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SPIRITUALITY AND RELIGION IN WHOLE-PERSON GERONTOLOGY

Professor Emeritus, Social and Cultural Sciences Marquette University Milwaukee, WI 53201

Aging, Spirituality and Pastoral Care: A Multi-National Perspective, edited by Elizabeth MacKinlay, James W. Ellor, and Stephen Pickard. Haworth Press, Binghamton, NY, 2001, 204 pp., $39.95 (cloth), $24.95 (paper).

Aging, Spirituality, and Religion: A Handbook, Volume 2, edited by Melvin A. Kimble, Susan H. McFadden, and editorial coordinator Mee-Ock Park. Augsburg Fortress Press, Minneapolis, MN, 2003, 494 pp., $35.00 (paper).

Keeping the Faith in Late Life, by Susan A. Eisenhandler. Springer Publishing Company, New York, 2003, 208 pp., $36.95 (cloth).

New Directions in the Study of Late Life Religiousness and Spirituality, edited by Susan H. McFadden, Mark Brennan, and Julie Hicks Patrick. Haworth Press, Binghamton, NY, 2003, 256 pp., $39.95 (cloth), $24.95 (paper).

These books can significantly move gerontologists toward improved understanding of people in late life as whole persons. They increase the awareness of huge gaps related to religion and spirituality, but they also suggest ways the gaps can be filled.

A pervading theme in many discussions is technological society's push toward ever-greater specialization and the resulting fragmentation of society. Too often the boundaries circumscribed by one scholarly discipline and its research methodologies or by any clinical, therapeutic, or educational profession have forced us to be very narrow and particularistic. At least in the area of aging and spirituality, these books help to integrate knowledge and wisdom.

The 71 chapters in these books are by 70 different authors and co-authors (several authored more than one). Nine are from Australia, 3 are from Scotland, and 58 are Americans. A variety of Jewish and Christian perspectives are evident with only passing references to other religions, but the professional orientations of the authors include a wide range of psychology, social work, sociology, theology, nursing, medicine, and other disciplines, and many of the authors direct gerontological centers.

Condensed Overviews
The chapters in the volume edited by Elizabeth MacKinlay, James W. Ellor, and Stephen Pickard—Aging, Spirituality and Pastoral Care: A Multi-National Perspective—are mainly by Australians. But the topics and themes fit the American scene well, for people are people the world over and both societies have British antecedents. Section 1 has five essays on the ethical, theological, and biblical dimensions of "ageing." (British spelling is used everywhere except in the book's title.) The volume first shows how the commodification of technological society gives priority to efficiency, productivity, and competitiveness with "an ethic of achievement that starkly contradicts the Christian theology and ethic of being" (p. 12). This accentuates the fear of death and gives rise to "aging as pathology, the incurable disease of living" (p. 13), in contrast to the fact that growth and development occur throughout the entire life journey, with each person moving through one system of dependency after another. The solution for questions of justice in the distribution of resources and other issues related to aging and the quality of life relates to values about solidarity versus individualism, humans as both embodied and historical persons, and virtues of courage and humility. This means that the spiritual, not only the physical and social, dimension of each individual needs to be acknowledged and valued. Restoration of a biblical perspective on aging with each person as an image of God brings inward renewal to the outwardly cracked and decaying person. This has profound implications for the meaning and wholeness of the aging self, with both caring and being cared for understood as God-like.

Section 2 has seven chapters on "Issues of Ageing and Pastoral Care." It begins with a discussion of the lack of meaning in life as a main source of social and spiritual isolation among older adults and concludes that relationships with God and with others are important to self-transcendence. Other contributions deal with late-life sexuality; research on a developmental perspective of psychosocial and spiritual dimensions of the aging process; the parallel worlds of people with dementia, their caregivers, and the community of faith; ritual as an extremely important gift for people with dementia; the spiritual dimension of caring (including a model for applying spiritual tasks of aging); and the challenges of parish nursing in an aging society. Pickard's stimulating homily on time and radical discipleship for an aging society concludes the book. Although this volume is clearly the most applied of the four reviewed in this essay, it bristles with stimulating perspectives and brilliant insights that have the potential of improving geriatric care, motivating innovative research, and bringing back to gerontology the perspective that the older person is a human being rather than simply an object of study and care.

Aging, Spirituality, and Religion: A Handbook, Volume II, edited by Melvin A. Kimble and Susan H. McFadden, is the most encyclopedic of these works. (An earlier volume for which Kimble was the senior editor has been renamed as "Volume I"; Kimble, McFadden, Ellor, & Seeber, 1995.) All 33 chapters plus the introduction are new. Part One on "Late-Life Spiritual Potentials" has seven chapters about the spiritual potentials of aging as pilgrimage; spiritual counseling of persons with dementia; the process of becoming a spiritual elder; emotions in religious contexts; the impact of gender upon late-life spiritual potentials; presence of the Divine in Alzheimer's disease; and a framework for ministry in the final third of life. Among the many perceptive insights woven into this part of the volume is that aging is a two-sided experience of both gain and loss that permeates the entire spiritual pilgrimage from its beginning at conception (not just during aging).

Part Two has seven chapters about "Aging in Faith Communities." Its topics are congregational care in the lives of Black older adults; the meaning and effects of congregational religious participation; ritual as an anchor amidst anomie during aging; cooperative alliances between congregations and community agencies; small group approaches to the writing of spiritual autobiographies; volunteer ministries with older adults; and caring for caregivers.

The third part has seven chapters on "Pastoral Care With Older People." Care categories include religious coping with late-life crises; family involvement in pastoral care of elders; care of aged persons afflicted by addiction; issues of grace and sin; depression in long-term care residents; narratives of suffering; and the role of spiritual assessment in counseling. It is followed by six chapters in Part 4 on "Theological Perspectives and Ethical Issues," one of which is an approach to end-of-life decision making based on sacred Jewish texts. The six chapters on "Anticipating the Future: Religion, Spirituality, and an Aging Society" in Part 5 deal with responsibilities, especially to one's family members, to plan appropriately for the remainder of one's life; mysticism in religious gerontology; a pastor's pondering on the uniqueness of the baby boom generation; the "conscious aging" of elders as spiritual seekers; religious humanism and spirituality in gerontology; and a brief essay about "final time" as death approaches.

The Handbook is oriented far more toward the potentialities than the problems of late life. Its main focus is upon praxis more than research and theory, especially emphasizing the need for realistic narrative accounts of the totality of the aging process of "whole persons," in contrast to the reductionistic approaches that dominate empirical research on relatively minute details. By examining countless aspects of religion and spirituality in late life, the Handbook enhances the exploration of relationships between the humanities and the sciences and their relevance to well-being. The need for further research is repeatedly evoked, although usually with a muted voice. For example, how does worship function as a gateway to opportunities and affirmations of life (pp. 129–130)? What are the features of effective and ineffective alliances between faith-based agencies and their communities (p. 154)? Can social and behavioral research apply a phenomenological perspective to the study of religious experiences of grace and sin (p. 242)? Which spiritual strategies help to alleviate guilt feelings, and which augment them (p. 263)? How do interpretations of suffering vary by time and cultural setting (p. 282)? How and why does "the mythology of the scientific management of aging" contribute to the cultural disenfranchisement imposed on older people in general (pp. 303–308)? To use Jeff Levin's words:

We ought to begin exploring the history and phenomenology of the esoteric or inner paths of exoteric traditions...for fresh insights about what will be relevant to tomorrow's elders.... There is a lot to be learned from these esoteric paths that can nourish our research agenda and often feeble theoretical and conceptual models. (p. 405)

Keeping the Faith in Late Life, by sociologist Susan A. Eisenhandler, focuses upon religious behavior and its role in daily life through in-depth interviews with 46 adults (ages 60 to 93; 21 Roman Catholics, 18 Protestants, and 7 Jews) who resided in Connecticut. The open-ended, one-on-one discussions were about religious and spiritual experiences over the course of their lives, emphasizing the "folkways of faith, customary ways of ‘doing’ religion...[that] are the usual...taken-for-granted practices surrounding what is sacred or religious" (p. 43) and the "cornerstones of social identity in late life" (p. 64). The repetitive reinforcement of religious participation during childhood socialization was the foundation for commitment in late life for most interviewees. Their primary religious folkway is praying, which is so important that an entire chapter is devoted to its nature and nuances. Yet only two or three interviewees were aware that others had prayed or were continuing to pray for them.

To them, faith meant primarily a sense of belonging that survived high levels of social mobility. Most could not distinguish religion from spirituality. Four had moved ahead or apart from the folkways of their religion. Only one spoke in terms of faith's becoming stronger, and few expressed concerns about reflective dimensions of their faith that involve "stretching the soul,...moving beyond the usual and accepted patterns of faith" (p. 147). Although the rooms of the 15 interviewees who were residents in long-term care facilities were so full of space-greedy equipment to support life that "life itself was being crowded out by that very apparatus" (p. 132), many displayed meaningful representations and reminders of their faith. The qualitative methodology described in Appendix A of this book reveals a richness and depth of religion and spirituality that usually is absent from quantitative investigations.

New Directions in the Study of Late Life Religiousness and Spirituality, edited by Susan H. McFadden, Mark Brennan, and Julie Hicks Patrick, similarly explores many questions related to 21st-century studies of the how, what, and why of religiousness and spirituality in the lives of older adults. In addition to introductory and concluding chapters, four essays probe "epistemological stirrings" in such studies, four deal with definitional dilemmas, and four discuss "the fruits of the religious life." Nearly all directly confront significant issues related to gerontological research methodologies with perceptive critiques and stimulating suggestions. These include approaches to the qualitative reframing of life stories through the symbols and meaning systems of women's faith in God; cutting-edge statistical techniques of latent growth curve analysis and individual growth curve models of longitudinal change at the level of the person; intensive analysis of researchers' assumptions about religion and spirituality (they often are too simplistic and view spirituality in only secularized terms); definitional confusion that leads to superficial and distorted findings (e.g., the internalized meanings behind subjects' responses to questions about religion may differ radically from those a researcher intends); and confounding correlation with causation (as when increased use of prayer during personal crises leads to the claim that religiosity contributes to poor mental health).

Keeping the Whole Person in Focus
Significant innovative themes abound in these books. One set of them pertains to the biomedical models of health that dominate both care and research to measure or evaluate life satisfaction, quality of life, and well-being. Although generally responsible and helpful, these can dehumanize people by treating them as objects for study or services instead of as persons who deserve dignity and respect, so warnings and reminders about the limitations of biomedical models appear in many passages within these volumes. The authors recognize that the negative impact of biological aging is overwhelming for many persons, but also that people can transcend it with spiritual approaches to meaning-making, affirming personhood, enriching insights, increasing wisdom, and continuing growth toward spiritual maturity throughout the later years of life. People's perceptions of their personal essence are reflected in their worldviews, which are closely linked with their own spirituality and religion.

Gerontology tends to become a victim of developments analogous to those of the biomedical model. What is good for the heart may be bad for the liver, what's good for the liver may harm the skin, and so forth ad infinitum. Grateful as aging people are for the highly differentiated medical specialties, they still realize that treating the heart, joints, or colon can occur without recognizing needs of the person as a whole. How can we unambiguously and fully keep the whole person, for whom meaning, religiousness, and spirituality are central, in the forefront of gerontological studies and geriatric services?

How many older people have experienced detrimental side effects from medical therapies is not fully known, but their casual conversations often share accounts of negative interactions of pharmaceuticals prescribed by different specialists and other iatrogenic consequences of medical interventions. In the realm of non-medical "care of the aged" there are similar unintended consequences. Because each person is unique, what is beneficial for many may harm some. Discovering the who, what, when, where, why, and other circumstances associated with diverse outcomes of interventions is a challenge of which we are gradually becoming more aware.

The maturing of gerontology necessitates increased attention to people's wholeness, a wholeness that can never be fully addressed in the work of any one scholar, practitioner, or sub-specialty alone. Community is needed for the well-being of gerontology as much as for the well-being of persons—community that includes multi-dimensional triangulation and cross-fertilization in all of its applied, theoretical, and research components. These books move us closer to methodologies and insights that can link one's own work with that of other specialties. But unfortunately, the desire for recognition and need to satisfy formal requirements for promotions and upgrades within each professional domain often discourages cooperative programs and holistic approaches that promise greater benefits to aging people.

Scientific Gerontology
Sometimes an emphasis on science in gerontology degenerates into scientism, the metaphysical perspective that makes precise but narrow empirical methods into a cosmological idol that allows for no other "gods." New Directions reminds us that

in our efforts to define, operationalize, measure and analyze spirituality and religion, we face the danger of taking something very vital and dynamic in the lives of older people, and draining the very life from it in our efforts to maintain scientific objectivity and precision. (p. 231)

The theological and humanistic disciplines deal with many important issues that are difficult, if not impossible, for positivistic scientists to investigate. When the latter find no objectively measurable dimensions to concepts like the being of humanity that connects with spirituality, the soul, pain and suffering, or the value base for ethics and morality, they easily slip into a scientistic mode of believing that whatever is not measurable is only a reified figment of the imagination.

Sometimes research itself has dysfunctional effects. For example, its findings tend to support the popular observation that people in late life are more religious than younger generations. But these findings can be detrimental to older adults as a whole. When they are stereotypically perceived as "nearer to God" than others, religious institutions and their leaders may develop "a benign neglect with respect to educating the old more carefully...into the more reflective aspects of faith" (Eisenhandler, p. 65).

Balancing Universalism and Uniqueness
In the interest of reaching "everyone" through research methods and concepts that relate to religion and spirituality, the unique aspects of specific religious beliefs and behavior systems are often washed away. When dealing with topics like the coping, comfort, and companionship provided by religion, however, the effects of specific beliefs, whether on health and well-being, social action, personality, or any other domain, may reflect a dynamic process that cannot be captured by ordinary scientific research. Although "it is faith that is the common denominator across religions" (Eisenhandler, p. 105), certainly it must matter in whom or what faith is placed, topics about which the major world religions radically differ. What are faith's objects, explanations, supports, expressions, and interiorized nature in believers? The functional and dysfunctional effects of religious faiths and spiritualities probably vary widely also from one ideological school of specific beliefs and identities to another within each of the major world religions. When all their adherents are lumped together by the use of "universal" measurement tools, they tend to cancel out each other's positive and negative effects (see Moberg, 2002.)

Paradoxes of Aging
More, perhaps, than any other life stage, late life presents contrasting and paradoxical experiences. A few that are mentioned in these books are aging as simultaneously a source of spiritual growth and physical decline, of honor and vulnerability, of wisdom accompanied by ignorance of recent technological knowledge. Old age is a reward but it also brings disability. In Christian theology, death is an end but also a beginning. It is universal, but each death is unique. It is a biological but also a spiritual experience. Doubt is a prerequisite for faith. Growth occurs as the shadow side of loss. Letting go brings a sense of genuine attainment. Self-accentuation occurs in community. Bereavement after caretaking brings sorrow and relief. In Scotland the culture of health and social care has become more insistent upon working only with "evidence-based practice" at the very time the people are becoming more involved in exploring and expressing spiritual lives (New Directions, p. 53).

The dialectics in these contrasts parallel those in theologies of sin and grace, theodicies of suffering and disabilities, and mysteries of the coexistence of the mind, body, spirit, and soul. They deserve attention in the scientific/scholarly and applied, as well as religious and humanistic, domains of gerontology.

Predictions for the Future
Compiling the predictive statements in these books, then testing them against future change, would be a fascinating project. For example, in Aging, Spirituality and Pastoral Care, we are told that the application of quality-of-life criteria to issues impinging on the lives of aging persons will be a much debated issue (p. 19); that vulnerable persons like elders and disabled individuals will be under pressure to believe their suicide is socially desirable or expected (p. 20); that elders are likely to become the new poor (p. 22); that the rapid technological evolution of society will continue to be detrimental to those who are old (p. 80); and that issues of social and spiritual isolation will become still more important under expanding services that enable elderly people to remain in their own homes (p. 97). Will "the realm of mystical experience...be increasingly relevant to gerontologists...as the baby boomers age" (Aging, Spirituality, and Religion, p. 404)? And will evangelical and fundamentalist religion shape the experience of religion and aging for millions of them (pp. 428–429)?

Enriching Gerontology
Although weaknesses in the indices of these four books often betray their riches, there is something for everyone in each of them—something new, provocative, stimulating, creative—if we but overcome the resistance to books on this subject that results from being stuck in the ruts of stereotypes, prejudices, and professional traditions that bar us from investigating work that seems outside our central field of interest. These four volumes reflect significant growth and development in gerontology, especially in the religious and spiritual components that pervade all of its other concerns and subdivisions. They enrich our understanding of aging processes by emphasizing a holistic model that extends far beyond the psychosomatic, social, behavioral, and biomedical interpretations that dominate the discipline. They place older persons at the center of concern, showing them respect by listening to their voices, honoring their need for love and community, and heeding the meanings behind their thoughts and actions without reducing the ultimate concerns and transcendent mysteries of their religious and spiritual experiences to fantasy, hormones, or residues of ancient cultures.

Above all, these books demonstrate that our interdisciplinary field of study is still far from mature. It covers only some aspects of human experience and continually struggles with the growth pains of its early adolescence. To attain maturity, gerontology needs to reach back in time as well as forward—back toward deeper understanding and appreciation of the "applied religious geriatrics" that showed respect for elders and concern for orphans, widows, and the poor out of faith in and love for God, which, in turn, induced an imitative love for fellow humans centuries before our discipline acquired a name.

References

• Kimble, M. A., McFadden, S. H., Ellor, J. W., Seeber, J. J., (Eds.) 1995;. Aging, spirituality, and religion: A handbook (Vol. 1). Minneapolis, MN: Augsburg Fortress Press.
• Moberg, D. O., 2002;. Assessing and measuring spirituality: Confronting dilemmas of universal and particular evaluative criteria. Journal of Adult Development,. 9:(1), 47-60.

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