An Exploration of Health and Religion in Elderly People Through the Lens of Scriptural Reminiscence

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An Exploration of Health and Religion

in Elderly People Through the Lens ofScriptural ReminiscenceElizabeth MacKinlay

a& Colin Dundon

a

a

Charles Sturt University , Canberra , AustraliaPublished online: 10 Jan 2012.

To cite this article:Elizabeth MacKinlay & Colin Dundon (2012) An Exploration of Health and Religion

in Elderly People Through the Lens of Scriptural Reminiscence, Journal of Religion, Spirituality &

Aging, 24:1-2, 42-54, DOI: 10.1080/15528030.2012.632714

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Journal of Religion, Spirituality & Aging, 24:4254, 2012Copyright Taylor & Francis Group, LLCISSN: 1552-8030 print/1552-8049 onlineDOI: 10.1080/15528030.2012.632714

An Exploration of Health and Religionin Elderly People Through the Lens

of Scriptural Reminiscence

ELIZABETH MACKINLAY and COLIN DUNDONCharles Sturt University, Canberra, Australia

An extensive body of quantitative research associates well-being inlater life with religious involvement. This article reports on a pilot

study of one specific aspect of religious involvement hitherto insuf-ficiently investigated, namely, Scriptural Reminiscence (SR). SR isthe interpreting of biography in the light of Scripture in recognitionof Scriptures unique place in the self-as-narrative of older peopleof faith. The study was of two small groups of older people meet-ing weekly over a six-week period with a follow-up focus group toexplore SR, their faith journey, practice of religion, and mentalhealth. The qualitative findings are reported in this article.

KEYWORDS Ageing, religion, Scriptural Reminiscence, mentalhealth

INTRODUCTION

An extensive body of quantitative research associates well-being in later lifewith religious involvement. Yet, little is known of the reasons for these find-ings, particularly because religious involvement is too broad a category for

ready analysis. We aimed to study one specific aspect of religious involve-ment hitherto insufficiently investigated, namely, Scriptural Reminiscence(SR) (Anstey, 2008). SR is the interpreting of biography in the light ofScripture in recognition of Scriptures unique place in the self-as-narrativeof older people of faith. This article reports on a pilot study of SR, consistingof two small groups of older people meeting weekly over a six-week period

Address correspondence to Elizabeth MacKinlay, Centre for Ageing and Pastoral Studies,15 Blackall Street, Barton, ACT 2600, Australia. E-mail: [email protected]

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Scriptural Reminiscence 43

with a follow-up focus group to explore SR and their faith journey, practiceof religion and mental health. Pre- and posttests revealed significant decreaseon the Geriatric Depression Scale (GDS) scores, slight decrease in religiouspractices, and self-reported agitation (anxiety) and negative religious cop-

ing decreased, whereas a positive attitude to ageing and positive religiouscoping increased. It is important to note that this was a pilot study withsmall numbers thus statistical analysis cannot be relied upon. The qualitativefindings are reported in this article.

To what extent do older Christians engage with Scripture? Is there a linkbetween engaging with Scripture and health? Often it is assumed that adultChristians have a good grasp of Scripture and can readily apply Scriptureas a guide to living. A comment from a participant in the focus group heldafter completion of this pilot study was typical of the participants in the twogroups: Speaking personally, I mean Im not used to engaging in Scripture

at all, and therefore it was a learning experience for me to even find out thatthere are three ways that you can do it. And I certainly found the methodthat we used helpful.

LITERATURE

The Relationship Between Scripture and Health

The effects of religion on health are still not well understood in spite ofthe abundant literature from epidemiological data and increasing evidencefrom clinical trials that there is a positive relationship between religion andhealth (Koenig, 1998; Koenig, McCullough, & Larson, 2001; Moberg, 2001).

As yet, little is known of the reasons for these findings, particularly becausereligious involvement is too broad a category for ready analysis. Further,caution has been urged in the too-ready inclusion of religious activities as ameans of medical treatment (Sloan et al., 2000; Sloan & Bagiella, 2002).

Knowing whatabout the practice of religion makes a difference to thehealth of older people is much more difficult to discover. While measuresof church attendance have shown correlations of health and religion, it is

still difficult to account for the differences between churchgoers and thosewho do not attend. The actual nature of the relationship between health andthe practice of religion needs to be more fully understood to be of value inclinical settings.

A way of understanding the differences, at least in the Abrahamic faiths,may be through examination of the relationship of individual believers andtheir God. Joel Green (2003) describes the way that Western societies havecome to consider relationship of health, in isolated ways, for instance (myneed, my treatment, my health) and in ways more segregated (spiritual,physical, relational versus genetic) (Green, 2003, p. 6061). Green goes on

to assert that it is:


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44 E. MacKinlay and C. Dundon

precisely here that the witness of scripture holds out its promise andchallenge. Rather than begging to be applied to our lives, seeking for itsmessage to be molded to the contours of our worlds, the scriptures yearnto reshape and reconstitute the categories by which we comprehend ourlives, our worlds, even our greatest needs. Reading scripture, we enterinto its evaluation of our condition, but also encounter its promise ofrestoration, its hope of health. (Green, 2003, p. 61)

This constitutes a re-evaluation of life challenged by scripture, Greencalls this an autobiographical reconstruction (Green, 2003, p. 116), notingthat this generally comes through understanding ones place within thehistory of Gods purpose (2003, p. 116).

Scripture contains the central stories of faith, it is through linking thesestories of faith with the life of the person journeying in their faith that healing

and health can come.Recognition of the central place of story in the lives of human

beings is one of the important developments being seen in the earlyyears of the twenty-first century. Reminiscence, life review, autobiography,narrative gerontology, spiritual reminiscence, and spiritual autobiography,reminiscence therapy, spiritual reminiscence work, whichever term isapplied, there is growing interest in human story (Coleman, 1994; Gibson,1998, 2004; Haight & Webster, 1995; MacKinlay, 2006; Webster & Haight,2002).

In the current busyness of work and social spheres of Western societies,story has been neglected until relatively recently. Without these connectionsof story between generations we are lessened in our humanity and in ourcommunities. Kenyon, Clark, and de Vries (2001) note that a basic assump-tion of narrative gerontology is that storytelling and story listening are notjust things we do occasionally, rather they constitute the process by which

we create and discover our personal identity as human beings (Kenyon,2003, p. 30). He enlarges on this to include the function of story-telling andlistening, to not only ideas, but emotions and behaviour. As well, we areeach a part of the larger stories of our families, our faith, our communi-

ties, our nation and our own story is interwoven with each of these largerstories. Reminiscence is the general term that refers to remembering eventsfrom the past and it is a naturally occurring event (Butler, 1995). Coleman(1999) describes the characteristics of a successful story as being one thatbears on the subject of reconciliation or harmony between the past, present,and future.

Spiritual reminiscence is reminiscence that focuses on life meaning inremembering and in particular, this strategy seeks to consider the personsstory in relation to his or her spiritual life journey, that is, ones life journeyas an individual, with family and community, and with God (MacKinlay,

2006, Moberg, 2001).


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Reminiscence is now used as a therapy by Haight and Webster(Webster & Haight, 2002). Faith Gibson (1998, 2004) has used the termreminiscence work in her study and research. This view of reminiscence is a

valuable one as it places reminiscence as a process for engagement by older

adults. In our work (MacKinlay, Trevitt, & Coady 200220051

) with peoplewho have dementia, we have chosen to use the term reminiscence work asit seems to more accurately reflect the interaction with the participants in thestudy; the participants do workwith their memories. In fact we have furtherrefined the term in our work to focus on spiritual reminiscence work; inthat perspective, we are examining issues of meaning in later life, includingrelationship with others and/or God.

Coleman describes four characteristics of story: the need for coherence,assimilation of life events into the story, a convincing structure, and a truth

value that is, story has an ethical dimension (Coleman, 1999). These four

characteristics fit well into a spiritual understanding of being human andageing. First, to say that we arestory, is to acknowledge that story connectsus to our deepest points of being, to our souls. Story is deeply tied to ourindividual identity, to the core of our being. Second, stories being composedof both facts and possibilities leaves open the possibility of spiritual journeythrough the life span. Conversion, change, and renewal of being may occur;the future is open and remains so as long as we live.

Third, the meaning and nature of time can also be considered at aspiritual level. At the spiritual level it is suggested that story time becomesmore relevant than clock time; again, there is an air of openness to the

future and the possibility of connection to our past. Fourth, the interrelateddimensions of both the personal and the larger story link very well to thespiritual dimension. We are individuals, but we are part of a larger whole,and we yearn for connections with others, with the stories of others and

with God, or a sense of otherness, however perceived by the person.Thus reminiscence, or narrative gerontology, is a central component

of being human, and part of the spiritual journey in life. Increasingly thisis being recognised in our ageing society and in residential aged care.

A biomedical model for ageing simply does not paint the whole picture;

story lies at the centre of what it means to be human and growing older.Butler notes that in later life people tend to have a particularly vividimagination and memory for the past and can recall with sudden andremarkable clarity early life events (Butler, 1995, p. xvii). He writes that thepersonal myths of invulnerability and immortality are no longer satisfyingand this results in reassessment of past life that may result in depression,acceptance, or satisfaction. Butler contends that this process occurs in allolder people in their final years, while Coleman (1986) found in his researchthat some older people did not appear to engage in reminiscence. Theremay be various reasons for this; perhaps they have already processed their

life story, perhaps very privately or perhaps they feel unable to deal with


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some aspects of their story and a blockage to reminiscence may be experi-enced. However, Butlers assumption of the universal nature of reminiscenceseems now to be well accepted.

Possibilities for Health and Well-being Through StoryApplication of Erikson, Erikson, and Kivnicks (1986) stages of psychosocialdevelopment, lead to an inclusion of all life experiences, and the strugglethat occurs in the final stage of life development between integrity anddespair may enable the person to review and reframe earlier life experiences.In fact, the remembering and reprocessing of earlier negative memories mayenable the person to move towards ego-integrity in later life.

To deny the existence of disturbing or negative memories may movethe person towards a blockage of psychosocial and spiritual growth in

later life (MacKinlay, 2006). Taking this perspective, Coleman found thatnormally reminiscence is rewarding for both the speaker and the listener;however, this is obviously not so with painful memories (Coleman, 1999).Coleman notes that the healing and reconciling activity of life review hasbeen neglected, despite Butlers early work in the 1960s. In a study of olderpeople and their war memories (WWII) Coleman noted that where disturb-ing memories remained unintegrated it was necessary to make the originalexperience explicit by categorizing and understanding it, for it to lose itspower to haunt us (Coleman, 1999, p. 136). The techniques needed to dothis may be found in reframing. Birren has developed a process of guided

autobiography over the past 25 years that is valuable in this process (Birren &Cochran, 2001).

Scriptural Reminiscence

Reminiscence is already established as a valuable means of assisting olderpeople to find meaning in their later years; our work with spiritualreminiscence has taken this further (MacKinlay, 2006; MacKinlay & Trevitt,2006). We propose to take this already established work to develop a pro-cess of scriptural reminiscence that will harness the naturally occurring

reminiscence with the story of Scripture. Thus we intend to intentionallylink the peoples story with Gods story to assist older people to come to asense of the purpose and meaning of their lives.

Faith Stages Among Older People

It is assumed that the older people in the study may be at different stagesof their faith development, based on the work of Fowler and subsequentstudy of stages of faith development (Fowler, 1986; Fowler, Nipkow, &Schweitzer, 1992). Thus participants in a study may respond to engage-

ment with scripture at different levels. Some guidance for these stages may


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be given. Fowler has asserted that meaning, relationships, and a sense ofothernessthe supraordinate valuesare at the centre of his frameworkof faith. This framework assumes the possibility of progression through anumber of stages of faith development. It is assumed that not all people will

progress through all stages, and, according to Fowler older people are morelikely to be at stages 3 to 5 of his 7-stage model (0-VI) (Fowler, 1986). 2 Thesestages are:Stage III: Synthetic-conventional faith, a faith stance of late child-hood that may remain through life, where the judgments and expectationsof others are important and it is accepted without question and is con-formist. Next,Stage IV, Individuative-reflective faith, which sees a relocationof authority in the self, with a critical distancing from previously held valuesystems, may be a final stage for some. Stage V: Paradoxical-consolidative orconjunctive faith is described as balanced faith, inclusive faith, a both/andfaith (Astley & Francis, 1992, p. viii) and may be found among older adults.

Finally,Stage VI, the so-called Universalizing faith, is described as a selflessfaith and involves relinquishing and transcending of the self. It is seen byFowler (1981) as being rare.

It is noted, however, that this stage of spiritual development is seenin numbers of frail elderly people and has been reported by numbers ofauthors. Fowler did not interview people in the fourth age of life and thismay account for his view that this final stage of faith or spiritual developmentis rare. A more recent article by Fowler (1986) responds to critique from apostmodern perspective and in it he argues the place of stages and types offaith, suggesting that stages may be relevant for perhaps half of the pictureseen in faith development. How relevant is it to consider faith stages in thisstudy? In later life, it is argued that spiritual development is a dynamic pro-cess with individuals being able to respond to the deep stirrings of spirit; tolife-meaning and choice-making in their spiritual lives. Further, there may beblockages to continued spiritual development that may include such thingsas a sense of meaninglessness or hopelessness in life, resentment, anger,unforgiveness, or unresolved grief. Conversely, these factors may also serveas triggers for spiritual growth (MacKinlay, 2006). It is asked how much ofthis understanding of faith development might be relevant for older people

intentionally linking study of scripture with their faith journey? How mightthis affect their mental health?

Research Questions

The questions for the pilot study were:

What is the relationship between mental health, religious practices, andbeliefs of the study group of elderly people?

Does scriptural reminiscence increase a small groups capacity to fostertrust and connectedness between members?

Refine the method of scriptural reminiscence for a larger study.


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MATERIALS AND METHODOLOGY

Recruitment of Participants

All members of two separate Christian congregations of 65 years and over

were invited to participate, making it clear that this was a pilot study, andonly one group from each congregation could be formed. The study wasadvertised during the notice time of the weekly church services, and infor-mation sheets and consent forms were distributed to interested people. Thefull study, of which this study was a part, had been approved by the EthicsCommittee of Charles Sturt University.

Characteristics of the Group Members

All over 65 (one about to turn 65) and all practising members of a Christiancommunity of faith, they were able to speak English, and were cognitivelycompetent. All participants were living independently in the community.

The Study

A mixed-methods study was used to provide an evaluation of the men-tal health and religious and spiritual well-being of participants. The itemsused were Geriatric Depression Scale (GDS), short form; Philadelphia MoraleScale (PMS), Religious scales: Fetzer Daily Spiritual Exercises, Fetzer PrivateReligious Practice Scale, Fetzer Religious Coping Scale and Fetzer ReligiousSupport Scale. Analysis was by Statistical Package for the Social Sciences(SPSS).

The GDS and PMS were both used to provide a broad perspective onparticipant affect, both depression and positive morale. The religious scales

were used to examine the religious practices used by the participants; theseasked questions that provided richer data than typical questions used instudy of religion, that have traditionally only asked frequency of church

attendance and frequency of prayer. It was recognised that these measuresused over such a short time frame of the pilot study could not be reliedupon for as justification of results. The religious measures were all designedin the United States and have not been previously used in Australia. It wasimportant to test these in the pilot groups before attempting to use them ina wider study.

Qualitative measures of the weekly meetings over the six sessionswere taken by audiorecording and transcribing all sessions, and a researchassistant keeping a journal of nonverbal interactions of participants.Qualitative data were analysed using NVivo8. Each of the two groups was

facilitated by an experienced, but different facilitator.


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STRUCTURE OF THE SESSIONS

Group Themes

The themes for the Scriptural Reminiscence were all stories from the New

Testament, with a focus on Advent, as the groups were conducted inthe Advent season of the Christian liturgical year. The six sessions weretitled Becoming Who We Are, Accepting Healing, Facing Our Fears, BeingResponse-Able, Finding Sight, and Taking Our Time.3

Length of Groups

Two groups met for approximately one hour each week for six weeks (onegroup had a preliminary information and orientation meeting, while the sec-

ond group only met six times, with the orientation incorporated into the firstsession). Both groups participated in their own focus group meeting afterthe conclusion of the sessions. The reason for group two having the orien-tation in the first session was to allow the whole exercise to be completedprior to Christmas, after which it was anticipated that numbers of the groupmembers would be unavailable.

The short duration of only six weeks of the two group sessions meantthat it could not be expected that any of the quantitative measures wouldchange over the duration of the study; however, it was decided that the shortgroup sessions would provide valuable information on the nature and faith

experience of the group members and the way that they were able to usethe process of Scriptural Reminiscence to address life issues.

RESULTS

Quantitative

PAR TI CI PANTS

A total of 13 participants contributed responses to the questionnaires of thePilot Study, of which 4 were male and 9 were female. Average age of theparticipants was 75.15 years, with a range of 65 to 91 (SD =7.57).

Analysis of the pilot study data showed significant decrease on theGeriatric Depression Scale from the pretest to the posttest session. This resultis remarkable as only 6 of the 13 participants could be included in thisanalysis (due to participants being removed from the analysis if they hadmissing responses anywhere in the GDS on either the pretest session or theposttest session). Therefore, from pretest to posttest, a significant decreasein depression scores was observed, on average, for the 6 participants with a

complete set of responses on the GDS. It is noted however, that none of the


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scores of the participants were indicative of having depression, only that thescores changed significantly over the six-week period.

A significant difference was also observed on the Private ReligiousPractices Questionnaire (PRP) of the Multidimensional Measurement of

Religiousness/Spirituality for Use in Health Research scales. This scalewas reversed for interpretation such that a high score indicates frequentengagement in religious practices (PRP). On this scale a small but sig-nificant decrease in religious practice was observed between pretest andposttest.

All scales have been scored, except the Daily Spiritual Experiences(DSE) questionnaire. The failure to score the DSE is due to the fact thatitem responses vary from 1 to 4 on some items, and 1 to 6 on others,and so neither adding item responses nor averaging item responses (as wasundertaken with other scales) would be appropriate.

It is noted that these results were found on a study of a very smallnumber of participants. A larger study is needed to obtain useful data. Withonly 13 participants, the current pilot study did not have sufficient statisticalpower to detect even moderate effects in the data. Thus, it is important tonote between pretest and posttest that self-reported agitation (anxiety) andnegative religious coping decreased, whereas a positive attitude to ageingand positive religious coping increased.

Comparison of these figures suggests that the significant improvementbetween pretest and posttest can be attributed to higher ratings of life sat-isfaction and an engagement (or re-engagement) in (unspecified) activities.

Despite the overall decrease in depression levels, and specific gains in someareas, there was a decrease in overall energy levels reported by partic-ipants between pretest and posttest, which cannot be explained from thedata.

Qualitative

Qualitative analysis of the weekly sessions of Scriptural Reminiscence, using

NVivo8 produced themes of identity and faith, relationships, wisdom andmeaning, vulnerability and transcendence, mental health and faith, andidentifying with the text as being important.

The two groups responded differently in the sessions and it is noted thatthe different facilitation methods of the group leaders could be a factor inthese differences. Another factor to be considered is the faith developmentstage of the participants, in line with faith development stages identified byFowler (1986, 1992), so that older people could be expected to be in any ofthe last four stages of faith development from stage four through to the finalseventh stage (Stage VI, in Fowlers stages of 0 to VI), described earlier in

this article.


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Focus Groups

A focus group was held for each of the study groups, after the completionof all six sessions. The focus groups were led by a research assistant. Groupmembers found all themes for the sessions helpful. When asked: Which

ones (themes) were most meaningful for you? The first responses fromthe one group were on accepting healing. With the participant saying that:SB07: Um, my memory has gone. It was, no, it, it was comforting for me.

Another participant said: SB05: The theme, . . . that I remember mostdistinctly, and it was the theme of loneliness and addressing loneliness. AndI dont think its in the, quite in the set, and its actually forgiveness that is theimportant factor, forgiving others and forgiving yourself. The members ofthe one group noted that forgiveness had not been the focus of a session andbelieved that it would be important to include in future work. In responseto the questions by the facilitator of, Why did they think that forgiveness isimportant to include, SB05 replied:

We were having a joke before about cultural awareness, and I think itspart of the Australian character, particularly the male character, not toaddress your emotions . . . kind of run away from your emotions andpretend they dont exist. And whats been helpful in this process hasbeen to have people talking about their experiences. And becomingaware that, you know, you can actively engage in a forgiveness exercise

which will, in fact, relieve some of the emotional pressures that exist

for you.

In response to the question: How do you understand your own biogra-phy, your own self, in relation to Scripture? Has that changed as a resultof these sessions? SB07: It was delicious and pleasing and brought every-thing together on past experiences within Scripture. SB06: I found week4, actually, Being Response-Able, about, um, Anna and so on, Simeon, that,and the whole idea of the wisdom of the age, I found that good. Did thatimpact on my biography? I suppose the thinking about my own wisdom or

whatever. Yeah, that was good.Further reflecting on health, the life story and faith, SB03 responded:

I think those two and health, not necessarily in the state of being inabundant physical health, but in being, I suppose, in the frame of mindand body, health in that sense, even if you might be physically sick. Youknow, I think its not being contradictory to say that you can, there canbe a sense of health, even if youve got a terminal illness. I think, mightsay its quite subjective, but the three of them are integrated, you cantput them into nicely measured doses; its more of a state of being than

anything.


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DISCUSSION

This study should be replicated to examine the factors in mental health andageing, associated with the use of Scriptural Reminiscence. The depression

measures used in this study would not be expected to show any changein such a short study, however they did show significant changes. If thiscan be shown in a larger study, this kind of program may have importantapplication in the alleviation of depression and raising levels of well-beingin older adults.

Other elements of this study lacked the statistical power to providemeaningful results. Yet this leaves some important issues in religious prac-tice and spirituality in older people unresolved, especially the role of SR infostering trust and connectedness, the qualitative materials suggest a fruitfulresearch field. Furthermore, those materials also suggest that it may now be

possible to explore the extent to which Fowlers (1981) Stage VI is foundamong older people and how SR may contribute to that.

This study was conducted with two small groups (total participants =13) all of whom were Christians. The content of the program used ChristianScriptures to engage with the life journey. In a larger study, other ways ofengaging with the story of the ageing person will also be developed andcomparisons made of the use of Christian Scriptures and other major faithgroups with their Scriptures, and for people without a faith, an attempt willbe made to connect with secular values and stories.

CONCLUSION

The small pilot study showed surprising and unexpected results. In thisshort study, two groups of older adults engaged in Scriptural Reminiscencein weekly sessions over six weeks. All participants said that they found thesessions helpful, and despite most of the participants having been membersof Christian congregations for many years, few had any knowledge of themethods used to deepen their knowledge and understanding of Scripture

and engaging with it in living their daily lives. Statistically significant resultsfrom this short study would need to be replicated in a much larger study.If they can be, there are clear implications for mental health of older people

who actively engage with their life stories and Scripture. Story goes to thevery core of what it means to be human; it is closely connected with identityand its formation in a context that creates a structure of meaning and value.

Would this be the case for other older people who do not hold a faith? Cana similar process be used to engage older adults with their life story and aprocess of life meaning that will be effective in alleviating depression andincreasing well-being in older people. At this stage, it is not possible to say.

Further study into both these areas may produce important results for thewell-being of older adults.


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NOTES

1. Finding meaning in the experience of dementia: The place of spiritual reminiscence work. ARCLinkage grant # LP0214980.

2. Fowler (1986) wrote that few older people reached the final stage of his faith development

model, that of Universalising Faith. In my studies I have interviewed numbers of older people whose faithperspective fits into this stage. I would thus disagree with Fowlers writings, that his studies containedperhaps too few older people to draw this assumption.

3. Program designed by Dr. Elizabeth West, LCM.

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Documents

An Exploration of Health and Religion in Elderly People Through the Lens of Scriptural Reminiscence