The Bible as coping tool: Its use and psychological functions in a sample of practicing Christians living with cancer

The coping process

Following Ganzevoort (1994, 1998a, 1998b), it is assumed that religious coping is composed of four processes—religion, identity, context, and coping—that are constantly in flux and in interaction with each other. To be able to identify the specific influence of religion in coping, therefore, one must adopt a multiphase perspective that views religion as a biographical process that includes all aspects of a person’s life.

Pargament (1997, p. 90) defines coping as “a search for significance in times of stress,” significance meaning whatever is important to an individual, institution, or culture. This search for significance can be understood as a process that includes (a) the psychological, social, and contextual resources available to the person; (b) the particular ways in which the individual makes use of these resources in a given situation; and (c) the outcome of the process, mainly in terms of the extent to which the coping process has been successful in reducing stress, even though other outcomes might also be at hand, such as positive or negative side-effects of the coping process (Ganzevoort, 1998a, 1998b; Lundmark, 2010, 2015, 2016a, 2016b, 2017).

The particular ways in which the individual makes use of these resources in a given situation are identified as coping methods (Pargament makes a distinction between four comprehensive coping methods, which each include a number of different specific coping methods), which, in turn, can include one or several coping tools (Lundmark, 2015, 2016a, 2016b, 2017). Coping mechanisms, finally, refer to how a method serves to reduce stress—in Pargament’s terminology, in terms of conservation or transformation of means and ends in coping (Lundmark, 2015, 2016a, 2016b, 2017; Pargament, 1997), or attributing control (Lundmark, 2015, 2016a, 2017). In the cases analyzed for this study, the coping methods vary, but the tool is the same: the Bible (or Biblical passages). The coping process includes the prerequisites of the methods (e.g. psychological disposition, context, etc.), the coping tool or tools, and the coping mechanisms involved. In the cases investigated in this study, the coping mechanism is, in most cases, the conservation of a sense of meaning or health/survival (which here is assumed to be the object of significance), by either conserving or transforming the means for upholding a sense of meaning or health/survival.

The term coping tool is used to denote a specific object used in the coping process. This is not to be confused with objects of significance, the term used by Pargament to denote physical or psychological objects that we care about, and that involve feelings and beliefs associated with worth, importance, and value (Lundmark, 2015, 2016a, 2016b, 2017; Pargament, 1997, p. 92). This coping tool could be a tangible object, including a person or other living being; or it could be a psychological object, such as a mental image or concept. For example, the Bible as a tangible object can be regarded as a coping tool if it plays a role in the coping process by providing the person with a sense of security when holding it. If a person uses scriptural passages from the Bible, seeking comfort through reading these passages, as an example, the Bible as an object is not to be regarded as a coping tool. Instead, it is the scriptural passages that work as coping tools.

It is important to distinguish conceptually between the coping tool and the object of significance, since both play a crucial role in the coping process, and it can sometimes be hard to fully differentiate between them (Lundmark, 2016a, 2017). What defines an object of significance is that it possesses significance intrinsically (in itself, independently of any function that it may perform). What defines a coping tool, on the other hand, is that it performs a certain function in the coping process: to conserve the object of significance, or, if this is not possible, to transform it (Lundmark, 2015, 2017; Pargament, 1997).

The theoretical framework concerning the coping process that has been elaborated upon so far is, however, not sufficient for answering the research questions. In order to understand how the use of the Bible, in all the varieties described in the interview-material, functions in the coping process, the framework must be complemented with a theory that helps us understand in what way(s) the Bible functions as a coping tool. Specifically, it must not only answer the question of which label in the existing corpus of possible coping methods and coping mechanisms can be appropriate to use when analyzing the use of the Bible, but the theory must also help us better understand why the Bible receives these functions. As will be revealed in the results, scriptural passages seem to have two different functions in the coping process. Differentiating between these two functions requires a complementary theory. In search of this, a theory that addresses the relationship between the reader of the Bible and its content seems appropriate. One such theory is Hjalmars Sunden’s role theory, which, as will be shown in the results, helps to provide a deeper understanding of at least one way in which Biblical passages can become a coping tool.

Hjalmar Sundén’s role theory

Hjalmar Sundén’s (1959) role theory, first presented in his book Religionen och Rollerna (Religion and the Roles), is based on two psychological elements: social psychology and perceptual psychology. The perceptual psychology-element of the theory deals primarily with the selective character of perception, especially how this selectivity is organized. Perception is conceived as being an interpretation process, where the consciousness is adjusted to perceive certain “patterns,” and to exclude others, based on processes where we conceive what we have learned to conceive (Stifoss-Hanssen, 1995). The social psychological element builds on Mead’s role-taking theory, as well as structural role theories. The former focuses on the interactional conception of role—that is, focus being on role-taking as taking the perspective of another person in order to anticipate the other’s behavior, and adjusting one’s own behavior in accordance with this anticipation. The latter focuses on the social structure and position of the role—that is, what playing a role means for meeting the requirements connected with a certain social position (Alma & van Uden, 1995).

Sundén developed his role-theory as an instrument for understanding and interpreting religious experience. The theory suggests that religious traditions contain systems of roles that function as models of performance in interactional systems. An example of such an interactional system is given by Thorvald Källstad (1987):

When, for example, Old Testament prophets speak of Jahve and Israel we find such an interactional system. God’s acts are known from the history of the fathers and the people, and the acts constitute the role “God,” and what is told about the fathers constitutes a number of human roles which together with the role “God,” in this case, form the interactional system. (p. 367)

The role functions as a pattern for structuring perceptions. In a coping perspective, given that we are talking about persons who are familiar with the Bible, a model of performance in a given situation can be obtained from the Bible when the person reads a story or passage that contains a human role with whom the person can identify, and this human role’s interaction with God. The pattern searching systems in the brain will structure the perceptions of the situation in accordance with this identification, and it will be a part of the coping process. Källstad (1987) describes this process as follows:

A reader of the Bible can identify himself, for example, with a voice from the Book of Psalms. In such a case, he acquires definite expectations of how the God of the Bible who dealt with earlier generations will deal with him. The God speaking in the Book of Psalms will be experienced as reality by the reader of the Bible. Taking the role of a human being and making the Psalmist’s words his own, he adopts at the same time the role “God,” God being the Partner of the human being in the Bible . . .//. . . Adopting the role “God” creates a specific readiness, and because of this readiness he begins to perceive his own situation in a new way. As he himself is the human role, the divine role of the interactional system functions as a momentary pattern of perception, and in certain cases a real phenomenon of restructuring can take place. A religious experience is produced as an “interpersonal encounter.” (pp. 367–368)

The process of assimilating roles from the Bible never really ends for a Bible-reader, and during this constant assimilation of roles, a more permanent disposition of the brain is formed which functions as a perceptual system where the experience of the course of events as divine activity is a reality. This means that the Bible reader will be more and more likely to expect that God will act in similar ways toward the Bible reader as in the roles the Bible reader has taken. In Sundén’s terminology, this anticipation of God’s action is labeled role-adoption; the person who has taken a role (role-taking) from the Bible will adopt the corresponding roles of the taken role, especially the corresponding role “God” (Källstad, 1987).

Case study 1: The actual reading of the Bible as a coping method

Mrs. K, a Lutheran, was 49 years old when I interviewed her for the first time. She had at that point undergone what seemed to be a successful course of chemotherapy for lymphoma. With the disease apparently in remission, she was newly optimistic about the future. But nine months later, on the occasion of a follow-up interview, she revealed that she had suffered a relapse only a few weeks after the initial interview. At this point, quite short of breath and with a severe cough, she was receiving strictly palliative treatment. She died 5 weeks after the second interview.

Mrs. K had been a workaholic. She said that, prior to becoming ill, she had lost focus on what she had earlier regarded as important in life; she had become consumed by her work. The disease, however, turned her around. Among other ways, this change became strikingly evident in the very way that she read the Bible. Here is how she described it during the first interview:

I brought the Bible to the hospital, even while not in a condition to read. and above all, I was not prepared that the reading, that is, the actual process of reading, would change in such a dramatic way as it did . . . it was something new, and perhaps also an interesting discovery somehow, that you read in a way that every letter becomes imprinted with such an enormously clarity that there is no possibility of stopping reading, to break in the middle of a sentence, but you really have to read to the end of the sentence. Extremely slowly. A way of reading that would never be possible at work because there you have to read fast, read what is most important, and then process what you have read. No, quite the contrary [compared to at work] . . . // . . . it is a radical difference. But then, this changed again when I regained more and more health. I turned back to my old way of reading the Bible, where you can read half a sentence and then break and think about something else, and then continue to read. I lost the enormous . . . direction against the very text that was present when I was unhealthier. . . that was something quite remarkable . . .

During the follow up interview 9 months later, Mrs. K answered the question of whether this new way of reading had continued:

It has continued, but not in the sense that it has been imprinted letter by letter as slowly as it was first, but I think Bible reading has changed . . . //. . . I read in a different way now . . . not that I can say that I have come closer to the word—Only God knows this—but still in the depth, so that you see a spatiality in the text and I find that very fascinating . . .//. . . I must say it is a grace that I have another rhythm of time now, and that I really try to take the time to read the Bible in a different way [than before I got sick] and I don’t mean the timely time, but a kind of inner time, so you get the chance to take it in . . .//. . . it becomes a different kind of reading, for which I am thankful. I hope it does not disappear . . .//. . . I have had some problems with my breathing lately, in the sense that I cannot breathe as deep as I used to do and perhaps some other problems as well, health problems, but it becomes an instant relief when you get into this calmness and start reading. . .

Interviewer: You become calm when you read the Bible?

Mrs. K: yes, the breathing gets calm, I can breathe deeply without problems, and there is no pain. This is a side effect that you discover with some amazement somewhat later, but I do not cough, surprisingly enough. And I think that it is strange how the inner soul can be so affected.

Interviewer: This relief, do you think it is because of the fact that you read the Bible, or is it the way you read?

Mrs. K: Both, and it also goes for . . . visits to church and the mass . . . The last time I attended church, I didn’t cough once . . . not once. At home, it is sometimes absolutely impossible [not to cough] . . . and it is not that I sit still, I do that most of the time, it’s absolutely not that . . .

The story of Mrs. K illustrates something that recurs in several different ways in the narratives of both groups A and B: there is an interdependence between the expressions of the informants’ religiosity and the life situation as changed by cancer (see also Lundmark, 2002, 2010, 2015, 2016a, 2016b, 2017). Mrs. K did not have the strength to read the Bible as she once used to. In a part of the interview not quoted here, she mentioned that she used to read fast and often, sometimes pausing to consult reference literature. Because Bible reading was such an important part of her religious practice, she still tried to read after she became ill, but her fatigue forced her to read virtually syllable by syllable. In this new mode of reading, however, a rhythm arose that she found pleasant. She returned to the common method of reading when she gained strength, but she soon discovered that she missed the important dimension added by the way she read while in the hospital. With some effort, then, she found her way back to the slow form of reading, which for her becomes a new coping method. When, late in the course of her disease, complications arose in the form of severe coughing and breathing problems, reading the Bible in the slower mode brought relief: her breathing became calmer and the coughing disappeared.

The interdependence between the religiosity and the life situation changed by the disease is evident in this case. The case also illustrates another recurring observation in both materials A and B: when a concrete aspect of the religiosity is changed (in another way than merely by frequency) due to interaction with a life situation affected by cancer, this often happens in the direction of higher functionality of that aspect of religiosity in the coping process (compare especially with the use of prayer cloths (Lundmark, 2015) and the process of sanctification of health care interventions (Lundmark, 2016a). The condition of Mrs. K forces one of the aspects of her religiosity—Bible reading—to change. This change, in turn, becomes something positive that contributes to her coping, including symptom relief.

The evident way in which the rhythm of reading is connected to breathing reminds one of the meditative reading that, for example, is associated with the Jesus prayer, and perhaps also lectio divina, suggesting that the reading in this case has physiological functions similar to meditation, in this way contributing to anxiety reduction (c.f. Pargament, Ano, & Wachholtz, 2005). The reduced anxiety, in turn, is likely to have a positive effect on breathing problems. The coping method in this case could be labeled “meditative reading,” and the coping tool is the Bible.

In terms of Pargament’s system of comprehensive coping methods, the coping method in this case, can be labeled as a reconstructing coping method. In other words, the means of the significance (in this case the way of using the Bible) is changed or transformed (transforming coping mechanism), whereas the ends of the significance (what is protected by the coping process) are conserved (conserving coping mechanism). Later, when this reading becomes normality, it functions as a preserving coping method, that is, both the means of the significance as well as the ends of the significance are conserved.

Bible passages of importance in the coping processes

Which Bible passages become important to relate to in a crisis says something about which significant object(s) is at stage in the coping process. One type of Bible passage that is a recurrent theme for some of the informants is passages that explicitly concern healing (from now on referred to as type a). For example, when Jesus heals the paralytic man in Capernaum, or the women with bleedings. These kinds of passages are, however, fewer than what might be expected, and can only be found in the narratives of three of the informants. In the narratives of some of the other informants, there are references to biblical passages that, on face value, are not about healing, but in the context implicitly give this meaning. One concrete example of this is how one of the informants sees Psalms 128:6 (“that you may see your children’s children”) as a promise of healing, or at least that the informant will live for several more years, given that his children was still too young to have their own children (more attention will be given to this particular case in case study 3 below). The importance of these types of Biblical passages that explicitly or implicitly touch on healing suggests that the significant object at stage here is health/survival.

A more common type of Bible passage to refer to (found among 8 of the informants) is passages that concern finding strength in difficult situations, and promises that God will be present in the situation, for example, that God will not give more burden than we can carry, or God will be with us all days (from now on referred to as type b). The importance of this type of Biblical passages suggests that the significant object at stage here is a sense of security, or perhaps quality in life.

A third type of Bible passages referred to is about death and that death is not to be feared, for example, passages about the death and resurrection of Christ or Lazarus (from now on referred to as type c). The importance of these types of Biblical passages suggests that the significant object at stage here is a scene of security. These kinds of passages are found in the narratives of three of the informants.

A constant feature in the narratives is that the informants interpret the Biblical passages in accordance with their own life situations. Besides the already mentioned examples, there exists references to Biblical passages that helps the informant understand a very specific experience. One example is an informant who first experienced what she thought to be a miraculous recovery, but she relapsed after quite a short time. In this situation, the words of St. Paul became important: “for the gifts and the calling of God are irrevocable” (Romans 11:29).

To sum up, the means of the significance in the analyzed narratives is the Biblical passages. The significant objects at stage in the narratives seem to be health/survival, and sense of security or perhaps quality in life. The specific coping method, adhering to Parament’s terminology, is the use of the Bible in the form of getting religious support through the content of the mentioned Bible passages.

However, when looking at the narratives in the interview material more closely, it seems as if the religious support through the content of Bible passages can function in at least two different ways, because they derivate from different kinds of psychological processes. One way is that the informants, in the Biblical passages, see a direct message from God to them on a personal level. Usually, we are referring to shorter passages, a few words, or perhaps a few verses. The Bible passages become a coping tool in that the informants have the belief that God talks through the Bible to the reader at all times. This will be further illustrated in case study 3 below.

Another way is that a specific character in a Bible passage serves as an object of identification for the informant. Usually, we are talking about passages longer than only a few words, or verses where the context is of importance. This will be illustrated in detail in case study 2 below.

Case study 2: Role-taking/role-adopting as a coping method

With the help of Sunden’s role theory, we can psychologically understand what happens in the coping process when a person identifies with a Biblical character in terms of role-taking and role-adoption.

The following is a freely rendered quotation from an interview with Mrs. D, a middle-aged Pentecostal woman who has been living with an incurable cancer for many years. The quotation is one of several examples of her experiencing that God has spoken to her:

When I became ill . . . there was this woman who recently had become a believing Christian, she had been so for about a year. She prayed and still prays for me . . .//. . . She called me one day and said, “there is something I want to tell you, but I don’t know how to do it, I don’t really understand it myself so it is sort of hard.” I said: “but what is it? I’m listening!.” Then she said “I was praying and then I experienced something, I was praying and suddenly I saw a vision, I saw a watch, and this watch was going counter clockwise. I thought, what is this? I have never heard of this! I didn’t know what to do of this, but it was when I was praying for you.” Then she told me that she prayed to God to help her understand what this was all about. She felt that she should open her Bible, and she opened it at random and started to read. The passage was about Hezekiah, when he was sick and asked for a sign that he would be well again, it is in Kings [2 kings 20:1-11]. And it reads that Isaiah said that it is easy for the sundial to go forward, but to take a step back is not easy . . . and then it says that the sundial went several steps backward, and then she understood that this was about me, that I would live. It says that he lived 15 more years after that episode. I took this to heart and was thankful, it was not like a revelation, but it has followed me all the time (the interview took place six years after this episode, the quotation is a freely rendered translation from the original interview in Swedish (Lundmark, 2002). The interview belongs to group B).

Mrs. D receives this Bible passage from a fellow Christian. The narrative that gives a context to this receiving of the passage includes an illustration of a religiously motivated use of the Bible, perceived as a tool for God to communicate. This is the habit of reading a Bible passage at random when in need of guidance, a habit well known in many Christian contexts. The way in which the fellow Christian received this passage is likely to give extra weight to the message perceived in it. We can see several dual role-situations in this example. The fellow Christian takes the role of “Isaiah,” the messenger in the passage, with the corresponding role-adoption of both “God,” and “Hezekiah,” the receiver of the message. Mrs. D, in turn, takes the role of “Hezekiah,” with the corresponding role-adoption of both “God” and “Isaiah.” In the case of Mrs. D, the role-taking of Hezekiah, with the corresponding role-adoption of God, becomes a coping method for protecting the significant object(s) health/survival, and likely also sense of security. This happens when Mrs. D identifies with Hezekiah and, so to speak, makes his story hers (the role-taking). The role-taking, in turn, means that Mrs. D’s pattern searching system will structure the perception of the situation so that (a) the vision of the fellow Christian have the same meaning as the proof provided by Isaiah that God would let Hezekiah live and (b) this proof is perceived as being intended for Mrs. D. Once the perception of the situation is structured in this way by Mrs. D, the role-taking becomes a powerful coping method for dealing with the uncertainty of the future, given her incurable cancer, by implying a promise from God that she will live. In coping terms, the coping method can be labeled role-taking, and the coping-tool is the specific passage which provides the interactional system with the actual roles at stage: the role-taking of Hezekiah with the corresponding role-adoption of, in this case, both Isaiah—the messenger (in the form of the fellow Christian), and God.

Case study 3: (Re)interpreting Biblical passages as a coping method

In case study 2, we analyzed the use of a Biblical passage where there was an obvious example of role taking. In some cases, in the interview material, there is no obvious role to take, but the passage is obviously still an important coping tool. A portion from the interview with Mr. D, already quoted in a previous section, can serve as an example here. Mr. D is a middle-aged Pentecostal man with cancer in a late stage. The treatment is strictly palliative, and the only interview conducted with him took place approximately 5 weeks before he passed away.

On questioning of if there are any Biblical passages or stories that mean much to him since becoming ill, he reported the following:

There is a word in the Psalms where it says that you shall see the children of your children. It has become a prayer of mine that I shall see them, because that means that I will be cured. Or, at least that the disease will not progress more. Because of this, I am very optimistic . . . //. . . even if you lose your speed, so to speak, when things like that happen [referring to an incident some days earlier when he had to receive hospital care for a complication]. Somehow, I feel that God is with me, all the time, and there is a meaning that I still cannot see to all this. . .//. . .it is like a promise. In my situation, it is not the medicines or the doctors first and foremost, even though I do think of them as tools in the hands of God. The optimal thing is to get help from the Lord. I see no conflict between [this and] visiting the hospital . . . //. . . But then we have [this Bible passage] that I received. This is what I think is so wonderful, that the Holy Ghost knows what stands in it [pointing at the Bible that lays at the table in front of Mr. D]. The Holy Ghost wants to show me, and because of that, it was so exciting to get it, like a direct word from God. I really thought God said, “you shall see the children of your children.” If I take this to my heart, then I don’t have to worry about dying yet, because my children are still small. This gives peace to my mind, no matter how God plans to make this happen. But my understanding of this right now is that it means I will live a while longer. I didn’t know exactly where this verse was in the Bible [he had vaguely remembered this verse], but then I read the Psalms and suddenly, there it was . . .//. . . and this became like a promise . . .//. . . my whole situation depends on God being faithful. Whether he chooses to take me home or not [meaning here to die], I do not hold God to be unfaithful to his promises. I must take it from whatever little knowledge I have at the moment about God. He knows this is how I think, and he must correct me if I have somehow gotten lost in my thoughts about this.

In this Biblical passage, there is no direct person to identify with (the Psalm is addressed to Israel as a people). Still, the passage is interpreted by Mr. D as a direct word from God to him. The important thing is the formulation, “you shall see the children of your children,” together with the deep belief that God speaks through the Bible to its readers at all times which is a method of interpretation provided by the religious tradition in question.

As in case study 2, the Bible as a coping tool is here conserved when it functions as a means in the coping process. Furthermore, the end of the coping process—the significant object—is also conserved. In this case, the significant object seems to be survival, and probably also a sense of security. Depending on how one looks at it, it could be argued that we are here talking about a kind of religious reframing. As a coping method, religious reframing is classified by Pargament as the comprehensive coping method reconstruction (characterized by a conservation of the ends of the coping by transformation of its means), and indeed, the Bible as a coping tool is changed in the sense that a new understanding of the passage has occurred. Yet, it could also be argued that the means is the Bible together with a religious tradition that provides the possibility of reinterpreting passages as direct speech to the individual reader. Following this argument, the proper classification, according to Pargament’s coping theory, should be the comprehensive coping method preservation (characterized by a conservation of both the ends of the coping and its means). Personally, I’m inclined to see it as the latter, and thus choose to see the coping method more as a sort of religious (re)interpretation instead of religious reframing. My main argument here is that although the Bible passages are reinterpreted, this is done within the framework of a religious tradition that allows, or even encourages, such reinterpretations, and this tradition is more likely conserved than transformed in this case. So, what is conserved is not the interpretation of the Biblical passage, but the tradition to reinterpret the Biblical passage as a direct message from God to the individual reader in his or her concrete life situation. The coping method in this case could therefore be labeled (re)interpretation of a Biblical passage (motivated by a religious tradition), in which the new interpretation of the Biblical passage is the coping tool.

To sum up with direct answers to the research questions, for the informants in the analyzed interview-materials: