...college student's reflection focus group, 2003

Spiritual struggle is an experience familiar to many students whose college years are marked by reflections on faith, purpose, and life meaning and by efforts to understand the preponderance of suffering, evil, and death in the world. From clinical standpoint, there is growing concern regarding the numbers of individuals suffering psychologically from religious or spiritual problems. Increased attention to these maladies led to the creation of a new category in the Diagnostic and Statistical Manual of Mental Disorders in 1994. Problems of a religious or spiritual nature have come to include such experiences as losing or questioning one's faith, religious conversion, and questioning spiritual values (Lukoff, Lu, & Turner, 1998).

The present study defined "spiritual struggle," a scale derived through factor analysis, as intrapsychic concerns about matters of faith, purpose, and meaning in life. The scale was comprised of five items dealing with questioning one's religious/spiritual beliefs; feeling unsettled about spiritual and religious matters; struggling to understand evil, suffering, and death; feeling angry at God; and feeling disillusioned with one's religious upbringing. The study is driven by questions regarding the factors that predispose students to spiritual struggles and the experiences through college that might lead to them. Further, it asks whether there are potential consequences of such struggles for students' self-rated physical well-being, self-esteem, and levels of psychological distress and whether spiritual struggles relate to growth in religiousness, spirituality, and acceptance of people with different religious/spiritual views. (1) In the sections that follow, we review the relevant literature in an attempt to summarize what is currently known about both the causes and consequences of spiritual struggle, identifying as well how this study will add to that body of work. Although the correlational nature of the studies reviewed precludes concluding with absolute confidence that certain variables are precursors to or outcomes of spiritual struggle, all studies were conducted within an implied causal framework, and we have organized the next section to reflect this distinction between causes and consequences.

Background and Conceptual Framework

Causes of Spiritual Struggle

Spiritual struggles may be rooted in numerous causes, but they are most notably linked to difficult life circumstances (Pargament, Murray-Swank, Magyar, & Ano, 2005) and to what Smucker referred to as "breaking the web of life" (1996, p. 84), or encountering events that unexpectedly threaten to shatter one's customary state of being. In a study of nearly 5,550 students attending 39 colleges and universities across the country, Johnson and Hayes (2003) revealed that fully 44% of their sample experienced at least "a little bit" of distress related to religious or spiritual concerns, and approximately one quarter felt considerable distress surrounding these issues. Moreover, the authors reported that the following were significant correlates of religious/spiritual concerns: confusion about beliefs and values, loss of a relationship, sexual assault, homesickness, and suicidal thoughts and feelings. Clearly, it is difficult to determine the direction of causation in these relationships, but at the same time, we can see how each of these experiences is logically connected to spiritual struggle, regardless of whether they occur in tandem with the struggle or precede it.

Personal characteristics and propensities are yet another set of factors that can lead to spiritual struggle. Individuals with weak spiritual orientations may come to a point of disequilibrium when life events are overwhelming (Pargament et al., 2005). Weak spiritual orientations vulnerable to struggle include orientations that fail to acknowledge and accept the troubling aspects of existence (such as evil and suffering), that are insufficiently integrated into an individual's life, and that are based on insecure religious attachments to an unpredictable or distant God (Pargament et al., 2005). Other personal traits such as anger and neuroticism leave people vulnerable to spiritual struggle as well (Pargament et al., 2005). In addition to psychological traits such as these, spiritual or religious struggle can emerge out of stress related to one's identity. As one example of this, Dubow, Pargament, Boxer, and Tarakeshwar (1999) reported that connectedness to religion and culture among Jewish adolescents might increase their likelihood of experiencing stressful situations such as exposure to anti-Semitic comments and peer conflict. These religious stressors, in turn, were associated with spiritual struggle in the form of wondering "whether God can really do everything," "if God cares about me," and "what I did for God to punish me." In light of the challenges that confront women and gay and lesbian individuals in certain religious contexts, one's gender or sexual identity is also grounds for potential spiritual struggle (Bryant, 2003; Chater, 2000; Love, Bock, Jannarone, & Richardson, 2005). Along a similar vein, Becker (1994) identified spiritual struggle with larger political and social movements in which individuals decry the oppressive transgressions of society and call for change. It is in the midst of these external conflicts that internal spiritual struggles are realized.

Outcomes of Spiritual Struggle

As Hill and Pargament (2003) illustrated in their review of research on religious/spiritual implications for health, studies to date have tended uniformly to support the notion that spirituality and religion have beneficial outcomes for physical and mental health (see also Larson & Larson, 2003). The limitations of such studies are that they utilize relatively simplistic measures of religion and spirituality (religious service attendance, denominational affiliation, etc.) (Hill & Pargament, 2003). Moreover, they might fail to identify the unique ramifications for specific groups of individuals. For instance, within certain young adult populations (e.g., college students), religious variables might not relate as clearly to well-being as in studies based on other populations (Schafer, 1997; Schafer & King, 1990). Finally, the focus of research on spirituality/religiousness and well-being often investigates the implications of positive facets of spiritual and religious life (Pargament, Koenig, & Perez, 2000; see also Adams, Bezner, Drabbs, Zambarano, & Steinhardt, 2000; Baker, 2003): feeling connected to a force or higher power beyond oneself; having a sense of purpose, meaning, and coherence in life; finding security in a supportive religious community; being encouraged to maintain a healthy lifestyle; and experiencing assuredness in having answers to life's perplexing uncertainties. This begs the question: What are the consequences of more negative spiritual and religious experiences? How are individuals affected by spiritual struggle and religious doubt--the feeling that God is distant, unloving, or perhaps nonexistent; the realization that suffering and pain are just as (if not more) common as happiness and joy; the disappointment in a religious family or community that ostracizes or oppresses?

Some indications of the impact of spiritual struggle are available in the current fund of research. To begin, spiritual struggle appears to be negatively associated with psychological health and results in such outcomes as depression, anxiety, negative mood, low self-esteem, and even suicidal thoughts (Hill & Pargament, 2003; Pargament et al., 2005). Pointing to the potentially harmful consequences of religious life, Pargament et al. (2000), in assessing various forms of religious coping, identified negative religious coping methods (i.e., punishing God reappraisals, reappraisals of God's power, and spiritual discontent) as predictive of mental and physical maladjustment among college students. Relatedly, in a sample of college students, Genia (1996) found that high scorers on the dimension "Quest"--defined by their tendency to critically evaluate their spiritual beliefs and values--were more prone to experience lower levels of spiritual well-being and psychological health.

Scholarship in the medical and nursing fields has contributed much to our understanding of the role spiritual struggle plays in health. A review of prior research led Fitchett et al. to conclude, "some types of religious struggle may contribute to poor physical and mental health outcomes for clinical samples" (2004, p. 181). Their work validates the correlation between serious illness and spiritual struggle ("negative religious coping") and between spiritual struggle and emotional distress/depression, noting that close to 15% of medical patients are at risk for poor physical and mental health outcomes due to religious struggle. Other work has linked spiritual distress--particularly feeling abandoned or unloved by God and inflicted by the Devil--to higher rates of earlier mortality (Larson & Larson, 2003). Because patients are often in particularly vulnerable states with respect to both physical and mental well-being, medical practitioners are implored by the extant literature to identify and handle potential spiritual crises among patients with cultural knowledge and sensitivity (Di Meo, 1991; Engebretson, 1996; Fitchett et al., 2004; Sumner, 1998).

Despite the potential for compromised psychological and physical well-being during times of spiritual struggle, other studies recognize the possibility of positive outcomes (Hill & Pargament, 2003). Greater open-mindedness has been observed among individuals who have struggled spiritually (Hill & Pargament, 2003). Regarding the positive consequences of questing, a religious quest orientation is associated with tolerant values, promoting tolerant action, principled moral reasoning, and helping behaviors (Batson, Eidelman, Higley, & Russel, 2001; Batson & Schoenrade, 1991). Likewise, spiritual growth can occur as a result of struggling (Pargament et al., 2005). To be sure, many developmental frameworks assume in fact that "crisis" is both necessary and instrumental in promoting personal growth and maturation (Chickering & Reisser, 1993; Erikson, 1968; Hall, 1986; Perry, 1968; Smucker, 1996). "Crisis" does not imply tragedy or total dissolution of the self; rather, it is a point of transition (Erikson, 1968). Perry has noted the import of "challenge by countervailing forces" in the course of young adult development (1968, p. 58), while Chickering and...

NOTE: All illustrations and photos have been removed from this article.



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