Spirituality, Religion, and Aging: Illuminations for Therapeutic Practice


Holly Nelson-Becker

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    I dedicate this book to my family, who tolerated my many absences so that I could complete this project: Alex for his patience, love, and impressive cooking; Alexa for her insights and skills; Alistair for his wit and medical worldviews; and Ella and Oliver for their affection, joy, and fun.


    Starting in the 1960s, a few gerontologists began suggesting that it was time to stop treating religiousness and spirituality as taboo topics. They urged their colleagues to see that the aging process motivates many people to wrestle with questions about life’s meaning and purpose that have deep roots in the religions of the world. However, although the 1971 White House Conference on Aging produced an important document about spiritual well-being in later life, the majority of academic researchers and many practitioners paid little attention. Slowly, however, momentum built as more books and journal articles appeared and as professional organizations supported the formation of groups interested in research and practice that takes spirituality, religion, and aging seriously. As this book notes, toward the end of the 20th century, a variety of cultural factors converged to stimulate fresh thinking on the roles of religious beliefs, practices, and communities in older people’s lives as well as new insights into the many ways they experience and express spirituality.

    I do not believe it is an exaggeration to say that Holly Nelson-Becker has written a book that represents a turning point in gerontology. Her work reflects contemporary postmodern assumptions about the intersectionality of various shaping influences on individual identity and it respects the many sources of diversity among peoples and cultures. At the same time, in every chapter, she shows how wisdom from the past can enlighten our thinking today. She also understands that research, theory, and practice related to religion, spirituality, and aging are shaped to some degree by their historical moment as well as people’s positions on the relation between science and religion.

    From her standing ground in social work research and practice, Nelson-Becker reaches out to colleagues in psychology, nursing, pastoral care, art and music therapy, and other disciplines and professions that study aging and serve older adults. She values interdisciplinarity and transdisciplinarity, respectfully showing how persons with different perspectives from her own have historically viewed religion, spirituality, and aging. She uses the metaphor of “leaping limits” to address how people can get out of the silos that restrict them to a particular disciplinary language and assumptive world.

    One criticism of much of the work from the previous century was that it treated religion generically and showed little understanding of the actual beliefs of adherents of different religions. Nelson-Becker corrects that problem by offering detailed descriptions of eight major religions, including the religions of indigenous Americans (recognizing, of course, that there is much diversity in this group). It is also impressive to see that she paints a differentiated portrait of spirituality, and accepts that some forms of spirituality have no theistic focus. Along with adding to their knowledge about specific religious beliefs and various forms of spirituality, Nelson-Becker urges mental health practitioners to be self-critical about their biases toward religiousness, particularly when they assume that devout people are rigid and judgmental. She also wants practitioners to understand that some older adults experience profound shifts in religiousness and/or spirituality, sometimes by leaving one tradition and turning to another, or by giving up previously held beliefs and practices altogether.

    This book breaks new ground in many ways. For example, it frequently addresses the spiritual and religious challenges experienced by people who immigrate to the United States later in life to be near their adult children. With immigration such a contested political issue in our times, it is refreshing to see the compassionate approach taken in this book. She understands that many of these elderly immigrants feel helpless and hopeless and she offers suggestions about how practitioners might offer support and assistance. Whether writing about newly arrived immigrants, or Americans who have lived in one place their entire lives, Nelson-Becker lifts up the spiritual resonances of their everyday lives. For example, she pays attention to the meaning of home for older adults, including those journeying into dementia.

    Although Nelson-Becker reviews the DSM-5 diagnostic categories often associated with older people, she tries to de-medicalize her approach to their suffering and speaks about their “maladies of the soul.” She offers new ideas about how elders with mental health problems might be accompanied through spiritual suffering to spiritual freedom and discovery. Her compassionate view of older adults extends to those with dementia and she offers many helpful suggestions on how to connect meaningfully with people undergoing changes in their ability to remember, plan, make decisions, and so forth. Ever open to creative new approaches to authentic connections with other persons, she affirms the importance of improvisational techniques as a form of communication with persons living with dementia.

    Even when she’s wrestling with weighty philosophical and theological topics, Nelson-Becker always returns to the real lives of older people. She also keeps her focus on how counselors and therapists can be helpful to elders who indicate that they want to address religious and spiritual issues. Warning that practice must always be ethical, and never coercive, she suggests that for some professionals with some clients, it might sometimes even be appropriate to introduce prayer into the encounter. On the other hand, she is quite aware of what she calls the “shadow sides” of both religiousness and spirituality.

    Holly Nelson-Becker is a highly skilled social worker, therapist, researcher, and teacher. Her commitment to teaching and learning shines throughout all the chapters of this book. Each one has discussion questions, assignments, and spiritual exercises that can be used in classes, and each also includes many helpful resources. People reading this book outside of a classroom setting can learn much from thinking about the questions, assignments, and exercises she provides, and all readers can take advantage of the opportunity to expand their own spiritual repertoires by reflecting on the epigraphs and practicing the meditations that appear in every chapter. This care in tending to the spiritual lives of readers is yet another example of this book’s courageous, wise, and fresh approach to how we might understand spirituality, religion, and aging in the 21st century.


    Aging is different for everyone who is lucky enough to live to older ages. Just as all persons have their own life, they will have their own death. Aging, too, though it has some common themes, is a uniquely perceived interlude of time. Thus, everyone has their own aging. No one is free, I believe, of some aches and pain that have their origin in the body, the heart, the mind, or spirit. This book is intended to teach about a somewhat neglected area in academia that is often left to theology or to pastoral care professionals, clergy, imams, rabbis, shamans, a sadhu or guru, a monk or nun, a bodhisattva, and other holy teachers. This broad area is the spiritual dimension of the aging experience.

    Mental health practitioners or therapists emerging from any disciplinary venue should know how to assess, engage, and address the spiritual and religious needs of their clients. Evaluation of any interventions or helping actions is also important. In contemporary societies, the persistent problems that clients and patients encounter cannot often be solved through application of one kind of tool or approach. Instead, a holistic perspective with its multilayered and multimodal complexities provides the potential avenue for healing. Healing is not merely a one-time occurrence for many individuals. Rather, people require healing of many kinds as they travel through a lifetime. In some cases, trouble just flies in to a life from external events; in other cases, demons in the form of fears and anxieties people battle lie deep inside themselves. Invisible, they fester and smolder there. When brought to consciousness or to light, there is capacity for transformation and growth. Perhaps, if in the middle facing toward the last decades of life, individuals think about their younger selves and what they have since experienced, they might furtively wish to go backward rather than forward in time. However, the truth is that wherever clients are in a life, they do have the resources to move forward across roiling rivers, stepping stone by stepping stone, until a greater vision enraptures them. Therapists represent some of those stepping stones to the other side—to spiritual freedom. To be the catalyst for change in a person’s life is powerful. This kind of power must be handled gently, and not in service of one’s own self-promotion or ego.

    Our lives are fleeting. We live and are then heard no more (at least in real time). From sacred text in the Christian tradition comes this question, “What is your life? For you are a mist that appears for a little while and then vanishes” (James 4:14, Revised Standard Version). Shakespeare put this idea a little more cavalierly in Macbeth: “Life’s but a walking shadow, a poor player that struts and frets his hour upon the stage” (Act 5, Scene 5). Perhaps so, but within that space of time there is so much potential for learning, for achievement, and for imprinting the world with whatever it is we have to offer that, long after our own voices are silenced, will remain in some form and be transmitted to following generations. This may be nothing more than a word of encouragement that allows a friend to make a better decision, an idea that improves life for clients or patients, anything at all that threads out to create good on the planet we now call home. The truth is that everything matters and everyone matters. In fact perhaps a purpose of people we may deem as antagonists or adversaries is to awaken something within us. Disturbing the status quo is at times a worthy aim.

    In Chinese medicine there is a fifth season, beyond the typical natural seasons in nature we know as spring, summer, autumn, and winter, all of which cycle in an endless round. This fifth season stands in late summer, the pause when the color of trees and plants is no longer so vibrant, but carries a truer pigment of itself, the median between the bold and the dull. Technically the fifth season begins in late August and extends until the autumn equinox. This is also the time when vegetables and fruits are ripe and ready to be harvested. Earth is at the still point of time. This is the pause when everything slows. It marks the transition between yang and yin energy, from fiery reds of summer into the yellows and oranges of autumn. Similarly, the heavenly pivot is the pivot point in acupuncture that represents the point between heaven and earth. It is a point of balance between being connected to heaven and grounded on earth.

    Each of these images applies to aging. The fifth season suggests that beyond the surface of what is seen as ordinary, or the four seasons that structure our years, is something deeper. When people are willing to go deep into their experience, there is something to be gained, fruit to be harvested that can last into later years—the winter period of life when passions and intensity may have cooled, but much still flows below the surface as a river runs deep under ice. The winter of life is not a time of stagnation, but can be a time of new openness to what life offers. The pause of the fifth season suggests a time and space for reflection before one enters this final phase; this interval consists of many years or few. At this still point, one considers the history that has brought one to this moment, and what may yet be available to choose. The heavenly pivot promotes the power older people continue to have at every age to change and grow and turn in new directions. It is an affirmation that no one need ever feel stuck, because even in the most physically limiting situations, such as permanent residence in a nursing care facility, there are choices that can be made about one’s response. Having choice connects people back to who they are and who they want to be. Beyond decision making capacity, for instance in the experience of dementia, we can trust that people continue to be held in the hand of the universe.

    Despite difficulties then, the possibility to live a life of meaning and joy is immeasurable, awe inspiring, breathtaking even. Meaning abounds through our personal reflection and social engagement. Aging is not best described by frailty, burden, or compulsory obligations, but by the opportunity for ongoing learning, volunteering, altruistic acts, and crafting a legacy of purpose in other lives we lightly and briefly join as well as our own. This is accomplished through the relational nature of linked lives and not through solitary pursuits alone. Meaning unfolds through the rhythmic departures and arrivals, exits and entrances, of people and places that structure the great dance of our lives.

    The questions of aging are the questions of history. What does it mean to have life? What does it mean to be or become old? Who decides who is old? What is the value of aging? What is abundance, generosity, hospitality? How are they created and/or enhanced? What is the spiritual self? How does religion speak to the experience of humankind? What is the call of justice for everyone when the needs of the many and the needs of the few sometimes collide? How can we support diversity in its many forms and types, so that our lives and the lives of everyone else are enriched instead of diminished and threatened? When political systems fall apart, how can we stay strong in our regard for common human needs and choose to support the need of another person because it is greater than our own? And beyond the question, what am I searching for, lies the question of commitment, what do I believe? How have my beliefs changed and how or where have they remained the same, if they have?

    There are also the scientific questions. How does empirical study, along with our theological or philosophical search, add to our knowledge of how to live a healthy and fulfilling life? What does the research tell us? As the positive psychologists suggest, what does it mean to flourish? How is flourishing facilitated, or does it only come from that inexpressible essence of the individual within? Under what conditions, by whom, and for whom can the pathways to healthy aging and flourishing be lit or ignited, cleared of debris, and maintained? How can the resident meaning within life challenges be accessed? These are a few of the questions I have welcomed, though not definitively answered, in the pages of this text. I pose them here for your consideration.

    As an academic text, this book is written to teach students of counseling, nursing, marriage and family therapy, pastoral care and chaplaincy, psychology, social work, and thanatology about older adults, aging, and spiritual and religious issues. While mental health professionals are the primary intended audience, I also believe this book holds value for people who just want to learn more about aging, spirituality, and religion. Out of my experience teaching for 20 years, I know that individuals learn through multiple formats. So, I have adopted an integrative style of teaching here, describing and explaining aging content, modeling meditations, and providing assignments and exercises that may be surprising to some readers.

    Further, this text is written to an inclusive audience of practitioners or public citizens who consider themselves spiritual, religious, both, or neither. A common category for those who choose to classify themselves outside of any religious or spiritual context is either agnostic, someone who believes one cannot know about the existence of God—or atheist, not believing in God or a god(s). However, those designations do not provide a clear definition of one’s developing identity. The latter groups may resonate with the term secular humanist or something different. In my classes, I suggest to students that it holds greater meaning to define themselves as what/who they are, rather than what/who they are not.

    Why did I write this book? I have carried within me some of the same ambiguities and contradictions that you likely live with. I have written this text to teach you from several levels/perspectives. Thus, you will at times find an academic and scientific voice, at times a spiritual voice, at places, a personal voice. Knowledge is not monolithic, univalent, and thus to learn about a thing, it is helpful to witness its multidimensionality. Achieving a balance across multiple influences and expressions is a challenge, but a goal of this book. I have added a transdisciplinary perspective in Chapter 12, while maintaining focus on the clinical or mental health professions introduced in Chapter 1. I have included important knowledge about specific aspects of aging that mental health or health practitioners need to work with clients, such as expanded or reduced emotional range, depression, anxiety, health issues, and dementia. Issues such as the social construction of identity, forgiveness, narrative work, and the meaning of home and public/private space are featured here. Brief incursions into ethnic, racial and gender/sexual diversity in aging are shown. Exploration of the arts in meeting spiritual and religious needs is discussed. However, showcasing religious and spiritual diversity and traditional and modern approaches to aging is the overarching task. As I concluded the writing of this book, I began to realize that each chapter could have been a separate book and other chapters might have been included. Those explorations must remain for a later time. Overall, I wrote this book because I discerned a need.

    How did I arrive in gerontology? I have benefitted from a multiplicity of careers and interests. I loved learning languages and saw them as a way to topple walls between people. As a student traveling in Europe, I once found myself in a train car among seven other young adults. Although three or four languages were represented, we were able to hold one wonderful and profound conversation with a couple of us interpreting for others. That image remains strongly fixed in my mind. I thought I might work in an international venue, but not seeing myself as a teacher at the time, I began an eight-year career with the airlines, performing multiple kinds of tasks.

    Years later, I began to experience a kind of discomfort with my perfect life. Several times I was assigned to an international flight to Mexico or South America. Spanish was not one of my languages, though it was close to one in which I was fluent. On one occasion, I overnighted from a flight to Maracaibo, Venezuela. My resort hotel room was not one of the ones facing the ocean, but instead, overlooked a hillside dotted with shacks that represented the slums of the city, and through this the poverty of the world. In a pivotal moment of deep incongruence as I sat on my balcony, I realized it was time to do something more with my life. When my schedule allowed, I began with Catholic Social Service in Mesa, Arizona as a telephone reassurance volunteer to elderly people, picking up an earlier undergraduate interest in social services that was filled at the time by a course on rural poverty. Volunteer work reaffirmed my ultimate decision to exit the airlines and obtain a master’s degree in social work at Arizona State University.

    My career as a social worker led to experience in the psychiatric hospital of Maricopa County, Arizona where we treated clients with a wide range of mental health issues including some of the most extreme disorders. From there I became an outpatient mental health case management supervisor and then a counselor with mostly older adult clients in long-term care who were referred to me by either their medical doctor or their psychiatrist. This long-term care psychiatric team offered great learning about the mental health and spiritual needs of older people. Fortified by the desire to learn more about spirituality and aging, I returned to academia for a PhD at the University of Chicago with a specialization in gerontology and religion within social services. From statistics gathered by Jim Lubben, PhD, University of Boston, I later learned I was one of two 1999 PhD graduates in social work with a dissertation in aging.

    My spiritual story began when I was very young. It has been a life’s work to try to integrate that part of my journey in a way that could be visible and would be at least somewhat acceptable to my profession. In that task I was assisted by some wise friends, particularly Dr. Edward Canda, who has been a mentor since my years at the University of Kansas, and Jim Kreider, LCSW, who also mentored me in spiritual understanding. I am grounded in a Christian faith tradition, the Community of Christ, where I was ordained and practice in the ministerial office of Elder today. I continue to learn from my Kansas spiritual group under the direction of our teacher, Renee Brown. Like some of you, I have had some extraordinary spiritual experiences of a mystical nature that have taught me something about the many streams or levels of living and the need to remain as fully awake as possible, living as congruently and truthfully as I can with my beliefs as they evolve. This involves being authentic, living with integrity, and sharing my learning and knowledge.

    Each chapter in this text is organized to include beginning quotations, an introduction to the chapter, material related to the chapter theme, a chapter summary, questions for discussion, a suggested meditation, exercises to explore your spirituality, websites, and additional suggested reading material. Some chapters also have concluding cases and potential assignments. A few chapters have shorter cases within the body of the chapter.

    My hope is that this book will take you, the reader, into a journey about aging and therapeutic practice with older people that relates to and reveals what they deem sacred, spiritual, or religious. My prayer and intention is that this book will open new lines of thinking and perhaps fresh responses for you in your work with older adults. Whether you stand in a spiritual tradition or not, I also hope this material will open a parallel path of dynamic discovery for yourself and your own aging, even if it is only a path to deeper and better-framed questions. Time spent in not-knowing, when you are able to acknowledge the limits of your understanding and give everything over to grace or that sustaining force which you do not know, represents the thin space, the quiet space, of readiness for radical transformation. May this book help bring you to that transformative place.


    There are many individuals who facilitated the completion of this book and for whom I give gratitude. One of the first was Denai Armer, a KU MSW graduate, who believed in this project and volunteered her time at the beginning to help search the literature. Other students who assisted me as graduate students across different terms include Jennifer Johannesen, Susann Ozuk, Eneke Frank Mwakasisi, Amanda Creden, Catherine Stowers, and Leanne Atwell. MSW graduates Lauren Dowden, Caitlin Maruyama, Sarah Hansen, and Mukhayyokhon Azamova provided valuable insights. I also owe my gratitude to the students who enrolled in my spirituality and aging courses, loss, grief, and dying well courses, and the social work and aging courses I taught over a number of years especially at the University of Kansas and Loyola University Chicago.

    Psychologists David M. Wulff and Susan McFadden offered constructive ideas and comments on specific chapters. Loyola University Chicago doctoral student Shveta Kumaria provided feedback on a section of writing, as did Loyola colleagues Shirley Simon and Susan Grossman. Manuscript reviewers to whom I am grateful for their insightful comments include Kathleen McInnis-Dittrich, Roseanna McCleary, and anonymous reviewers.

    I acknowledge the contributions of Alexa Gummow, my daughter and a medical anthropology master’s graduate, who provided me with many helpful suggestions and masterful photos.

    I am grateful for Nathan Davidson and the editing team at SAGE and their support of this book.

    I thank Bill Creed, SJ, who provided spiritual direction for the Ignatian exercises. Finally, I received encouragement from many friends, family, colleagues, and others who helped keep me on course, who modeled some of the concepts I have written about here, and who taught me through their lives.

    Holly Nelson-Becker, PhD, LCSW, Professor & Hartford Faculty Scholar in Geriatric Social Work

    More information at




    Publisher’s Acknowledgments

    SAGE wishes to acknowledge the valuable contributions of the following reviewers.

    • Roseanna McCleary, California State University Bakersfield
    • Kathleen McInnis-Dittrich, Boston College Graduate School of Social Work
    • Ann Verrett Guillory, Felician College

    About the Author

    Holly Nelson-Becker, PhD, LCSW, is a professor at Loyola University Chicago and a Hartford Faculty Scholar in Geriatric Social Work. Her PhD is from the University of Chicago and she obtained a MSW from Arizona State University. She holds BAs in modern foreign languages and in international studies from Graceland University. She is a recognized expert in social gerontology who has investigated the pathways to resilience and well-being in older adults. Her research areas focus on spirituality and aging, with an emphasis on end-of-life concerns and diverse cultural expressions. She helped create national standards for spiritual care in palliative care as one of six writers representing multiple health-related professions, and she is past chair of the Interest Group on Religion, Spirituality, and Aging for the Gerontological Society of America. She served on the National Program Committee for the Hartford Doctoral Fellows Program in Geriatric Social Work. She was awarded fellowship in the Gerontological Society of America in 2013.



    Leave assumptions behind and prepare

    To learn what you never knew and to rediscover what you already know deep inside

    about the spiritual geography of aging.

    Experience the dissonance and the congruence in what is accepted and proven,

    Expected, hoped-for, and given as gift,

    Culminating in the aesthetic endeavor of simply living your life.

    May your therapeutic practice be the art you send into the world.

  • Appendix: Older Adult Definitions

    A discussion of meanings would not be complete without a brief consideration of definitions delivered by adults themselves. The material that follows is a summary of some of the findings from my research. In the following study (Nelson-Becker, 1999), I invited older adults (n = 79) to identify up to three of the most difficult problems (called “life challenges” in the study) they had faced in their life. I asked them how they coped with these problems and analyzed both life challenge and coping responses using qualitative methods. I then asked them separate questions about the importance of religion and spirituality in their lives, using a 4-point Likert scale. Table A.1 illustrates how they defined their stance toward each.

    Table A.1 Participant Ratings of the Importance of Religion and Spirituality in their Lives (n = 79)

    Brief Look at the Sample

    The participants in this spiritual and religious coping study were primarily African American (AA) and Jewish American (JA; Nelson-Becker, 2005). There were many kinds of views expressed. This sample was community dwelling and tended to be generally healthy. Age range was 58 to 92, with a median of 78 years. Out of the 79 older people, 66 were female, 37 were JA and 42 were AA. Ninety percent of the sample earned less than $15,000 per year. Table A.2 describes the sample.

    Patterns in synagogue/church attendance varied significantly among participants. Only 8% of Jewish American respondents attended synagogue/church weekly or more, in contrast to 50% of AA respondents who attended religious activities weekly or more. Fifty-four percent of Jewish American respondents reported they never attended synagogue/church; 17% of AAs never attended church. Religious affiliation of the total sample included 16% Baptist and 24% Jews who attended synagogue. See Table A.3 and Figure A.1 for the range of religious denominations. Twelve denominations were represented, including African Methodist Episcopal (AME), Catholic, and Buddhist.

    Table A.2 Sample Demographics (n = 79)

    Table A.3 Religious Affiliation Characteristics


    Percentage of Total

    No Affiliation




    African Methodist Episcopal

    Apostolic Church of God




    Community Church

    Congregational Church

    Jehovah’s Witness

    Jewish (attending)

    Jewish (cultural, nonattending)

































    Figure A.1 Sample Religious Affiliation by Percentage (n = 79)

    One limit of the study was that this was not a large dataset; however, it was large for many qualitative studies, which tend to have sample sizes of 40 and under. The rich specific wording of their beliefs would not have been easy to capture in a quantitative study. A sample of respondent definitions was independently validated by a peer reviewer to ensure rigor.


    The following common themes are discussed below: religion is belief or trust, something personal, right behavior, moral code, heritage, faith, and a particular way of thinking. Some criticism of religion as insincere and not true to its teaching was also expressed by participants in the study.

    Religion is Belief, Trust in God

    While religion as an institution has value, many older adults separated personal belief from institutional doctrine. “Religion is a belief in God. To me it’s trying to live the best you can, doing the right thing for everyone. You don’t hate,” advised one AA woman. “There are so many different religions, you know. I think some religions are phony, not true to what they say. I believe in God,” asserted another AA woman. A third AA interviewee distinguished between religion and trust. “Religion is only a duty. I don’t accept religion. I would say, ‘Trust in the Lord and He will make everything alright.’ You have to have faith.” The AA respondent below identified several components of religious faith.

    I suppose believing in basic principles that develop your heart mind, soul and body. It’s something you believe in strongly and get satisfaction out of practicing. That’s about as deep as I can go. I believe there are so many different faiths and I get something out of all of them that I have intertwined with . . . I don’t believe there is any perfect one. If you believe in something, it helps give you satisfaction. You treat people better. You have peace within yourself and peace and harmony among people. That’s the bottom line. You have peace within—you can still cope with whatever is going on around you. You can have love . . .

    Something Inside, a Feeling in the Heart

    The following AA woman suggested there are many shared aims across religious faiths.

    Religion comes from your heart. Your belief. That’s my religion: my belief. I believe a Catholic has as much religion as a Baptist. I believe a Baptist has as much as a Methodist. They all read the same Bible; they all worship the same God. I believe a German, a Japanese or a Chinaman [sic] has just as much religion as me. How can I explain it? Nowadays people keep changing from one religion to another. It’s got to be within you. God is God. He’s spirit. It’s universal. That’s your religion.

    A JA woman described religion as something from the soul as well as belief, but she seemed to be employing the term belief as faith.

    Religion is something that comes from your own soul that has nothing to do with Bibles and temples and magnificent churches. It’s a belief that either you form or you don’t form, but it doesn’t depend on your background. It depends on you as an individual. I believe in God, personally, as much as I believe in nature. So name your own God. It’s what you believe in.

    Right Behavior, Moral Code, Opportunity to Socialize

    An AA woman highlighted the value of the code of behavior that many religions teach. “The way I look at religion is being truthful to yourself and being truthful to anybody else. I try to live my life in such a way that I treat everybody the same way I would love for them to treat me.” A Jewish American male recognized hypocrisy in people who would use religion for secondary purposes:

    You’d be surprised how many people call themselves Catholic or Jewish but they are falling away. They don’t practice it. People have various ideas. They go to church for various reasons. People move into town and go to church to get acquainted, for socializing—that’s a big point.

    Religion as Heritage, Faith

    One JA woman mused on her own relationship to religion and her history of sustained religious practice.

    Sometimes I believe in it and sometimes I don’t. I go to temple on all of the holidays; that’s something I’ve been doing all my life. But I don’t know if I believe in it because if there was a God in heaven, he wouldn’t do the things he does. Wars and—He wouldn’t give so much sorrow to so many people. They call it the golden years, but I don’t know what they meant.

    Religion as Insincere

    Similar to the woman above, another JA woman expressed conflicted feelings about her own relationship to religion. Further she expressed doubts about the ability of religion to assist people in dealing with problems.

    I’m not raised a very religious person and yet I guess I am. I don’t know. I’m not religious I guess because I don’t go to church, but I have a very bad attitude about religion. I think religion has become a very commercial type of thing. I look on religion frankly as a crutch. I think it’s almost as bad as the guy who believes his answer lies at the bottom of a whiskey bottle is the guy who believes the answer lies at the cross.

    Lastly, a JA woman summarized her own views by deliberating about the darker side of religion.

    Finally, in the name of religion, more people have been killed than in any other cause on the face of the earth. It’s an excuse for money, power and to keep people mollified. I do not believe in any omnipotent being. I never will. It’s all right here. Make the best of it.

    Table A.4 Content Analysis of Religious Definitions (n = 79)



    Belief * (8)


    Personal, within, comes from your heart* (14)


    Doing the golden rule* (4)




    Faith * (1)


    Basic principles, a guide


    A way of thinking




    Going to synagogue, church


    Denominations don’t matter


    A con game, a make-believe story


    Involvement in community




    Never discuss religion




    * The number in parentheses denotes the same definition given for spirituality.

    ** Represents rounding error.

    This illustration of respondent viewpoints provides a perspective on the span of ideas expressed. These older adults, representing two different ethnic groups, twelve faith or philosophical traditions including Buddhism, and two types of nonreligious positions, generally held stances of acceptance towards other faiths. Religion was meaningful to them through self-referencing their own belief system. While many saw the value of religion, they could also be somewhat cautious toward religion and suspicious of religious leadership. What is important to note is that their views on religion were not stereotypically what some people would assume of an aging population: blind, unexamined faith. See Table A.4 for further information about the themes and percentages of endorsements for each theme.


    Older adults in the same study cited above found it more difficult to define spirituality and especially to distinguish it from religion (Nelson-Becker, 2003). For many older persons, this term was newer and not part of their lexicon. Some older people thus gave similar responses for spirituality that they had provided for religion, or could not say what it was at all. Major themes were a feeling in the heart, connection with God, beliefs, relationships, and forgiveness. The individual quality of spirituality and connection with nature were also noted by several people.

    A Feeling Inside, In the Heart, Embedded in Being

    Several respondents spoke about the numinous quality of spirituality and an intimate connection with Spirit. One AA woman explained,

    The Spirit sometimes tells me to do or not to do something. It’s in my mind. And sure enough if I don’t do it, I be so happy that I didn’t do it. Because something [would have happened] that I would have been very unhappy about. I call that spirituality.

    “Spirituality is embedded in your being, in your soul,” reported another AA woman. Another response included, “Spirituality comes from the heart. You have to believe in it very deeply.” A woman from a JA couple who reconnected with their religious heritage after immigration from Russia stated simply and eloquently, “It is my soul.” An AA woman who was also a minister in a storefront church related her thoughts.

    Spirituality is something you think—something within. That’s the way I feel about it. It’s different from religion. Religion is a big word; spirituality is something within. As you know we’re made up of three parts: spirit, soul, and body. The body is the outer appearance; the temple of God is within you.

    A JA female instructed,

    Spirituality is a gift. And not everyone is blessed with having it unfortunately. It’s not that it isn’t there, but it is a gift. Sometimes you are born with it. Sometimes you come by it through various means. Trials and tribulations give a lot of people spirituality that they might never have come by.

    Connection With God

    “Spirituality is being in tune with the Higher Presence,” stated an AA female. A different AA female reported, “I think my relationship with God helps me solve problems. Only by believing, it gives me peace and comfort.” Another AA female suggested what she saw as a key characteristic of spirituality and then distinguished it from religion. “Spirituality is the knowing of God and feeling his presence. Believing him. Religion is just attributes of it—like going to church.” A JA female explained spirituality directly in terms of a connection, “There are times when you feel spiritual but not especially religious. You connect.” [Researcher: “What is it you connect to?”] “You connect to another Higher Being. I can’t explain it. Only from the standpoint of I have felt it.”


    Similar to definitions specified for religion, belief was prominently mentioned. “Spirituality is a teaching, a learning, a self-feeling, your beliefs,” offered one AA female. “Spirituality is belief in a thing,” affirmed a JA female. An 89-year-old AA female who suffered from chronic health problems and pain, especially in the morning, postulated,

    We each one of us come along with a different spirit and a different life. I can’t get angry at you because you believe in this religion and I believe in that one. There is but one God. We have to turn around and say, Hey, ain’t but one God so we all got to depend on Him because He’s the one who’s made this world and made it so beautiful for us to live in. Some mornings I get up and look out there with all those beautiful colors. Man didn’t do that. God did it. So we’ve got to be thankful. Maybe I might not be thankful this morning but I’ve got to get to it this afternoon.

    “What is spirituality? I know the difference between right and wrong. If I do wrong it bothers me. I have a very deep conscience,” admitted one JA female.

    Relationships and Forgiving

    Constructing and maintaining relationships was another area where older adults spoke about how spirituality was included. “I believe spirituality is to be forgiving. That’s all I can say,” detailed a JA female. Others spoke about friendships with “soul-friends” who would listen to them deeply as they would listen in return.

    “Connection with nature.” A JA female who was a Holocaust survivor stipulated,

    Spirituality is more in touch with nature, the soul, the better part of a human being. Being whole and not necessarily having a religious belief, being in tune with nature. Nature gives me a lift. What I see out my window [the lake] gives me a sense of eternity and my place in it.

    A second JA female who described herself as an atheist articulated her thoughts as follows:

    I would say that it’s a form of communication with nature, or natural things or other creatures of the earth. I think man as an entity treats other living beings in a horrifying manner. Really. We destroy everything we touch. I think spirituality is the ability to communicate. Communication is the essence of human endeavor.

    Struggle to Distinguish Between Spirituality and Religion

    One AA male suggested, “I can’t think of a definition. I don’t know. Spirituality and the way you deal with things, as opposed to a set building. I think that’s religion. Go over there and sit down in a pew and pray.” An AA woman told me, “I’d give the same answer as for religion.” A JA male answered, “I don’t know what spirit is. Religion was built into me from day one.” “‘I haven’t the slightest idea,’ would be my answer,” verbalized a JA woman. “Spirituality? That is religion,” firmly instructed a second JA female.

    Overall, while some older respondents expressed a clear understanding of spirituality and how they saw it separately from religion, a fairly large number of individuals either did not distinguish it, found the term confusing, or just couldn’t say what it was (see Table A.5). In a sense, the perspective individuals provided represented their practical philosophy for living. Although I was asking for definitions and meanings, what people gave me was the life philosophy that they had built over many years and circumstances that represented their way of being in the world. It felt like such a privilege to be invited into what existed as private space and to be generously given what felt like intimate responses.

    Table A.5 Content Analysis of Spirituality Definitions (n = 79)



    A feeling inside, in the heart, embedded in Being*(14)


    Connection with God




    Relationships, forgiving


    Same as religion


    The way you live*(7)


    Individuality, what you think


    Communication with nature


    A higher form of something


    I avoid these conversations


    Don’t know




    * The number in parentheses denotes the same definition given for religion.

    As I asked about their interest in talking about religion and spirituality, individuals told me that had I not directly asked, they would never have spoken of such things. This provides evidence for the value of asking about religion and spirituality in assessment with all older people. If they are nonreligious and nonspiritual and their views about these domains are not a problem for them, then nothing further needs to be addressed in this area. Several people who I had earlier invited to participate and who had declined at the time, asked to be included later in the study. I was told this occurred due to the safe space created for previous interviewees. This seems to emphasize the importance of the therapeutic relationship, perhaps even revisiting religion and spirituality later in the relationship once an individual feels more comfortable. At any age, it appears that people enjoy reflecting on and responding to the deep questions that reappear across the centuries.


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