In this post, Joe Wood reviews Meaning-making Methods for Coping with Serious Illness (Abingdon: Routledge, 2018) by Fereshteh Ahmadi and Nader Ahmadi.
In Meaning-making Methods for Coping with Serious Illness, Fereshteh Ahmadi and Nader Ahmadi attempt to synthesise much of their existing work from the last fifteen years, which aims to rectify how research into coping with serious illness overemphasises religious responses. Using examples from three countries taken to be culturally secular (Sweden, China and South Korea) and two Muslim examples as correctives to a Christian-leaning literature (Malaysia and Turkey), they introduce a framework for understanding the complex cultural influences at work when people seek meaning in a diagnosis that can often feel meaningless: the umbrella term ‘meaning-making coping’ which the authors divide into ‘religious, spiritual, and secular existential coping methods’ (2).
Starting from the work of Kenneth Pargament and others from the psychology of religion, Ahmadi and Ahmadi’s introductory chapters give working definitions of religion, spirituality and coping, before presenting Pargament’s RCOPE measurement instrument. RCOPE is used mainly in quantitative research to generate data that differentiates between various religious and spiritual coping methods along axes – positive/dysfunctional, inward-looking/outward-looking, organised/personal – and establishes coping method categories such as Punishing God Reappraisal or Spiritual Connection. Ahmadi and Ahmadi explicitly question Pargament’s restricted definition of spirituality as a search for sanctity and implicitly question the usefulness of research that assumes that the coping methods of mainly Christian, North-American respondents could ever be universal.
Instead, they provide their own more manageable stream-lined version of RCOPE that also includes secular responses that are neither associated with organised religion nor recognisably spiritual in a broad sense. The next chapters apply this expanded S/RCOPE framework to Ahmadi and Ahmadi’s qualitative and quantitative studies of coping methods in Sweden, and then more briefly to the two East Asian studies and the two predominantly Islamic countries. The final chapter summarises all the results by exploring more generally the relationships between culture and health, establishing both that many of our coping responses to serious illness are culturally conditioned and that socialised faith systems underpin these responses to varying degrees depending on a national culture’s religious tendencies
In a book that generally advocates the need for greater cultural awareness when helping those living with serious illnesses, I hoped to find a sense of contingency. Even if the numbers of those practising a religion have dwindled, the contemporary cosmology of any secular country contains residual socialised practices and beliefs that echo what would previously have been thought of as religious. In this way, for me, the differences between religious, spiritual and secular coping methods do not stand up, particularly when Ahmadi and Ahmadi suggest the latter includes things like ‘belief in the healing power of nature’, ‘relying on a transcendent power’, sensing a mind-body connection or a heightened sense of being in relation to others (61). I would contest, for example, that the practices of communing with nature or seeking ‘positive solitude’ that they find are prevalent in Sweden and categorise as secular have more than a little to do with the Protestant ethic they elsewhere suggest still defines a mostly non-believing population. It is telling, too, that all three coping methods are conflated into ‘culture’ for the final summary chapter. The rigidity of dividing all coping responses into religious, spiritual or secular, inherited from Pargament’s RCOPE framework, cannot acknowledge the complexities of an individual’s reaction and thinking more broadly in terms of culture allows a more realistic fudging of these three terms.
I have reservations about a self-declared ‘sociological study’ (1) of this kind being presented by Routledge as an advance in medical humanities. The authors make no attempt to position themselves as engaging with relevant medical humanities scholarship (e.g., a nod towards narrative medicine, thing theory or intersectionality) and ignore the value of their own qualitative data by rarely giving us examples of their participants’ own words. Instead, they spend more time reproducing the (often interesting) arguments of others from the psychology and sociology of religion, although they tend to allow a single article by someone else to represent a given topic, when that topic has a rich literature outside the psychology of religion (e.g., in theology, cultural studies or nursing and palliative care). Their fairly uncritical approach to the work they do cite means that occasionally arguments with clearly competing agendas jostle alongside each other with little or no qualification to bring them together. More often than not, the sense is of a missed opportunity, where perspectives from multiple disciplines could have worked well alongside one another. It is also frequently unclear whether Ahmadi and Ahmadi are commenting on a given quotation or continuing that critic’s argument in (sometimes uncomfortably close) paraphrase.
Medical humanities is certainly a broad church and the fact that social scientists are interested in engaging with aspects of it is surely valuable. However, this book lacks the nuanced discussion and synthesis that needs to accompany quantitative and qualitative data if interdisciplinary work of this kind is to succeed. For example, definitional confusion threatens to overwhelm any meaningful contribution that this study could make. Defining terms is important in interdisciplinary contexts but the authors here frequently redefine their basic terms – such as religion, spirituality, culture or coping – either in verbatim repetitions or sometimes using a completely different disciplinary approach.
Such confusion is understandable when dealing with the abstruse relationship between contemporary national cultures or religions and individual practices, but Ahmadi and Ahmadi seem to fall into all-too-easy traps. As well as contradictory definitions, there is not enough teasing out of the differences between cultural reactions: they distinguish Swedish ‘positive solitude’ from the Korean tendency to become self-aware of relationships with others (64), but then suggest with little elaboration that Koreans try to ‘break free of the bounds [sic] of family relationships’ (72), unlike family-minded Chinese informants. This is partly because Ahmadi and Ahmadi do not allow themselves enough space to compare their results, which sometimes means their brief conclusions, based only on small studies and the opinions of one or two critics, mirror national or cultural stereotypes: Swedes go for long walks in the woods and Muslims believe in predestination. An approach informed more by psychology or social science may have provided greater scope for direct comparison; a co-author with an ethnographic, linguistic or theological approach might have led to more careful discussion of the results.
Ultimately, although they do not frame their research in this way, Ahmadi and Ahmadi also seem interested in the possibility of the death-bed conversion, or at least the ways in which serious illness can turn an individual towards spirituality. Only one of five religious Chinese participants had been a believer before their illness and there is an interesting discussion, based, as much of the analysis here is, on the work of Kenneth Pargament, of how illness often leads people to sanctify everyday objects, concepts and relationships with a renewed sense of meaning which we can think of as sacred.
If Meaning-making Methods for Coping with Serious Illness had concentrated on exploring participants’ individual relations to this sense of the sacred and used more relevant literature to explore some of the conceptual gold dust scattered here (like how a sense of being limited by time might necessitate a need for space, or how cultural emphasis on transcendence or immanence is experienced affectively), then it would be a valuable and innovative advance in the field. Unfortunately, this book is instead a demonstration of the perils of interdisciplinary research and a testament to the way in which quantitative research without sufficient thoughtful analysis can at once illuminate a problem and, through its insistence on being categorical, cover it up again.
About the reviewer:
Joe Wood is a PhD candidate in English Literature at the University of Glasgow, Dumfries Campus, examining the conceptual background to the idea of ‘total pain’ used by the hospice pioneer, Cicely Saunders. He is part of the Glasgow End of Life Studies Group.