritual crisis following loss." Religions 7 (2016): 67 [electronic journal article designation] --available online. [(Abstract:) Following the death of a loved one, many grievers endorse spirituality as a source of both solace and strain. Studies show that some grievers struggle significantly with both their relationship with God and their faith community, a condition known as complicated spiritual grief (CSG). However, researchers have lacked a simple, multidimensional, well-validated, grief-specific measure of CSG. In this brief report, we reviewed the psychometric validation process and clinical utility of a measure called the Inventory of Complicated Spiritual Grief (ICSG), which was tested with 304 Christian grievers. The 18-item ICSG was shown to have strong internal consistency, high test–retest reliability, and convergent and incremental validity and supported a two-factor model, measuring one’s insecurity with God and the disruption in one’s religious practice.]
Burke, L. A., Neimeyer, R. A., Holland, J. S., Dennard, S., Oliver, L. and Shear, M. K. "Inventory of Complicated Spiritual Grief: Development and initial validation of a new measure." Death Studies 38, no. 4 (2014): 239-250. [(Abstract:) Although spirituality often has been associated with better outcomes following bereavement, it can be significantly challenged by loss as well. Studies have shown that some bereaved individuals suffer profoundly not only in relation to the death of their loved one but also in their relationship with God and their faith community, a condition known as complicated spiritual grief (CSG). However, to date, in the absence of a simple, multidimensional, and well-validated measure of spiritual crisis following loss, investigators have measured CSG with nongrief-specific instruments. In this study, the authors tested the reliability and validity of a newly developed measure of CSG, called the Inventory of Complicated Spiritual Grief (ICSG). With 2 diverse samples of bereaved adult Christians (total n = 304), the authors found that the ICSG had strong internal consistency, and high test-retest reliability for both subscales in a subsample of participants. Analyses of both samples supported a 2-factor model, with one factor measuring Insecurity with God and the other assessing Disruption in Religious Practice. Analyses further supported the convergent and incremental validity of the 18-item ICSG relative to other theoretically similar instruments and measures of poor bereavement outcome, suggesting its usefulness in clinical research and practice.]
Neimeyer, R. A. "Meaning reconstruction in the wake of loss: evolution of a research program." Behaviour Change 33, no. 2 (June 2016): 65-79. [(Abstract:) As theories of bereavement have evolved, so too have evidence-based interventions to mitigate complications in post-loss adaptation. This article reviews one line of programmatic research grounded in a conceptualisation of grieving as an attempt to reaffirm or reconstruct a world of meaning challenged by loss. Anchored in therapeutic encounters with the bereaved, a meaning reconstruction approach to loss has grown over the past 15 years to generate an increasingly substantial research base, as well as to develop and refine a wide array of contributions to psychological assessment and therapy. By summarising the major models, measures and methods resulting from this collaborative work, it offers an introduction to meaning reconstruction for those unfamiliar with it, noting its contributions to date, its areas of future development, and its relevance for clinical practice.]
IV. Note that our May 2011 Article-of-the-Month, "Grief in healthcare chaplains...," found that 9% of the sampled members of the Association of Professional Chaplains indicated that they were uncomfortable hearing or talking about death from murder [p. 83 of that study].