Original articles Elisabeth Assing Hvidt, Hans Raun Iversen, Helle Ploug Hansen

Belief and meaning orientations among Danish cancer patients in rehabilitation A Taylorian perspective This article proposes Charles Taylor’s secularization theory as presented in A Secular Age (2007) as a useful tool for interpreting empirical data on cancer patients‘ meaning orientations during rehabilitation. The data is taken from a qualitative project on Danish patients‘ self-reported secular existential, religious and/or spiritual orientations. The authors will show how concepts that lie at the heart of Taylor’s secularization theory, such as „fullness“, „the immanent frame“, „cross pressures“ and „porous and buffered selves“ offer interpretative space for the data. It will furthermore be argued that the analytical findings of this study, situated within humanistic health research, can make an important contribution to ongoing secularization theory by showing the complexities in meaning-making processes that exist for secular Danish cancer patients in rehabilitation. Secularization theory, Charles Taylor, modernity, meaning-making, cancer rehabilitation, patient perspective

Introduction The debate generated by Charles Taylor’s magnum opus A Secular Age indicates in itself that this work marks a turning point in the last fifty years of secularization debate (Nagl 2009, Warner 2010, Schweiker et al. 2010, Joas 2009, Gordan 2008, Admirand 2010).1 So far, however, only little has 1 Responses to A Secular Age have been most widespread in philosophical and theological circles. A search on A Secular Age in the database „Philosopher’s Index“ resulted in 39 articles and a specific search using „Charles Taylor“ and A Secular Age as se-

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been done to use and discuss Taylor’s theory in the light of empirical findings from current studies, and this we shall attempt to do here. Taylor has two primary points of departure. Firstly he deals with the current ways in which secularization is undersarch terms resulted in 14 articles. In this context I have only included selected references found in „Web of Science“. Political scientist Ruth Abbey runs a web-based bibliography of Taylor-related material see: http://nd.edu/~rabbey1/. See also the response to Taylor’s book on a blog called „The Immanent Frame“: http:// blogs.ssrc.org/tif/2007/10/19/secularismof-a-new-kind/ ….

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Original articles tood, making reference to religion as 1) that which is retreating in public space and 2) a type of belief and practice that is in decline. Integrating these two understandings of secularization, he offers a third sense, which focuses on the shift from a society where belief in God is taken for granted to a society where belief in God is merely one option among many (Taylor, 2007: 2). Examining secularization in this sense, he focuses on what he calls the „conditions of belief“, which include the whole „context of understanding“ or background framework within which we accept or reject belief in God. According to Taylor, what secularization has brought about is a change in context from that which existed before the rise of modernity – the context in which we experience and search for beliefs both of a transcendent and immanent, religious and irreligious nature. „Secularity in this sense is a matter of the whole context of understanding in which our moral, spiritual or religious experience and search takes place“ (Taylor, 2007: 3).

We have moved from a condition of immediate embodied certainty to a condition of uncertain disembeddedness, a development that Taylor calls „excarnation“ and which he describes as „a transfer out of embodied, ,enfleshed‘ forms of religious life, to those which are more „in the head“ (Taylor 2007, p. 554). Despite this changed condition, Taylor argues, the modern secular individual is still experiencing autono-

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mous religious and/or spiritual aspiration (Taylor 2007, p. 515–16). Secondly, Taylor develops a comprehensive analysis of the development of the history of ideas and conditions for meaning-making during the last five hundred years in Western societies. This historical analysis serves the argument that conditions for meaning-making by the individual have changed dramatically since the Renaissance and Reformation: „It is a crucial fact of our present spiritual predicament that it is historical; that is, our understanding of ourselves and where we stand is partly defined by our sense of having come to where we are, of having overcome a previous condition“ (Taylor 2007, p. 28).

Taylor offers only scarce contemporary material, however, in order to illustrate his theories. This article has a twofold purpose: 1) To show that Taylor’s theory regarding the existential condition for meaning-making of the modern secular individual is potentially an aid in analyzing and interpreting empirical data on the secular existential, religious and/or spiritual meaningmaking of Danish cancer patients in the context of rehabilitation. 2) To show that the findings of this study can contribute to ongoing secularization debate by pointing out how far Taylor’s theories can help us understand the complexities of secular existential, religious and/or spiritual meaning-making in secular societies.

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Original articles Following an outline of the existing research that inform the project, we present the research design and methods. Hereafter follows a section where the main concepts of Taylor’s secularization theory are used to analyze excerpts from the empirical data. Lastly there will be a discussion of what the findings of this study can contribute to a sociological enterprise: the development of secularization theory.

Existing research This study is informed by two research fields: 1) religious/spiritual coping and illness (Pargament 1997, 2002, Ano and Vasconcelles 2005, Koenig et al. 1998, Koenig 1997), specifically research on the relation between existential, religious and spiritual meaning-making and illness adjustment, and 2) the past thirty years‘ re-evaluation of secularization theories in the sociology of religion (Bruce ed. 1992, Swatos et al. eds. 2000, Hunter ed. 2006, Martin 2005). Many studies conducted in a US health setting find that cancer patients rely on religious and spiritual strategies in order to find meaning in their cancer experience (Halstead and Fernsler 1994: Norum et al. 2000, Cigrang et al. 2003, Bloom et al. 2004, Thune-Boyle et al. 2006). These findings can to a large extent be explained by the fact that religion and spirituality prove to be prominent in the lives of US Americans, as indicated in the nationwide World Value Study (WVS), according to which 83 % of adults find religion very

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or fairly important and 60 % attend religious services at least once a month (la Cour 2008). Research-based knowledge about religious and spiritual coping patterns during illness and crisis is sparse in research settings in Denmark, and indeed, in Scandinavia as a whole – a condition that may be explained by Denmark’s significantly lower scores on the same items when measured comparatively in the WVS. 47 % of adults find religion very or fairly important and 27 % attend religious services at least once a month (Andersen et al. 2008, la Cour 2008). Although such studies reveal interesting quantitative findings about certain expressions of religion in late modernity (e.g. belief in traditional dogma, frequency of religious practice etc.), such general religious dispositional variables say little about the specific secular existential, religious and/or spiritual meaning orientations that people are likely to employ when dealing with cancer. From international research we know that expression of faith and the need to believe proliferates in connection with life-threatening illnesses, including cancer (Halstead and Fernsler 1994, Norum et al. 2000, Linley and Joseph 2004, Calhoun et al. 2000). Such findings should be treated with caution, as they primarily reflect the situation in a dominantly religious society, namely US. When people in secular societies are confronted with life-threatening illnesses such as cancer, what meaning orientations do they hold on to? Or which coping strategies do they

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Original articles make use of? Research aiming at answering these and similar questions is still sparse, although there is a growing interest in investigating meaning orientations utilized in Scandinavian societies in connection with illness (Calhoun et al. 2000, Ahmadi 2006, Pedersen et al. 2007, Hvidt 2008, la Cour and Hvidt 2010). Conventionally, findings from quantitative surveys such as WVS and EVS (the European Values Study) would lead us to presume that religious and spiritual cognitions and practices would be of little or no significance to Danish patients. We would also presume that secular existential meaning-making centering on the meaning of life, freedom, loneliness and death would be particularly meaningful to Danes in that they are embedded in a secular culture where traditional religious meaning systems and explanatory models have been declining. A recent Danish study of existential meaning-making has sought to investigate whether Danish patients admitted to hospital intensify their existential and religious thoughts. Although there may be marked differences in religious intensity between American and Danish patients, the result of the study shows that we should no longer presume that religion and related existential thinking is not a viable option for Danish patients from a secular background. The study finds that during illness Danish patients do intensify their existential and religious thoughts – thoughts about the purpose of life, about beliefs, about life and death (la Cour et al. 2008). The ex-

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planatory logic behind these findings can only be surmised. One explanation suggested in the research literature is, that regardless of existential and religious persuasion, the need to create meaning is essential to the human psyche and that this need becomes more pronounced when a person is confronted with crisis and life-threatening illness (Lavery and O’Hea 2010, Sorajjakool and Seyle 2005, Silberman 2005, Emmons 2005). If we go along with this assumption, there is reason to believe that there is more to the Danish religious landscape (especially that of Danes who are struck down by illness) than can be extracted from quantitative statistical findings such as EVS/ WVS. The secularization theories dominating the sociological scene for the past fifty years have largely based their predictions of religious decline on statistical findings. They have tended, then, to focus on religious decline as an integral part of the process of modernity. Such assumptions have been modified in various ways, in particular the assertion that secularization has not caused the disappearance of the need to believe for modern secular individuals (Hunter ed. 2006, Dobbelaere 2002, Davie 1994, 2007). Religion has survived the modernization process – has thrived in some respects – but nevertheless something has happened that makes it difficult to talk about and relate to the transcendent (Hervieu-Legér 2006). Social scientists have for the past two decades focused primarily on describing the change in forms and elements in religion in modernity. Tay-

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Original articles lor’s historical narratives and analyses of secularization used in this article offer a deeper understanding of the changed selves of individuals in modernity and how they relate to, experience, and search for belief alternatives.

Research design and method The empirical data was generated by the first author of this article at a Danish cancer rehabilitation centre RehabiliteringsCenter Dallund („Dallund“ hereafter), located in the northern part of the island of Funen. In 2001 Dallund was rented by the Danish Cancer Society and receives annually between 600–700 cancer patients for a one-week residential course. The courses are basically structured in the same way with a few variations depending on the theme of the week (this might be „Women with breast cancer“ or „How to overcome discouragement and depression“). Each course holds around 20 participants, who have been referred from their GP or hospital doctor. The majority (84 %) of participants are women most of them with a breast cancer diagnosis. The week-long rehabilitation intervention focuses primarily on information, education, physical training, psychosocial care and meeting other cancer survivors. The staff at Dallund is made up of nurses, physiotherapists, a social worker and a number of externally associated experts such as a dietician, a psychologist, an art therapist and a chaplain.

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Assing Hvidt carried out a fieldwork study involving participant observation and informal interviews. The fieldwork also included 11 semi-structured interviews conducted in the private homes of the participants 1–2 months after the one-week courses and five focus group interviews conducted during the courses with 3–8 participants from each group (2 groups with 3 participants, 2 groups with 7 participants and 1 group with 8 participants). The interviews lasted 1–2 hours and were transcribed verbatim shortly after the interview had taken place. The interview guide was designed using results from an earlier pilot study, from observations made during participant observation (field notes), and from the existing research literature. The participant observation took place during the course of a total of seven residential course weeks. The researcher initially took part in all the scheduled activities including physical activity, lectures on disease complications, nutrition, sexuality, etc. Later she limited participant observation to those timetabled activities that were found to be particularly relevant to the research topic. These were activities where secular-existential, religious and/or spiritual orientations were most likely to be expressed by the patients such as 1) the presentational round scheduled for the day of arrival, when the participants provided demographic information about themselves, shared their illness history and talked about their motivation for participating in the course and about their expectations for the week; 2) group sessions toget-

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Original articles her with the psychologist dealing with the existential and psychological dimensions after cancer; and lastly 3) the chaplain’s weekly talk on existential, religious and spiritual issues in the wake of a cancer illness, followed by an opportunity to ask questions. Field notes were taken during and after participant observation. Meals and other breaks in between the scheduled activities were also found to be relevant. They created opportunities for social relations and informal interviews, which paved the way for the interviews. Selection of participants for the interviews was informed by the participant observation. Participants who showed an interest in the research topic during their time either with the psychologist or the chaplain or during non-scheduled activities were asked if they wanted to participate in an interview. Participants who themselves showed interest in participating were also selected. The interviewees of the focus group interviews were made up of participants who had written their name on lists indicating that they wanted to participate. For both interview methods the selection technique can be characterized as purposeful selection (sometimes called criterion-based selection), which is a selection strategy particularly useful for reinforcing analytical generalizations (Maxwell 2005: 88; Buus et al., 2009). It is worth noting certain points of criticism that might be raised of the focus group method and that may raise questions as to the validity of the data. It could, for instance, be argued that the focus group

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is less able to foster an atmosphere of confidentiality between interviewer and informant than the one-to-one interview, and that group interviews can give rise to undesirable group dynamics, where individuals dominating the group discussion can create conformity (Rosen 2009, Patton 1990). In this particular study the focus group method was found very helpful in identifying as broad a variation of meaning orientations and experiences as possible and in creating a sense of synergy, in which the interviewees became curious about each others‘ beliefs and challenged each other’s interpretations. What was learned from the interviews was that the belief and meaning orientations were part of a tacit knowledge, which in many cases had not been revealed or articulated prior to the interviews. Bringing several people together meant that the participants formulated ideas and thoughts out of a borrowed vocabulary that might not otherwise have been at their disposal. In keeping with the core principles of qualitative data analysis, field notes and each interview transcript were read in their entirety several times in order to become familiar with the data and to gain a sense of the participants‘ experience as a whole (Maxwell 2005, Bernard 2009). The left-hand margin of the transcripts was being used to annotate what was found to be significant or interesting in what the informants said with a special attention to statements in which informants expressed belief and meaning orientations. This process was continued for the whole of

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Original articles the transcript and could be caracterized as „basic coding“ that was still grounded in the particularity of what was being said by the informant (Bryman 2001). Following this stage where the transcripts had been read as theory-neutral as possible it became clear that Taylor’s theory and key concepts were well suited as tools for analysis. The transcripts were then read in the light of the chosen theoretical framework using the right-hand margin of the transcript for notes that made connections to theoretical concepts. Thus the analytical strategy can be caracterized as primarily deductive with a mindful awareness of not just reducing the empirical statements to illustrations of the chosen theory but also reading and analyzing them in their own right (Hastrup et al. 2011). In a like manner the excerpts presented below were selected through a strategy that took into consideration both their illustrative and unique value.

Fullness Taylor argues that every individual has his or her version of „fullness“: „Somewhere, in some activity and condition, lies a fullness, a richness; that is, in that place (activity or condition) life is fuller, richer, deeper, more worthwhile, more admirable, more what it should be“ (Taylor 2007, p. 5).

„Fullness“ is thus understood both as a condition and as an activity, having as its source orientations that are both immanent and transcendent, religious

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and irreligious and with the process of meaning-making as its centre (be it conscious or unconscious). At the heart of „fullness“ lies a subjective experience, but fullness is not merely an inner state but is also understood to be objective – the way the world is thought to be, at least occasionally. In using the concept of fullness, Taylor’s ambition is to challenge the conventional understanding of belief and to capture all those feelings of connectedness and intensified belonging, both to the world and to the hereafter that many modern people have. When asked about their secular existential, religious and/or spiritual orientations, the informants were often referring to a sense of something larger in life – identified as either the divine, God, a higher power and nature – and something deeply meaningful in life, such as love, compassion, solidarity and peace. This sense sprang out of intuitive and subjective feelings and experiences, reflecting on one hand their meaning orientations (be it secular existential, religious and/or spiritual) and on the other their epistemological criteria for knowledge about the world: „… As long as I can feel that the divine is present, then I feel comfortable, well, it … well it isn’t, well, I would wish, that it was a greater part of me, or I know it’s important that it is a part of me, the divine, and also the way in which I consider life, I would like that, well, that it has that aim, in one way or another, right? …“ (Karen)2

2 The listed names of the informants are all fictitious.

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Original articles „Now I am happy, because I am at peace, and that is a state of there not being anything that hurts or jars or seems wrong, and that’s real happiness, and it can last five minutes, it can last two hours, I am also happy now (smiles) …“ (Ann-Margit) „I say the Lord’s Prayer every single night and if I forget, then I get up again, I have to do it, and I have always done it, prayed for my children and grandchildren, I can’t do otherwise … if I have forgotten it, then I feel like hell … I mean, I really must, and I love to go to church, I don’t do it that often, but I feel so peaceful when I go to church, yes, I really like that …“ (Marie).

Karen is talking about the presence of „the divine“. It lies within her – as an immanent source – that she wishes to be filled with, because it gives her comfort and orientation in life with fellow human beings. As with Taylor’s „fullness“, Karen senses the presence of „the divine“ as a feeling of richness and comfort, a condition that she strives for because it makes her life fuller and more worthwhile. Taylor’s fullness can derive both from an immanent source that is within the individual as a personal life force and from something that is beyond the individual and separated from it. Ann-Margit is describing a state of mind obtained through her God consciousness whereby she feels peaceful and happy. Marie obtains the feeling of peace through prayer and going to church. For a couple of the informants who confessed traditional beliefs in the Christian God, the God relation gave them a feeling of being loved and cared for to a point where a life without God would be without hope and meaning:

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„Well, I discover that God loves me also – even though I’m ill, all right. And I believe in that. And that keeps me going. Because if I don’t believe in God, well, then life wouldn’t matter, whether I am alive or not, then it wouldn’t matter, then we could just as well jump in the river tomorrow and say, I won’t bother to waste my time on this anymore, but um, I can’t recognize that.“ (Finn) „To me what it means to be a believer is that you are not able to let go, because someone is holding you firmly …someone is holding me, right? And drags me along, and if it wasn’t like that, well, then I don’t know what would have become of me, you know, but there is someone, who is pulling me, yes …“ (Inger) „To me religion has meant the difference between hope and hopelessness … It meant that, when I got my diagnosis, at that time I was 33 … I felt like a little kid who had fallen down an abyss, and I could jump a little way up the cliff wall, and I could see some light, but all the time something kept coming and pushing me down again, and there I stayed for a long time – completely crushed and annihilated. And it was not until …um …it was not until the gospel was preached to me, if you can put it that way, that I got to the top, so to me it was crucial.“ (Tina)

In the above excerpts we can see that what lies behind the traditional beliefs is a subjective feeling of a divine being that is loving and caring towards the individual during illness and hardship. Following Taylor, this feeling can be characterized as a fullness connected to the traditional Christian beliefs of the individual. The beliefs held by the informants were to a large extent part of a tacit knowledge resulting from the embeddedness of each individual in their culture and language. Thus the sense of something larger and more

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Original articles meaningful in life, which the informants were describing, was drawing on fragments of former belief systems dating back from their childhood and now being experienced at a deeper and more reflexive level: „I went to church, I mean I sang in that church for seven years as a child, and I return to it thirty years later, and I have also found, the man I was living with, he was the organist at that church, so I was pretty attached to the church and familiar with the rhythm, but um, and I have also gone to church in Viborg Cathedral as a child, I mean also on my own, Christmas Eve, but I have just been living this in another way …“ (Ann-Margit) „So I had some conversations with a vicar, where we were praying together and where he taught me to pray and where we had quite a lot of conversations about what it’s like to be ill and also what it’s like to be in a situation where you stand face to face with a situation where you don’t know how it’s going to end, and this has also meant that I go to church more often, I was connected to the church beforehand, because I sang in a gospel choir and I still do, so it’s not that I’ve never gone to church, but it means more to me now, and it’s just as M describes it, that I can easily get up on a Sunday morning and go to church on my own, and no priest has told me to do so …“ (Mette)

Ann-Margit’s religiosity has developed from a kind of religious heritage that has been kept at a distance until she finds herself in a situation of illness and crisis, where religion in some form is being reconsidered. To Mette the motivational force to reorient herself towards religion is the uncertainty that her illness entails. Her religiosity is building on former cognitions and

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practices from a past religious enculturation and is now being shaped anew in her present situation. In the above we have given examples of what was found in the data reflecting a sense of something larger (God, the divine) and more meaningful in life (hope, peace) which was closely related to a meaning-making process that had arisen in the confrontation with the severe cancer illness. We suggest that the nuance and variation of this sense is captured by Taylor’s concept of „fullness“, which is much broader than that of „belief“. Thus praying, reading the Bible, going to church as well as a subjective feeling of peace, of connectedness with something within or beyond the self or of a divine presence can be said to reflect fullness as it is described by Taylor. We have also argued that it is useful in capturing the subjective side of a belief. In the examples given above, it can be seen how to some the experience of transcendence is still an important orientation in a secular age. In the following section we shall look at the framework within which this experience – and also, maybe mainly, the experience of unbelief – takes place. According to Taylor, both the openness and closeness to a transcendent source takes place within what he calls „the immanent frame“ – a background context, which conditions the individual’s choice of and relation to fullness in both its religious and irreligious version.

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Original articles The immanent frame – from porous to buffered self Taylor argues that the result of the secularization process is a shift in the condition in which the individual seeks (and finds) fullness, rather than an elimination of fullness altogether. The shift to our current conditions for relating to belief and unbelief is common to all of us: each individual’s understanding of fullness takes place within an „immanent frame“ (Taylor 2007, p. 543). This is not so much „a set of beliefs which we entertain about our predicament … rather it is a sensed context in which we develop our beliefs“ (Taylor 2007, p. 549). The immanent frame becomes part of the unquestioned background, something that conditions, largely unconsciously, the way we think about and understand our life in this world. Taylor sees the immanent frame as a result of „disenchantment“, which is to be understood as the dissolution of the „enchanted“ world of spirits and causal forces, which has given way to the reliance on science and instrumental reason together with the development of what he calls a „porous self“ into a „buffered self“ (Taylor 2007, p. 539) These respective identities can best be explained by a shift in epistemological outlook: for the buffered identity, spirits and causal powers are not matters of fact in the outer world but constructions of the mind. A new sense of the self and its place in cosmos has thus emerged: not open and porous to a magical and spirited world, but

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bound to a modern self, capable of rational control, and drawing clear boundaries between meanings that are only in the mind or in the physical world outside (Taylor 2007, p. 38–39). Along with the development of a buffered self came a rich understanding of interiorization, self-examination and authenticity (Taylor 2007, p. 539–540). In the previous section we showed how some of the informants experienced what Taylor calls fullness as being linked to a transcendent source, God. Using Taylor’s terminology, we could say that they were living the immanent frame as open to something beyond (Taylor 2007, p. 544–556). To some of these individuals the reference to God made the best sense presumably because of a former religious-theistic enculturation and education. According to Taylor, in our secular age there are multiple positions that live the immanent frame as closed to something beyond, since their moral and scientific orientation has foreclosed it. One male interviewee to whom there is nothing beyond the „natural“ order exemplified Taylor’s closed take on immanence: „I don’t believe that there are some higher powers that kind of rule things apart from nature’s own powers, which represent the divine … I believe in those powers that nature has, they are incredibly strong …“ (Bent: focus group 2, l. 203)

In this statement we find a clear adherence to the idea that we human beings are part of an order of nature; we arise from it and do not transcend it. We also sense a kind of tension in this discourse, since on one hand it

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Original articles stresses that in nature, scientifically understood, there are no mysteries, nothing divine. On the other hand, there is a strong sense of mystery, of something divine and powerful in inanimate nature. This immanent and materialist orientation functions as an alternative source morality to God. Taylor argues that to those who live the immanent frame as closed, the conclusion is that one can no longer believe in God and be a rational being at the same time – a position that does not arise from scientific „facts“, but from a certain moral and materialistic outlook that includes values such as disengaged reason and impersonal order which generate what he calls „exclusive humanism“. Taylor argues that the development of exclusive humanism or atheist humanism, which he understands as „accepting no final goals beyond human flourishing“ (Taylor 2007, p. 16) have for the first time widened the range of possible options and ended the era of naive religious faith. It has involved a significant „anthropocentric shift“ that has limited the place of the transcendent in human life. God’s demands are no longer beyond or above everyday existence but reduced to the achievement of human good. The withering of transcendence opened the way for a viable conception of fullness to be conceived without need for a divine reference. One of my male interviewees, Jens, could be said to be a representative of such a secular existential order that is without reference to God.

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„I believe in the energy that is within me, that I can find some powers to carry on with, I can find something positive in being something to other people … I am a product of my own destiny or activity or energy, that I can, I am happy, if I can make other people happy“ (Jens: Focusgroup 2)

According to Taylor, beliefs within the immanent frame may take other forms. Apart from the closed stance on immanence that opts for the ordered, secular existential universe, e.g. as something scientific materialistic or exclusive humanist, there are those who „feel the imminent loss of a world of beauty, meaning, warmth as well as of the perspective of a self-transformation beyond the everyday“ (Taylor 2007, p. 592). Among the informants there were those who called themselves „spiritual“ and believed in their inner strength. They stated that they were shaping their own spirituality according to their needs and purposes: „I am a very spiritual person who um, who lives very spiritually um … and um … what is spiritual to me is not necessarily spiritual to other people, but to me, it’s very spiritual … I believe that one, that one’s God looks the way you yourself want it to look, that it’s important that you define your own God the way you want it so that it makes sense to you.“ (Ditte)

To Ditte only what is being experienced as true and authentic is worth believing in. Bent, who was earlier expressing what we, using Taylor’s concept, have called a closed immanent stance, stated that we can never determine the truth of someone else’s belief:

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Original articles „It isn’t something you can prove, of course it isn’t, because we are not able to prove that the thought that I have is the right one, not at all, I mean we all have to find out what we believe in and what we find to be the truth, right.“

The quotations above show personal convictions that could be said to arise from what Taylor calls „a culture of authenticity“ (Taylor 2007, p. 475). In line with values such as self-expression and selectivity, people have to discover and choose their personal belief route, making choice a prime value. In line with other sociologists Taylor points to the fact that the 60s marks the climax of an expressive and individuating development that led to a loss of commitment to previous, traditional religious forms and practices (Taylor 2007, p. 473). Some of the informants exemplified this spiritual turn, which has turned religion firstly into a question of choice and secondly into something immanent: „If I believe in God, then I believe that God is within me, I do. I mean, I don’t see him as a person, I don’t see him as the man on the cross or the man with the beard or whether he has curls or not curls and things like that, I don’t see him as a body in that way, I don’t, I don’t …“ (Leila: focus group 3) „I believe in a God, but it probably isn’t a Christian God or Christianity I believe in, it’s probably more a mixture of … well, I don’t know what it’s called, but at least reincarnation and karma and things like that … I don’t go to church in order to find God there, no, I don’t … I mean God is within me … I mean, I live, I hope, that he is there, right …“ (Charlotte)

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A striking feature about the two women’s statements is that their belief seems undefined, vague and uncertain. Charlotte, having said earlier that she was „perfectly sure, that there is a God“, is here expressing doubt about the existence of God: „I hope that he is there, right …“. Leila is initiating her statement with an if thus leaving room for both the possibility of belief and unbelief and showing a kind of ambivalence in the feeling about God. According to Taylor, the sentiment of ambivalence towards religiosity and spirituality is a defining feature for many modern, secular individuals. Their rationality tells them to keep at a distance from any kind of religious and spiritual belief, yet their existential condition make them aspire towards resources beyond this world that can give them a sense of inner peace and dwelling. They are experiencing what Taylor calls „cross-pressures“, entailing a feeling of permanent ambivalence.

Cross-pressures The immanent frame with its accompanying conditions, such as buffer, authenticity, interiorization and individualization, is, according to Taylor, more descriptive of a secular age than the disappearance of or decline in religion. Taylor argues that the immanent frame permits a whole range of alternative beliefs. Therefore our modern world is not simply pushed in one direction closed towards the transcendent but is being pulled both ways. The disen-

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Original articles gaged and scientific stance is not the only one available to us, nor are we making a full commitment to it. Instead characteristic of our contemporary belief condition is that we are constantly wavering between the immanent and the transcendent orientation, adopting each to a greater or lesser extent. This condition Taylor calls „cross-pressured“. Religion is still a viable interpretation of life, as are humanism and naturalism. These cross-pressures render each of the positions more fragile, making the religious life of Western societies more fragmented and unstable than ever before (Taylor 2007, p. 595). In the cross-pressured condition, the individual debates whether or not to believe in some transcendent power, or, for many people in Western Europe, whether or not to believe in God. Taylor’s thoughts and elaborations on cross-pressures are particularly illuminating as regards the data. Positions that leaned towards the closed understanding of immanence were very poorly represented as compared to the cross-pressured position, which might have something to do with the situation that the informants were in, suffering from severe cancer. As Taylor has put it: „The cross-pressured condition leaves the issue open whether, for purposes of ultimate explanation, or spiritual transformation or final sense-making, we might have to invoke something transcendent“ (Taylor 2007, p. 594).

Some of the informants stated that although they were not „very“, „especially“ or „strictly“ religious, they were

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not closed to something transcendent, which could lie either beyond or within themselves. A general pattern in the data was that there was a momentary need to relate to or evoke something transcendent for purposes of existential, religious or spiritual meaning-making. As indicated, this need for meaning-making in relation to a transcendent source was not experienced as something permanent but rather as one possible strategy among others. This corresponds to what Taylor says about the individual’s freedom to choose in various periods of life to live the immanent frame as being closed to something beyond it or as open. Leila expressed it as follows: „because as it is at the moment, I have put it a little on ,stand-by‘, I wouldn’t say on ice, but on stand-by … but I have done that several times before in my life.“ (Leila: focus group 3)

This „flexible“ stance towards immanent and transcendent belief positions found commonly expression in a tolerant and respectful attitude towards other belief traditions. Some of the informants in the focus groups stated that one should respect other peoples‘ choice of belief without being judgmental, because any kind of orientation was seen as a viable option: „Well I do think that there are so many different religions in the world, and I am not going to judge whether Christianity is better than other religions, in fact, I believe that we are so close to each other, right, that we all believe in a God who is loving and who helps us and who guides us when life is hard.“ (Bente)

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Original articles Taylor sees the rise of the buffered identity in modernity and late-modernity as being accompanied by an individualization of belief, in which the individual stands responsible before God or a higher power. Ann-Margit stated that unbelief (in the form of atheist humanism) was just as legitimate and viable an option as belief although her current position was on the open side of immanence – a choice she had arrived at through the ethics of authenticity: „And should I end up with not believing, well, that he knows, well (laughs) (Int: God knows that too?) … then that’s what’s right for me, um …“

Ann-Margit’s statement is representative of Taylor’s description of the features of the present spiritual landscape: „a breaking-down of barriers between different religious traditions“ (Taylor 2007, p. 513) and, it could be added, between belief and unbelief. Therefore every option is a viable option. But Taylor is also assessing the problems besetting this contemporary religiosity. According to him, the crosspressured condition results in a fragmented and unstable religious or spiritual orientation that leads to doubt and uncertainty. This ambivalence in belief was found to be a very common position among the informants. One of the male interviewees told me with great enthusiasm that on several occasions in his life he had had the feeling that God had helped him out during crises. One particular occasion he asked God for help each time he passed the same church on his way home from

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work, and then suddenly one day God had answered his prayers and made him return to his former stronger self: „And then suddenly one day, well, I had gotten normal again, then I had just become that much stronger, right … whether it was that, or, whether it was me who hypnotized myself or what, I don’t know …“ (Svend).

In Taylor’s terms the buffered identity, which locates causal powers as constructions of the mind, is making Svend doubt whether or not he could believe in supernatural causalities. According to Taylor, the majority of modern secularized Westerners take such middle positions on the spectrum between closed and open immanence. These people want to respect as far as they can the „scientific“ and „natural“ side of the immanent frame, being suspicious of fanatical religious expressions. At the same time they still believe that there are more things between heaven and earth than one should think: „I believe that there is something higher, because it was my luck that they could remove it, um, and then I know that you could then say that, well yes, the doctors are also clever, but still, I mean that is also true, but I believe that there are some powers that said: this wasn’t the time and place for me to leave here … whether it be God or what it is, that I can’t say in any precise way …“(Jytte)

Jytte is vaccillating between confidence in bio-medical healing and belief in supernatural healing, a condition that makes her give equal status to the healing power of the doctor and some higher power, and so leave her living in parallel worlds. This condition

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Original articles is experienced as a challenge for those who, following Taylor, stand on the more open side of the immanent frame, because it makes it difficult to remain convinced of personal beliefs when confronted with alternative orientations: „I think that it’s really difficult, it’s really difficult to have faith in what I believe there is after life, in the way that our, um … then I need to talk to someone who somehow is on the same level as I am, um, I need to be understood, because I feel ridiculed or ashamed when I am together with people who say um: „Shut up, you have a cancer disease, you can die from it, how can you tell yourself, that this is how it is?“ Well, that I don’t understand and that’s when I, from time to time can get, there I can wobble a little and think, well, am I completely crazy myself? What the hell, what the hell, yes, what the hell is there anyway? I mean, do we only get down in this coffin and lie there?“ (Ditte) „It creates a huge fight in a way, or, not a fight but some kind of parallel world, I mean, all the time you have these worldly impressions, all the material stuff is in focus and all these problems and trifles and so on, and then you have the other dimension …“ (Tina)

Both Ditte and Tina feel torn between two worlds: the material and supra-material world. Ditte is aware of her uncertainty and doubt when it comes to the hereafter. She seems to be disturbed by the fact that perhaps, after all, the universe might be as meaningless as the most reductive materialism tells us. Therefore she feels that she has to protect her belief convictions against this flat and empty world, fearing that her desire for eternity might, after all, be the self-induced illusion that materialists claim it to be.

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For Tina, Ditte and several others the key motivation for openness towards belief has been the illness experience. Informants who, prior to their illness experience, had had difficulties imagining another background to their thinking and understanding of the world, were being provoked to look after alternative orientations for meaning-making in connection with their illness: „I mean the moment when you feel completely powerless and, um yes, what shall I say, in the case of such a serious illness, I mean you do feel completely powerless and you don’t know how to handle it and … then it’s nice to have the feeling that you can just put it in the hands of God, right …“(Bente) „I’ve felt like that for many years, I mean, actually, I mean, where I have been thinking, arhh, I don’t believe so much in that, I can just feel that there is something which is moving inside of me, I mean, where I start to think of other things, I mean, where it’s not necessarily influencing me to a great degree, but where it makes me feel secure and comforted, just like T says, it can give a hope, right, so … but um … yes … it’s how it has been for me at least in this process, and I can feel that this germ of faith I have, it gets bigger and bigger, I mean it’s growing, and I need to get the vacuum that I have, filled out, um, actually, so …“ (Mette)

Mette is conscious of the fact that a transformation is taking place within her. She has construed a narrative about herself whereby she was sceptical and insensible towards religion before the illness struck. Ann-Margit also picture a „before-and-after“ the cancer disease and describing the differences in religious intensity and sensibility:

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Original articles „At the time I wasn’t conscious of the fact that I could leave it to God, at that time it was more my own abilities I was worried about, right, whereas today I’d say more like that it’s yours, I mean, but I then do all that is in my power … (Int: It’s a cooperation?) yes, um, that’s also the reason why I have courage, because it isn’t courage coming from myself, I come with courage from some place else“ (Ann-Margit).

In Taylor’s terminology, it seems that Ann-Margit has to a large extent stepped out of „cross-pressured“ conditions relating to religion with a new identity. Although it is important for Taylor to show the idea of religion’s „excarnation“ on the level of official religion, it is no less important to demonstrate the modern individual’s need for rituals and „the festive“ on the level of popular religion: „People still seek those moments of fusion, which wrench us out of the everyday, and put us in contact with something beyond ourselves“ (Taylor 2007, p. 516–517).

We found expressions in the data of a similar need for fusion with something transcending the everyday – an experience deeply connected with bodily impressions.

From buffered to porous self We will argue that some of the informants were experiencing the body as an important mediator for experiences of connectedness with something greater than themselves or, to use Taylor’s concept, of fullness. Continuing in Taylor’s terminology, we can say that

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in those instances where the informants were experiencing fullness as a bodily sensation, the disembedding movement which Taylor calls „excarnation“ can be said to „develop back“ to „incarnation“, making the self „porous“ and responsive to signs. A neardeath experience, mentioned by four of the informants, is one example of the power of bodily sense experiences that leave the individual with a resistance to intellectual and rational explanation and reasoning. Instead, an important place is granted to the bodily impression. Olga, having gone through a near-death experience, is open to the possibility of a divine interference manifesting itself through her body: „I am completely sure that there is a God, I mean, I have never doubted that, certainly not, and that is whether I go to church or not, I mean … I believe in that … whether he plays a part in this, I don’t know, but I think that I’ve met him after a, in the middle of an operation some years ago … I saw that vividly before my eyes, really, yes … I thought that, when I woke up, then I asked, if I was dead and had gone to heaven, ,No‘, the nurse said (laughing), ,you are not!‘, but I was quite sure that I had wandered into heaven, I mean, I saw it before my eyes, and I can see it now today when I think back“ (Olga).

Olga’s state of mind is far removed from the disengaged, objectifying stance which characterizes Taylor’s modern, buffered, disciplined self. She has had a strong spiritual intuition and a moment of blinding insight which, to her, science is not able to refute. Lene is sharing her spiritual experience of the meeting with an angel, still in doubt as

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Original articles to whether it happened in her dream or in the real world: „And then I had some very special dreams and something which I have never figured, neither then nor since, that was whether I was dreaming or whether I was sitting in here watching it, but then, I am sitting here in my sofa, at the time I had different furniture, one afternoon, and then an angel enters the room from the window, and I can describe her, and I can remember her, and I see it before my eyes each time I talk about it, but it told me something, and I still doubt whether, whether I saw it or if I was dreaming it, and I just let that rest and be where it was, because it was a very, very smiling and beautiful creature, who just came in through the window, and it gave me something, now I’m being looked after …“ (Lene)

This experience where Lene is reassured that she is being looked after by some higher power bears a mark of authenticity, which proves to Lene that it is true. Applying Taylor’s terminology, we can say that the buffered self, concerned about instrumental rational control, in this case proves to be weak and an important place is given to the porous self, which is focusing on feelings. To Lene, the spiritual experience of something beyond remains a niche in a world organized and categorized in naturalistic categories. To Ann-Margit the body has mediated a powerful biological and phenomenological sense that we are in contact with something greater: „Then I began to have these synchronistic experiences which were so powerful that I had to yield and say, this, this, there is something, there is a power here, it rolls in the blood (int: yes), it’s in your cells (int: yes) in any cell and it’s integrated in your thought, I

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mean um and the body, it’s a completely physical experience, also that the brain is peaceful, I mean there is no, there is a … the thought is peace …“ (Ann-Margit)

Ann-Margit’s experience is so powerful that in Taylor’s sense it transforms her buffered self to a porous self that experiences supernatural signs as real. To Ann-Margit the feeling of peace is sensed on a physical level. Another woman, Georgia, experiences God’s powerful presence on a biological level: „… So it is his word, it’s Jesus‘ or God’s word, they are very lively words, they come into your veins, they speak in your veins, and then suddenly all these dead veins or heavy veins, they get very lively and strong …“ (Georgia)

What we can see exemplified in the above statements is the fact that to some of the informants of this study the illness experience has given way to belief expressions that are sensed through the body and are accorded such importance that they are experienced as being real. In these cases it ends up being the body that pushes towards belief, making more or less a return to Taylor’s porous self where signs, dreams and visions are bearers of meaning and experienced as causal factors.

Discussion The presentation and analysis of the empirical data demonstrate that the map of possibilities for meaning orientations is not a simple one, not even one of basic oppositions between be-

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Original articles lief and unbelief. Taylor’s analytical work has pointed to the fact that the meaning orientations available to the modern individual are a product of an underlying framework which involves values, narratives and discourses. As Taylor points out, the immanent frame is a result of a shift in world views that modernity has brought about and therefore a common condition to us all. The data show that the informants are not disengaged from sensibility to or participation in the divine or from other meaning systems; nor are they actively in search of meaning, choosing their own religious and/or spiritual convictions. Rather, for the most part the informants are „cross-pressured“ between a multiplicity of belief inheritances and meaning orientations depending on what is available to them from different discourses. Therefore, as Taylor has pointed out, the content of the immanent frame consists of different belief alternatives and different middle positions between immanence and transcendence. The data show that life situations such as illness, crisis and meaninglessness, situations in which ultimate concerns about life and death arise, prove to be essential for „leaps of faith“ such as openness towards the transcendent – if only momentarily. According to Taylor, all too many accounts of religious development in Western societies are belief-centred accounts that present the discovery of a withdrawal of religion from social, public spheres and of a decline in religious belief and practice as detached from a third dimension of secularity,

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namely the underlying framework that conditions the modern individual’s choice of belief possibilities. Calling these accounts „subtraction stories“ or „death of God“ stories, Taylor accuses them for giving „too much place to changes in belief as against those in experience and sensibility“ (Taylor 2007, p. 573). This study has focused on the different kinds of lived experiences involved in the secular existential, religious and/ or spiritual meaning-making of a group of Danish cancer patients in rehabilitation. Interestingly we can say that, in framing and describing the content of their meaning orientations, the informants are still to a large extent relying on an inherited religious language. This applies to the informants who have distanced themselves from „Christendom“ and its churches without breaking off from it altogether. They have retained some of the beliefs of Christianity and/or retained a nominal tie with the church, identifying with it in some way. According to Taylor, all beliefs are held, „within a context or a framework of the taken-for-granted, which usually remains tacit, and may even be as yet unacknowledged by the agent, because never formulated“ (Taylor 2007, p. 13).

Whether language corresponds entirely to content is therefore not to be taken for granted. The data can support the understanding of secularity as a decline in traditional beliefs and practices, what one could call Christendom, but not necessarily a decline in Christianity conceived in broad and

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Original articles nuanced terms: an individualized nondoctrinal kind of belief.3 From the analysis of the data it can also be concluded that for the informants illness experience has represented a push towards belief or intensified meaning-making. When struck by illness, they stated that they started to question the meaning of life and their place in it, and a feeling rises that there is some richness either beyond themselves or outside themselves that deserves more attention and engagement. To some, the illness has meant a transformation from inside orienting them towards an immanent or transcendent source in the search for existential meaning. The religious and spiritual resources from which some of them have kept themselves at a distance prior to their illness now give them a sense of what Taylor’s describes as fullness. Religious and spiritual answers to the question of the meaning of illness and suffering, and ultimately to the question of the meaning of life, have 3 In analyzing the data from Denmark in EVS surveys in the time span of 1981– 2008, a similar individualization trend crystallizes, resulting in the following conclusion: „The Danes‘ religiosity has become individualized and religion has become an individual choice. This means that religiosity will continue to exist but in a new form. The authoritarian has faded into the background whereas the individual aspect has come to the foreground …“ (my translation), see: Andersen PB, Lüchau P (2011) Individualisering og aftraditionalisering af danskernes religiøse værdier. In: Peter Gundelach (ed.) 76–96. Små og store forandringer Danskernes værdier siden 1981. København: Hans Reitzels Forlag.

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become a real option and even a desirable one to many of them. However, the data also show that the search for meaning for these people embedded in a secular age is uneasy and uncertain – a stance captured by Taylor’s concept of cross-pressure. They are torn between a variety of secular existential, religious and/or spiritual belief alternatives/orientations integrating them more and less on their personal and fragmented horizon of belief. We have shown that Taylor’s theory and accompanying concepts can serve as analytical tools in order to understand part of the meaning-making process among cancer survivors embedded in a secular society. We have argued that concepts such as „the immanent frame“ and „cross-pressures“ are descriptive and operational terms when trying to capture inconsistent and incongruous belief expressions that are conventionally placed outside the core of a traditional belief system or religion understood as a predefined concept. Furthermore „fullness“ has proved to bear a potential for encompassing the subjective, emotional and intuitive side of an individual’s convictions and commitments, whether or not they are associated with religious and/or irreligious beliefs. We will argue that there is more to the Danes‘ religious and/or spiritual orientations than the mere question of belief or unbelief, conventionally measured in quantitative surveys. Especially when examining the segment of the Danish population that is made up of people who are suffering from ill-

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Original articles ness and crisis, the picture is more complex and multi-levelled. Taking this into consideration, there are reasons to believe that the conclusion of the American sociologist Phil Zuckerman on the subject of Danes‘ religiosity, namely: „religion is distinctly marginal, relatively powerless, and more or less unimportant in most people’s daily lives“ (2009) would look differently had he conducted his study among Danes with life-threatening illnesses such as cancer (see also Zuckerman 2008). In confirmation of existing research findings, the data show that the cancer illness has given rise to renewed reflection on the meaning of life and death. The illness experience has led some to make a leap of faith, whereby they have stepped out of their distanced and ambivalent stance towards religion, if only momentarily. In consequence, we argue that the patient perspective is crucial in order to give a nuanced account of meaning orientations in modern secularity. The sociology of religion may well benefit from an examination of meaning orientations in life situations where people start to ask questions about the meaning of life. Such questions are typically asked when confronted with illness, crisis, insecurity and meaninglessness, as documented in the data of the present study. Taylor’s concepts will facilitate the analytical process of capturing the complexities and nuances in the secular-existential, religious and/or spiritual landscape of meaning-making in Western societies and thus enhance a broader epistemologi-

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cal approach to religion in contemporary Western society.

Acknowledgements We would like to thank the participants and staff at Rehabilitation Centre Dallund, Funen, Denmark who let Assing Hvidt undertake participant observation and who shared their experiences with us. The project is supported by The Danish Cancer Society, The J. M. Dæhnfeldt Foundation and University of Southern Denmark. Assing Hvidt and Hansen also want to thank the Interdisciplinary Network for Research in Faith and Health as well as the Danish Milieu for Humanistic Cancer Research for inspiring discussions.

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Elisabeth Assing Hvidt Mag.art., Institute of Public Health, Research Unit: Man, Health & Society and National Research Centre for Cancer Rehabilitation, University of Southern Denmark [email protected]

Hans Raun Iversen Prof. Dr. theol. Aassociate professor Department of Systematic Theology, University of Copenhagen [email protected]

Helle Ploug Hansen Professor, Ph.d., mag.scient., Institute of Public Health, Research Unit: Man, Health & Society and National Research Centre for Cancer Rehabilitation, University of Southern Denmark [email protected]

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