Abstract
It has often been noted that people with a severe illness endeavor to deepen their religious and spiritual practice and knowledge. It is generally accepted that spiritual and religious factors help sick people confront their suffering. The authors conducted a qualitative research on the role of religious and spiritual practices and knowledge among 10 cancer patients in Québec, Canada. Individual interviews focused on their illness experience confirmed that religion and spirituality can be present and contribute to coping when life is threatened. More precisely, the analyses of the place and use of these resources during the patient’s illness showed that these resources contributed to an individual empowerment process that was undertaken in response to a biographic and existential disruption induced by the illness diagnosis. The sick people took advantage of religious and spiritual content in their quest for meaning and a cure, progressing from a stage of despair and powerlessness to a stage of hope, a critical analysis of the disease, and a better management and control of it and its evolution. This article describes how people suffering from cancer use and participate in religious and spiritual content. It demonstrates the contribution of this content to an individual empowerment process. The use of religion and spirituality constitutes a quest for self-mastery, an acquiring of power and control. We understand that religious and spiritual phenomena do not always prevent people from fighting against their suffering, limit their freedom, or systematically reduce people’s viewpoints and worldviews.
Introduction
According to Thuné-Boyle et al, 1 religion and spirituality have received little attention with regard to their role in the adaptation strategies of people with serious and chronic diseases. It is generally accepted, however, that spiritual and religious factors help sick people confront their suffering,2-4 even though there are no genuinely in-depth analyses of the way in which these factors influence sick people’s experiences. Several authors who have examined the place of spirituality and religion in the health field accredit them with a positive role, notwithstanding the fact that they may as well reveal negative effects.5,6 To that purpose, Nelson 7 mentions that some religious beliefs may lead affected people to interpret their illness as a sanction, rejection, or punishment from a divine source such as God. Referring to the work of Pargament et al, 8 Nelson stresses the fact that this style of coping—negative religious coping as it is commonly conceptualized in the literature—can lead people to experience feelings of abandonment, guilt, and emotional distress and may eventually reduce their capacities to face harsh life events. On the other hand, some state that spirituality helps construct signification and make use of meaning at times when difficult life transitions arise.9-11 In this regard, Pargament 12 mentions that spirituality and religious coping act as a process that people go through to (re)consider the value of events and things, specifically through significations related to the sacred; by doing so, they define new meanings about what drives and inhabits their lives. Spirituality would seem to be useful in interpreting illness, in redefining oneself when a biographical fracture occurs, in identifying a worldview and new values, and in setting new priorities that support a new path in life. Spirituality might perhaps foster positive emotions or regulate painful ones. 13 This would be the case when a person has a transcendental, spiritual experience or a moment of ecstasy or when the person is intimately linked with a divine, sacred entity. The person draws feelings, strength, and positive sensations from this relation and experience. Others propose that spirituality can lead to a positive affective experience when it is expressed in a harmonious, balanced, and peaceful relationship that a sick person has with another, be it someone close or God. Research also points out that spirituality and religion help because they foster social ties and a feeling of belonging,5,13-15 give people more certainty about their destiny, 16 foster emotional support, 17 and offer hope. 18
Religion and spirituality would also seem to contribute to individual empowerment when a person has a serious, chronic disease, though this relationship has not been greatly examined. Indeed, we do not really know how they might enhance this process and on what aspects of empowerment they might act. Those studies that have discussed this relationship only do so in a cursory manner. Baldacchino and Draper, 19 for example, state that the contact with a higher power through a spiritual and/or religious experience results in self-empowerment but do not elaborate on this. In a chapter discussing powerlessness and chronic disease, Fitzgerald Miller 20 briefly states that spirituality can be a source of empowerment when a relationship with God helps us accept illness. Similarly, Thomas and Retsas 21 and Tanyi 22 present empowerment as a consequence of the quest for and construction of meaning, without going deeper into the subject. Siegel and Schrimshaw 23 affirm that some people with HIV/AIDS feel that religious and spiritual beliefs and practices help them preserve health, control the illness, slow its progression, and may cure them when no efficient therapy is available. Moket al 24 state, in their exploration of the empowerment process, that religious beliefs, in particular belief in the presence of God, are a useful source of meaning for sick people. Finally, Kinneyet al 25 use medical-spiritual practices and techniques inspired by Western and Oriental philosophies in an individual empowerment program that they propose to people with cancer.
Our study on the role of religious and spiritual practices and knowledge among cancer patients confirms that religion and spirituality can contribute to individual empowerment. It must first be stated that serious, chronic diseases are characterized by many types of change and loss, be they physical, social, psychological, or symbolic.26-31 Cancer is not an exception to this rule. Like other diseases, it often constitutes a crisis situation and an attack on physical integrity, which leads to a feeling of powerlessness and a lack of control.24,32-34 Cancer robs them of hope by making them lose a sense of meaning and purpose in their personal life, by occasioning a lack of commitment in life in general, by creating an uncertainty about future possibilities, and by making it difficult to even imagine oneself in the future.35,36
During this type of experience, sick people are often likely to turn to religious and spiritual practices and knowledge. As soon as they identify the source of the misfortune, sick people often become committed and active actors in the resolution process by bringing to bear these practices and knowledge, which they use to overcome their uncertainties, to actively manage their disease, to take part in decisions concerning them, to develop abilities, to hope, and to acquire a feeling of control and power over what happens to them. In other words, calling on these practices and knowledge contributes to the development of empowerment in sick people.
In this article, we wish to provide support for the preceding affirmations with empirical data that were obtained in our cancer patient study. More precisely, we propose to show how religious and spiritual content can help sick people move from despair and powerlessness to a feeling of control and power.
Research
The goal of our research was to understand how people with cancer turn to religious and spiritual content and how these elements positively influence their experiences. By religious and spiritual content, we mean practices and knowledge arising from religious and esoteric traditions, an established church or new religious movement, or alternative, popular, or traditional medicines where medicine, religion, and spirituality mix. This content thus includes the wide range of heterogeneous practices and knowledge to which sick people now have access. The choice to open our research to a wide range of content was justified by the multiplicity of religious, spiritual, and medical-religious practices present in Western societies. This choice is in keeping with sociological observations that indicate that the current form of religious phenomena is fragmented and multifaceted and that there is a multitude of meanings available with which to understand and explain the world, life, and human existence. 37 These observations indicate that modern individuals are on a shifting, religious marketplace where there is a tendency toward individualization, toward the decomposition and recomposition of beliefs, and toward serve-yourself and do-it-yourself beliefs. 38 These observations also underline a marked interest in invisible, mysterious, and magical phenomena that can endow people with useful powers for transcendental, immanent, and sacred experiences.39-41
We thus adopted a functional approach to religious phenomena by considering that people’s spirituality, beliefs, values, personal growth, the meaning given to their life, and any other spiritual dimension all contain a pragmatic logic, especially when one is trying to conquer suffering or illness. And just as religion often aids practitioners, believers, and groups in their quest for daily well-being, spirituality aids them in questions of life, death, healing, and quality of life.
Participants
A total of 10 people participated in our research (7 women and 3 men from 55 to 74 years old; see Table 1). All participants were Quebecers and grew up in a Christian family context. They were recruited through community organizations, and all lived at home. Of these, 5 were diagnosed with cancer in the 6 years preceding their recruitment and 4 were still being actively treated; 5 women had had breast cancer, another had uterine cancer, and the seventh, skin cancer; 2 men had prostate cancer, and another had lymph node cancer.
Religious and Spiritual Practices and Knowledge Used After the Diagnosis of Cancer
Study Technique
Individual interviews were conducted in each person’s home. The mean length was 2 hours (ranging from 1½ hours to 2 hours and 15 minutes). The interviews reconstructed the history of the illness in chronological order. We first asked the respondents to discuss the period before the cancer diagnosis to identify a way of life, a worldview, a relationship with religion, or a spiritual life. They were then asked to discuss the medical diagnosis and the period that followed. Finally, we concentrated on the use and place of religious content in this period.
Analysis
The data, which were obtained in the form of personal narratives, were analyzed using NVivo 8, a qualitative analysis program. We codified the contents of the first 4 interviews. The codes were then organized into recurring categories that were used to structure the next 6 interviews. This analysis allowed us to identify elements of content and meaning regarding powerlessness, participation, skills, control, mastery, and power during the respondent’s illness.
Results
First Stage: From Shock to Powerlessness and Despair
Lack of a time horizon
A cancer diagnosis often signaled the start of a brutal episode in people’s lives entailing despair and powerlessness. A social representation of cancer as imminent mortality was activated as soon as the diagnosis was given, encouraging people to take their diagnosis as a death sentence in the short or midterm. A recovery prognosis sometimes added some nuance to the association Cancer = Death, but it did not invalidate it. The representation and prognosis led sick people to brusquely consider the end of their existence, what they risked losing or missing, what they had foreseen, and indeed the impermanence and fragility of life. The illness erased a positive image of themselves in the future, made them conscious of their finiteness, and brought on a feeling of meaninglessness. All reason for living sometimes disappeared when such a feeling of despair took hold. The following statements illustrate this well.
Thing is, when you are diagnosed with cancer, even if you’re a doctor, you can’t help but think, “Is this going to kill me?” Everybody thinks about that “What if?” (Participant 4) When I got my breast cancer diagnosis, my mind went blank. Everything I thought I knew didn’t exist anymore. Nothing but my cancer existed to me. All that mattered was my physical health. I had retreated within myself so much that it seemed like I was now living in another world. (Participant 1) Those were really dark times for me. Darkness is the only way to describe that period of time: utter meaninglessness and chaos. Not only did the present time, place, and situation make no sense, I had the distinct impression that all my past actions and choices up to that point had just been robbed of any kind of meaning or purpose. (Participant 7) I’ve been thinking about many things. Euthanasia, death, disappearing. I just can’t do it anymore. I don’t want to fight anymore. I want to get my things in order and just drop off the face of the earth. To disappear without a trace. (Participant 2) I would think about dying. I had never thought about killing myself, but I kept thinking that, if I were dead, I would stop feeling the way I did. I couldn’t help having these thoughts. They would just keep coming into my head. (Participant 3)
Change and loss in the body and interpersonal relations
The feeling of powerlessness and despair was reinforced by changes and losses in the body, everyday activities, and interpersonal relationships. These changes 1 and losses were intensified moreover when sick people experienced particularly unpleasant side effects from their medical treatment.
Those whose bodies were affected by the illness had to cope with a new image of themselves. They were obliged to acknowledge their body’s fragility as it lost strength and energy and became a source of dissatisfaction, pain, and other cumbersome symptoms. The question here was one of identity transformation, of a loss of oneself, and of too great a distance and difference between oneself and others.
It was as if I’d lost an important part of me. It made me feel incomplete and that rocked me to my very core. I hated feeling like that. It made me sick to my stomach. I knew I wasn’t like everybody else anymore. (Participant 1) After a breast cancer operation, you can’t help but feel like less of a woman. Following the operation, you end up spending quite a bit of time examining yourself in the mirror. In my case, they didn’t remove my whole breast. And so, you examine your reflection from head to toe. Then it hits you, you have one big breast and one small breast. You also can’t help but notice the scar. . . . And, there it is, the physical reminder that you have breast cancer. And, because of it, you hate how you look. I mean, at 60 years old you already don’t like how you look, but now, you have one more reason to hate your body. I know my body wasn’t very beautiful to start with. But now, it is so much worse. (Participant 7) But, you have to understand. For me, my breast! I was rather chubby. And, my breasts were pretty much what I considered my best assets and the features I liked best about my body. So, it all really came as a shock. You inevitably think about how you’ll never be the same. It’ll never be the body you used to have. (Participant 8)
Their bodies were still failing them in their daily routines. Indeed, a few respondents stated that they were incapable of accomplishing the simplest everyday acts or taking care of their most basic needs, such as sleeping, feeding themselves, washing themselves, or resuming activities that they partook in before their diagnosis.
I spent a whole year at home. It was the first time in my life that I had to stay at home for so long. I would split my time between crying, reading, falling down, and doing absolutely nothing. I couldn’t even do a quick wash of the daily dirty dishes. . . . Thing is, chemo only gets harder and harder to endure when you start noticing that you’re losing your hair, you’re falling down all over the place, you can’t wash your own clothes or even dust around the house. And, to add insult to injury, all this has been going on for 2 years and there are no signs that it’s going to stop anytime soon. (Participant 2)
These changes were further complicated by losses in their interpersonal relationships. Some people could no longer stay involved in their social networks and felt isolated. They could no longer play certain roles and had to stay away from certain situations that might be uncomfortable or require a participation that they felt unable to ensure. As one participant stated,
When you can’t dance anymore, when you can’t go out on the town or to the movies, when you’re not able to do any kind of physical exercise, when you can’t do the household chores and tend to the upkeep of your house, when you always need somebody to assist you with getting dressed, even when you just want to put socks on, you lose your friends along the way. Your more intimate friends start to drift away from you. You stop playing host for your family. (Participant 2)
In addition to intense emotional reactions and the lack of a time horizon, the preceding changes and the exclusion from everyday life led the respondents to feel that they were no longer the masters of their own lives. Confronted with the harsh reality of a serious disease, these sick people no longer thought they could change their lives and choose the desired direction. This cruel situation thus neutralized any form of action, dooming the participants to a passive wait for outside solutions.
Second Stage: The Use of Religion and Spirituality
During this period of despair and powerlessness, the respondents used religious and spiritual content that came from Christian, Buddhist, Hindu, and shamanic traditions as well as other content that had no evident link with traditional religion; 5 of the people drew on a primarily Christian content. Particularly noteworthy were going to mass, prayer, and meditation retreats; regular meditation practice using Christian texts; the development and confirmation of Christian faith; conversion to a Christian church; and a special relationship with invisible, greater, and supernatural powers, such as Jesus and God and the angels, archangels, and saints.
As for Buddhist-, Hindu-, and shamanic-inspired content, 6 people made use of meditation practices (yoga, Reiki, Qigong, etc) and communion with nature and its forces. Likewise, 7 people turned to mindful techniques to transform their consciousness, exploit the mind’s strengths, and focus their energy on the body using things such as visualization techniques or the ECHO method.
The respondents adopted religious and spiritual practices and knowledge with which they were not always entirely familiar before their diagnosis. Even though most of their practices were a continuation of previous ones, they often strengthened certain beliefs or commitments. Table 1 shows the practices and knowledge that were used during their illness.
Third Stage: Religion and Spirituality in the Empowerment Process
Initially, religion and spirituality helped the respondents interpret the meaning of their disease. Religion and spirituality compelled some of them to critically reflect on the disease and led them to take responsibility for how they interpreted and managed the problem. They allowed people to hope, to develop abilities and skills in their fight against cancer, and to actively participate in the resolution of the problem. These components of individual empowerment, which are presented successively below, were interwoven one into the other in the participants’ experiences and itinerary. They did not constitute a succession of linear stages and are only disassociated here for analytical purposes.
A critical consideration of one’s disease and participation in its resolution
For most of the respondents, the illness did not remain a biological reality or a mass of undesirable, anarchic cells. In trying to answer the important question, “Why did I get this disease?” they progressively interpreted the meaning they gave to it. The respondents placed it in their life history and avoided reducing it to a causal agent or mechanism. On reflection, the meaning that 5 of the respondents gave to their misfortune allowed them to determine strongly, in spirit of a “self-accusation and self-responsibility” typical of the modern world, that their lifestyle was responsible for its emergence.42,43
Our interviews showed that the subject of spirituality appeared implicitly in this interpretation of misfortune. This subject, which by its very nature encompasses people’s priorities, values, worldview, and view of themselves in the world, was nonetheless sometimes absent in the participants’ lives before the cancer diagnosis. One participant stated that her illness highlighted the materialism and desire to always perform and have more money that had permeated her life.
I believe I’m sick in part because my husband would put too much pressure on us to be the most efficient possible in all aspects of our lives. And, whatever we did achieve, it was never enough. He always wanted more money. There were other factors that probably led me to get sick like the fact that the clients were extremely demanding. I was leading an unbalanced life. (Participant 2)
Another respondent focused excessively on performance and the present. Having no religious beliefs, he rejected the existence of God and considered that there was nothing apart from the material world. And 3 people deemed that they did not approach relationships very well and believed that they had relationship traits, such as difficulties in affirming themselves, that were at the root of their cancer. For example, 2 of them stated:
I made a list of the psychological tears to my being that had developed with time. . . . And then, I had started to work at mending and eliminating the little tears. . . . I could identify all kinds of causes for this emotional and psychological wear and tear. . . . My work. My fear of losing my job. My struggle to finally be able to be my true self. This whole process was clear for me. I’m not saying that everyone having gone through the same life experiences that I have would have gotten cancer. However, I was unable to personally dissociate myself from situations and keep my distances. I’m a very nervous person and I tend to take things to heart a lot. . . . In my case, it’s obvious to me that my cancer is the result of too many unresolved psychological tears. It can’t be anything else. (Participant 1) I have prostate cancer. What does that even mean? Masculinity . . . I consulted . . . I met with someone who uses the Hamer method. I tried to get a consult. It mainly centered around self-assertion. Self-assertion of myself as an individual and of myself as a man. These were things I was already aware of. Simultaneously, I had to work on establishing limits for myself. I needed to learn when to say yes and when to say no. I had to work on not getting unsettled and overwhelmed so easily by others. I had to become able to confront the people in my life, my children and others. (Participant 6)
It was therefore time to reexamine their style and quality of life, to create strong ties with a higher power, and to change their priorities, values, worldview, and relationships with themselves and others. Some developed a religious practice through their belonging to and presence in a church. Others focused their spirituality on the self as a way of preventing the disease and fighting its presence and effects.
Once they understood that they were also responsible for their disease, these sick people realized that they had some power over what happened to them. They could therefore begin taking steps in the opposite direction toward recovery. This etiological openness allowed respondents to acknowledge their power over the disease and take the monopoly on healing away from biomedicine by developing a critical view of illness and its causes. The sick person thus took over the management of the disease, whereas initially it was the responsibility of biomedicine. There were numerous strategies for undoing the illness, some of which focused on its origins.
People could thus detach themselves from the sources of their misfortune, which they felt they could now control to some extent. They could now turn to a different lifestyle by initiating a new spirituality or by strengthening a spirituality present before the diagnosis. In addition to taking shape through the meaning given to the problem, spirituality and religion became useful in the sick person’s eyes as a way of curing their disease.
Now that they had certain powers, the respondents had to set to work in their new quest for a cure by counting on themselves and by drawing from religion and spirituality. Whereas before they had no therapeutic abilities and were essentially passive in the biomedical treatment of the disease, they were now ready to commit to a more active stage of the therapy by making use of spiritual and religious content.
Finding hope in other people’s recovery and supernatural forces
These sick people acquired the right to think that they could get better after consulting books telling of how spirituality could help the healing process and after reading the testimonies of people who had survived cancer and who had had a specific spiritual and religious experience. They proceeded by imitation, following the same path as these survivors. With regard to their reading, they told us the following:
I started reading three weeks after my first chemotherapy treatment . . . the books were about people that were forced into concentration camps and people that were able to escape or survive them. . . . The books were always on the topics of defining the illness, what the recommended foods were that you should be eating. The books were always making examples of people that have survived and overcome the problems that we were currently living through. . . . As far as I’m concerned, it was reading and reflecting that gave me strength and allowed me to get through the hard times. Religion also played a part in this. In this kind of context, you cling to whatever you think might help. In fact, you start negotiating and making deals with the big guy upstairs like you wouldn’t believe. (Participant 2)
I read books. . . . I read the book on Lance Armstrong who went into remission from multiple cancers when he’d already been told that he was destined to die from his condition. His book had a very positive impact on me. I read many books. . . . One of these was entitled “Guérir envers et contre tout.” This book covered the medical journeys of people that had been given a death prognosis and still beat the odds by going into remission. (Participant 8)
I started to practice meditation. I tried out all the visualization techniques the Simonton method suggested. I discovered the book that recommended these techniques when it was given to me by a Christian, whose sister was afflicted with cancer. . . . The book contains this patient’s testimony and doctor Simonton’s recommendations. This patient included letters he wrote to help and inspire people to push through their illness by telling them how he had survived. . . . I consulted other books as well. Of course, the Bible is my number one reference. (Participant 4)
The participants left behind their daily discomforts and despair through these testimonies and books, whether they were religious, spiritual, or medical-spiritual and whether replete or bereft of miraculous cures. They found a way to hope and imagine themselves cured. The testimonies and life stories showed them that their bout with illness might end positively. In short, if others had succeeded and if a path to a cure existed, why could they not benefit from it? They thus decreased their doubt and increased their certainty of succeeding.
It bears repeating that this hope of a cure was nourished by turning to supernatural forces. Having understood through religious traditions that supernatural powers could influence men’s lives, these sick patients considered that a divine cure, brought about through faith, prayer, or other types of communication or relationships with these powers, was possible. They could thus turn to these powers and be cured by first believing and initiating a relationship with them. They nonetheless had to fulfill certain conditions, to develop the appropriate abilities, and to respect, in particular, a certain number of actions to be able to obtain their favours.
Some of the participants thus appealed to God, Jesus, the Virgin Mary, the Holy Spirit, saints, angels, archangels, and deceased kin or friends. They tried to convince them by explicitly proposing them a contract or simply asking them for help, supposing that these spirits would be disposed to helping humans. They used the standard communication channels of the Christian churches to achieve this. They visited holy places and pilgrimage sites, undertook retreats in places conducive to spiritual development, formulated prayers, turned to religious texts, participated in rituals in places where these powers were supposedly present, and were the object of prayers. This is well illustrated in the following statements.
It was clear as day to me. What I needed to ask of Him that is. I wanted to live. I still had reasons to be alive. My community still needed me. I had responsibilities. I still needed to finish raising my children. And so, I made a promise to Him that as long as he’d keep me alive, I’d make sure to take care of Him from then on. And, I made sure to take care of Him for the following 10 years. (Participant 2) Personally, I believe a great deal in the God of impossibilities. . . . That God, I believe in him. I’d say to him, “God, I can’t see a solution to this problem, I have no way out. But, you’re the God of impossibilities. You have the power to create solutions. . . . I was operated on the night of May 2, which just so happened to be the night of the full moon. The eve of my operation, I called upon the spirits of light from heaven and earth to inspire and guide the hands of the one who would be operating on me. My surgeon. So that she would remove anything that could be harmful. . . . And I asked the Great Healer, concealed within the spirit world, to come and chase away any spiritual obstacle that was holding me back from becoming my true spiritual self. (Participant 7) There’s another morning ritual I observe every day. It’s what people think of as calling upon His holy light. I find it’s quite a demanding concentration exercise. With regards to this practice, I would also include thoughts concerning my health and my physical well-being. I would practice this ritual every morning. . . . I had learned this holy light invocation exercise from an Indian yogi master. Also, every night, before falling asleep, I would put some time aside for prayer and meditative purposes. (Participant 6)
Developing proactive abilities
These sick people also accessed know-how by consulting the above-mentioned literature and by using complementary, medical-spiritual approaches. They discovered diverse techniques and learned how to handle themselves in the therapeutic field.
They now began to focus on their body which, after being invaded and colonized, now had to become a territory that was hostile to all pathogenic agents. It had to be armed with solid defences and protected against all types of aggression. The abilities that were developed came from complementary techniques and alternative therapies, such as Reiki, Qigong, different meditative practices, the ECHO method, yoga, and psychospiritual therapies.
Furthermore, the respondents developed abilities in the fight against cancer cells. Like their oncologist, they tried to destroy the agent responsible for their illness by using “military strategies,” in particular by using visualization techniques sometimes combined with meditation. They especially drew inspiration from lessons in very popular books by Simonton et al 44 and Simonton and Henson. 45 They called on psychic powers to act directly on the cells, using mental images and scenarios that were intended to provoke biophysiological changes. The 3 extracts below indicate how they proceeded.
I would turn to myself. Eyes closed, I would look deep within myself and witness my cells as millions of tiny beings, just like humans. I would speak to them and say, “Ok! I’m the queen, I get to make the decisions, and I’m telling you we’re going to be undergoing chemotherapy. It’s a harsh chemical treatment and I know some of you will die from it. But, I have to do this, because, as you all know, a select few of you are cancer inducing. . . . So, I ask of all of you to embrace this treatment and rise above it as best you can so as to minimize the side effects; nausea, diarrhoea, and all of those.” On the days I wouldn’t feel well, I would speak to my cells. . . . This whole process stems from the concept that I picture my body as the earth. Consequently, I see each one of my cells as an exact replica of a human being. (Participant 3) I would create a visual representation of my prostate cancer in my mind. It’s a technique from the Simonton method. . . . You need to really focus on visualizing and identifying the locations of the cancerous cells. Then, you needed to picture them getting destroyed, or at least getting changed into normal cells, until no cancerous cell would remain. And, after you needed to project yourself into the future and witness yourself living cancer free. . . . I would strike at them with rays of light. White light. . . . I’d do this about 2 to 3 times a week. (Participant 6) There were all kinds of workshops, visualization workshops, group support meetings. . . . And then, I subscribed to everything I thought would help. . . . For example, in one workshop, you’d close your eyes and see wonderful things, beautiful sceneries. You were instructed to project yourself into the future, and then, to picture yourself fully healed, doing something you love. They would also tell us that it was very important to visualize our sick cells and throw them away. . . . I used these techniques a lot . . . even more so when I was undergoing my rounds of chemotherapy. (Participant 8)
These techniques were used by the sick people to act on the material body, on its organs and symptoms, and on functions and physiological substances. They tried to master and tame their body and thoughts by improving their ability to use these techniques and thereby get rid of the biological disease.
Interpretation
The early stages of cancer, which were marked by diagnosis, prognosis, a popular representation of cancer, surgery, chemotherapy, and radiotherapy, were very emotional. The respondents contemplated the losses caused by their disease. In keeping with Schütz’s work, 46 we would say the disease was a shock that forced them to withdraw from everyday life and that pushed them into a zone of specific meanings. In this zone, they concentrated the small amount of energy they had on themselves, on survival-related concerns, and on the possibility of their nonexistence. They were attentive to a body that had never before expressed itself so vividly, doing so through symptoms, signs, and unforeseeable events that flooded their consciousness.
What was once taken for granted had now been put on hold. The meaning that drove the cancer patients’ actions when they were in good health no longer held true. Other meanings had to emerge to sustain their new presence in the living world. Because these people could no longer envisage their present or future self-actualization, they were more susceptible to passiveness, depression, dark ideas, despair, and feelings of powerlessness. In keeping with Tillich, 47 we would say that the conflict between the will to live and the burden of no longer living, between the wish for greatness and the realization of one’s smallness and weakness, between the quest for perfection and the realization of one’s imperfection (caused by the illness) provoked severe anxiety in the cancer patients—a feeling of despair and powerlessness that was difficult to overcome.
This is what people in this study went through before they cast off their despair and powerlessness. In their worst moments, when they had withdrawn from a daily life devoid of meaning, the management of their illness was delegated to the biomedical practitioners who had discovered the disease and who had the social legitimacy to tackle it. However, after critically considering the origin of the illness, the cancer patients took more responsibility, tempering biomedicine’s exclusive management. They initiated a different resolution process in which the patient became therapist. Their active participation in the management of their misfortune led them to become genuine orchestra conductors.
A subjective, spiritual, religious experience thus became a viable alternative in this management, just as its absence was linked to the origin of the illness. Most of the respondents did not diverge from the modern tendency to make the most of current religious and spiritual content and to combine or juxtapose them in an individual approach so as to develop and benefit from personal powers that would transform their situation.
48
This was exactly as it was mentioned by the French sociologist Hervieu-Léger in 2001:
While participation in organized religion in Europe has dropped dramatically, there has been little decline in interest in spirituality or religion, just a shift from communal participation to a system where individuals choose their own constructed belief systems and participate in communal activities only as they advance their personal agendas.
7
On this path where magical-religious practices and spiritual experiences are respected, the sick people tried to develop their psychic powers; to uncover hidden potential; to cultivate self-mastery; to fulfill themselves; to find their ideal, powerful self; to love themselves; and to make themselves the center of their attention and devotion (see Wunenburger 49 ).
The diverse religious and spiritual content thus appeared to be useful means for involving people and their subjectivity in a quest for self-healing. They first of all guaranteed that the people with cancer had intrapersonal or extrapersonal healing powers and that there was space for multiple and available powers other than biomedical ones. In their search for these powers, the people integrated this content into a toolbox of sorts. These tools allowed them to envisage a plurality of possibilities, and they thus began to believe that they might see a healthy tomorrow, despite the fact that the diagnosis and treatment effects had cast doubt on this perspective. Their efforts allowed them to rediscover a feeling of their own permanence, to extend their time horizon beyond the present moment, and to take concrete actions toward this end.
Conclusion
Within our study, all participants did not make use of religious and spiritual content following identical patterns and motives. Indeed, participants’ quests for religious and spiritual beliefs and practices took place through various alternative paths and emerged at different moments of their illness episode, depending on personal factors. Using religious and spiritual content, the people with cancer in our study ameliorated their critical consciousness (thoughts and reflections about themselves, about the world they live in, and about the origins of their illness and meanings of their life), self-mastery, and hope. They developed abilities to act on the body and their biological disease and to control and master forces, energies, and various powers. This is expressed very clearly in the following statements.
If you get diagnosed with cancer, there’s only one treatment plan available to you. You then agree to that treatment and you live through the experience in a rather passive manner. Once you start having side effects, you’ll be given a bunch of pills to try and counteract them. But, you have to realize, that’s not all that can be done. There are things you can do to contribute and participate with your treatment. (Participant 4) I’ve always been a spiritual person, but that part of me was always pushed to the side. It was as if, I’d pushed it all the way into a waiting room with no way out. And now its number has come up and it’s all coming back. . . . By adding a kind of spiritual component to your life, you open your eyes to a whole new perspective. In my opinion, a person’s spirituality can really help in overcoming the hard times in life. (Participant 9) I don’t give a crap how cancer works. . . . I just want to be done with it. I want to be reading about how to live the most comfortably and peacefully possible, given my situation. So, in my case, my reading was all about getting techniques that would work for me. And, they turned out to be mostly based on spirituality. (Participant 1) I’m a fighter. That’s who I am and where I pulled my strength from. I also turned to religion for strength. My nights were for reading and reflecting, but my days were spent in church. . . . I started praying again. . . . I started going to mass to make up for all the times I hadn’t gone and for the times when I had gone, but was only going through the motions and not really meaning any of it. I met with priests. I would go into seclusion and isolate myself from the world. I would even take a vow of silence for weekends at a time. (Participant 2)
These research results thus show the quite considerable relationship that exists between religious and spiritual practices and knowledge and individual empowerment. The participants’ statements echo several of the components of individual empowerment noted in the literature. In particular, they refer to (1) the development of a critical analysis about the origins and meaning of the disease, which initially modifies the interpretation that sick people have of themselves and their disease 28 and allows them to make coherent sense of their experience24,32; (2) the person’s active participation in the decisions concerning the management of their disease and its treatment 50 ; (3) the development of healing-related abilities and skills24,50,51,52; and (4) personal effectiveness.52,53
It is worth noting, nonetheless, that our research was exploratory and that it did not initially presuppose this relation indicated by the data analysis. Furthermore, our research method is based on illness narratives from a single interview, during which the participants had to refer to their illness, relating to past events of their life (sometimes dating a few years back). Through this act of recollection, the respondents might have privileged positive aspects of their religious or spiritual experience. Necessarily, this way of doing might have set aside negative aspects of religious coping. We must therefore consider limitations regarding the selected method and attempt to bypass them by carrying out more interviews for each person, thus following them during their illness episode, and among a larger number of patients with cancer and other serious, chronic illnesses. We should also be attentive to potential negative aspects of religious coping that may disempower—above all, when beliefs lead people to feelings of abandonment and helplessness and make them accept their illness without battle. Further testing of our analysis must be based on an explicit study of the ties that exist between certain types of spiritual and religious content and an individual empowerment that cannot be reduced to a sole component, such as hope or a feeling of control. Doing so would allow us to better define empowerment that is supported by religious and spiritual phenomena, to distinguish the types of practices and knowledge that can influence it, and eventually to better evaluate the strength of the relation between empowerment and religion or spirituality.
In the meantime, we invite caregivers to take into account a spiritual and religious experience that arises before the end of life and which manifests itself as a practical solution to disease. Caregivers can support this use of religion and spirituality that in itself constitutes a quest for self-mastery—an acquiring of power and control.
Footnotes
Declaration of Conflicting Interests
The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
Funding
The authors disclosed receipt of the financial support for the research, authorship, and/or publication of this article: Funding has been provided to the first author by the Canadian Institutes of Health Research (CIHR).