European Journal of Mental Health 11 2016/12

Volume 11  Numbers 1-2  April

EMERITUS PROFESSOR of clinical psychology (psychoanalysis) and psychology of religion at the KU Leuven (Belgium) and retired professor of psychology of religion at the Free University of Amsterdam (Netherlands) DR. HON. C. AT SEMMELWEIS UNIVERSITY (Budapest, Hungary) and honorary professor at Universidad Nacional Mayor de San Marcos (Lima, Peru) and Pontificia Universidad Catolica del Peru (Lima, Peru) RESEARCH INTERESTS: psychoanalysis, psychology of religion, psychological factors in situations of extreme vulnerability (poverty, family violence, structural violence)

INSTITUTE OF MENTAL HEALTH FACULTY OF HEALTH AND PUBLIC SERVICES

European Journal of Mental Health Volume 11  Numbers 1-2  April 2016

JOZEF CORVELEYN, editor-in-chief PhD in psychology (KU Leuven, 1983)

Editor-in-Chief: JOZEF CORVELEYN Honorary Editor-in-Chief: TEODÓRA TOMCSÁNYI

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We interpret mental health promotion to include every effort and all manner of individual and communal endeavour to realise principles and ideals of mental health at a social level. This means approach and attitude, praxis and theory, fields of activity and institutional systems alike. This approach to mental health promotion always requires cooperation and communal efforts, these days not only between individuals, specialists and groups but also between states, nations and research groups.

East Central Europeans must therefore strive to find each other and come closer together, but certainly not at the price of the hard-won contacts between the two halves of an all too long divided continent. On the one hand, our common history, the many similarities in our past pave the way for cooperation both rationally and emotionally; on the other, we all share a vision of a truly common European future, hopes and goals that unite us. Between past and future, our situation, our problems and experiences are similar but not identical. They can mutually complement and enrich each other and contribute to the achievement of our common goals, the reduction of harmful factors and the promotion of mental health. For mutual and deep understanding, however, we must develop a common language, common forums and organs in which we can share our experiences and reflect on them together. This journal seeks to contribute to that effort with its abstracts in 9 languages in order to serve, through the emergent dialogue, a colourful and many-faceted reality which consists not so much of education, social work, health care, religion, mass media, political activity and legislation as of individuals, families, communities and societies.

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European Journal of Mental Health Individual, Family, Community and Society VOLUME 11, NUMBERS 1–2, APRIL 2016 Editor-in-Chief / Leitender Herausgeber Prof. Jozef Corveleyn, Katholieke Universiteit Leuven (Belgium)

Editorial Board / Beratende Herausgeber Dr. Milda Ališauskienė, Vytauto Didžiojo universitetas, Kaunas (Lithuania) Prof. Jacob A. Belzen, Universiteit van Amsterdam (Netherlands) Prof. Beáta Dávid, Semmelweis Egyetem, Budapest (Hungary) Prof. Valerie DeMarinis, Uppsala universitet (Sweden) Prof. Emmy van Deurzen, Existential Academy, London (United Kingdom) Dr. Jessie Dezutter, Katholieke Universiteit Leuven (Belgium) Dr. Rob Fisher, Inter-Disciplinary.Net, Witney (United Kingdom) Dr. Rita Fóris-Ferenczi, Universitatea Babeş-Bolyai, Cluj-Napoca (Rumania) Dr. János Harmatta, Semmelweis Egyetem, Budapest (Hungary) Dr. András Ittzés, Corvinus Egyetem, Budapest (Hungary) Dr. Gábor Ittzés, Budapest (Hungary) Prof. Jutta Lindert, Hochschule Emden/Leer (Germany) Dr. Dinka Marinović Jerolimov, Institut za društvena istraživanja u Zagrebu (Croatia) Prof. Martin Jäggle, Universität Wien (Austria) Prof. Paavo Kettunen, Joensuun yliopisto (Finland) Dr. Peter Raeymaeckers, Universiteit Antwerpen (Belgium) Dr. Gergely Rosta, Westfälische Wilhelms-Universität Münster (Germany) Dr. habil. Igor Škodáček, Univerzita Komenského v Bratislave (Slovakia) Dr. habil. Péter Török, Budapest (Hungary) Prof. András Vargha, Károli Gáspár Református Egyetem, Budapest (Hungary) Prof. Andreas Wittrahm, Caritasverband für das Bistum Aachen (Germany)

INSTITUTE OF MENTAL HEALTH Faculty of Health and Public Services Semmelweis University, Budapest

Advisory Board / Wissenschaftlicher Beirat Dr. Lucia Adamovova, Slovenská Akadémia Vied, Bratislava (Slovakia) Prof. Jerzy Aleksandrowicz, Uniwersytetu Jagiellońskiego w Krakowie (Poland) Dr. Hardy Júlia, Thyris Ambulancia, Budapest (Hungary) Dr. Márta Merényi, Magyar Mozgás- és Táncterápiás Egyesület, Budapest (Hungary) Dr. Hanekke Meulink-Korf, Protestantse Theologische Universiteit, Amsterdam (Netherlands) Dr. Renáta Németh, Eötvös Loránd Tudományegyetem, Budapest (Hungary) Tom Ormay, MentalPort Kft., Budapest (Hungary) Dr. János Réthelyi, Semmelweis Egyetem, Budapest (Hungary) Dr. Kinga Szabó-Tóth, Miskolci Egyetem (Hungary) Prof. Jenő Szigeti, Miskolci Egyetem (Hungary) Dr. Szabolcs Urbán, Pázmány Péter Katolikus Egyetem, Piliscsaba (Hungary)

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Frontcover: The view of Delphoi (sanctuary, theater, and stadium) Titelblatt: Sicht auf Delphoi (Tempel, Theater und Stadion)

CONTENTS / INHALT STUDIES / STUDIEN Research Papers / Wissenschaftliche Arbeiten Marinus H.F van Uden & Hessel J. Zondag: Religion as an Existential Resource: On Meaning-Making, Religious Coping and Rituals . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 Jobi Thomas Thurackal, Jozef Corveleyn & Jessie Dezutter: Personality and Self-Compassion: Exploring Their Relationship in an Indian Context . . . . . . . . . . . . . 18 Gellért Gyetvai & Judit Désfalvi: Changing Roma Identity: A New Kind of Double Identity and How To Model It . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 36 Olga Shek, Kirsi Lumme-Sandt & Ilkka Pietilä: Mental Healthcare Reforms in Post-Soviet Russian Media: Negotiating New Ideas and Values. . . . . . . . . . . . . . . . . . . . 60 Common Past / Gemeinsame Vergangenheit Jakub Doležel: Catholic Charitable Social Work in the Former Czechoslovakia: With a Focus on the Czech Lands. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 79 Short Communications / Kurzmitteilungen Benedek T. Tihanyi, Andrea Sági, Barbara Csala, Nóra Tolnai & Ferenc Köteles: Body Awareness, Mindfulness and Affect: Does the Kind of Physical Activity Make a Difference?. . . . . . . . . . . . . . . . . . . . . . . . . . . . 97 Benedek T. Tihanyi, Petra Böőr, Lene Emanuelsen & Ferenc Köteles: Mediators between Yoga Practice and Psychological Well-Being: Mindfulness, Body Awareness and Satisfaction with Body Image. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 112 Kimmo Kuosmanen, Suvi Rovio, Miia Kivipelto, Jaakko Tuomilehto, Aulikki Nissinen & Jenni Kulmala: Determinants of Self-Rated Health and Self-Rated Physical Fitness in Middle and Old Age. . . . . . . . . . . . . . . . . . . . . . . . . . . 128 András Láng: Relationship between Recalled Parental Care and Religious Coping: The Mediating Effect of Attachment to God. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 144 BOOK REVIEWS / REZENSIONEN Regina Polak: Pioniergeist und Engagement: Udo Tworuschka (Burkard, F.-P. R. Pokoyski & Z. Štimac, Hrsg. (2014) Praktische Religionswissenschaft: Theoretische und methodische Ansätze und Beispiele.

Festschrift zum 65. Geburtstag von Udo Tworuschka). . . . . . . . . . . . . . . . . . . . . . . . . . . . 153 Anett Mária Tróbert: A Life in the Service of Mental Health (Ittzés, G., ed. (2013) Cura mentis – salus populi: Mentálhigiéné a társadalom szolgálatában: Ünnepi kötet Tomcsányi Teodóra 70. születésnapjára: Festschrift für Tomcsányi Teodóra zum 70. Geburtstag) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 157 Agnieszka Krzysztof-Świderska: Priest in the Eyes of Young People: Is This Issue in Mental Health Professionals’ Interest? (Baniak, J. (2013) The Image of the Priest in the Awareness of Polish Youth). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 161

Mónika Földvári: Religious Dimensions of Europe (Pollack, D., O. Müller & G. Pickel, Hrsg. (2012) The Social Significance of Religion in the Enlarged Europe: Secularization, Individualization and Pluralization). . . . . . . . . . 164 Csaba Török: Empathische Wegsuche in der Welt der interreligiösen Begegnungen (Stettberger, H. & M. Bernlochner, Hrsg. (2013) Interreligiöse Empathie lernen: Impulse für den trialogisch orientierten Religionsunterricht). . . . . . . . . . . . . . . . . . . . . . . 169 Médea Kis: An Encounter of Two Worlds: The Intercultural Aspects of Helping Relationships (Merle, K., Hrsg. (2013) Kulturwelten: Zum Problem des Fremdverstehens in der Seelsorge) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 173 Norbert Mette: Bioethik und Klinikseelsorge vor der Herausforderung des Pluralismus (Haker, H., G. Wanderer, & K. Bentele, Hrsg. (2014) Religiöser Pluralismus in der Klinikseelsorge. Theoretische Grundlagen, interreligiöse Perspektiven, Praxisreflexionen) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 180 Olaf Müller: Zwischen Anspruch und Wirklichkeit: Werteforschung (in Österreich), quo vadis? (Polak, R., Hrsg. (2011) Zukunft. Werte. Europa: Die europäische Wertestudie 1990–2010: Österreich im Vergleich) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 182 Contributors to This Issue / Autoren dieses Heftes. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 188

STUDIES / STUDIEN

European Journal of Mental Health 11 (2016) 3–17 DOI: 10.5708/EJMH.11.2016.1-2.1

Marinus H.F van Uden* & Hessel J. Zondag

RELIGION AS AN EXISTENTIAL RESOURCE On Meaning-Making, Religious Coping and Rituals (Received: 22 October 2014; accepted: 31 December 2014)

In this paper, we make a contribution to the treatment of post-traumatic stress disorder. We show how religion can function as an existential resource. Religions enable people to perceive an underlying pattern of order and purpose below the surface of life’s incomprehensible inevitabilities such as death and suffering. Religion then works as a meaning-making system that can positively influence the individual’s mental health. Recently, the relations between religion and health have been studied particularly in the context of the ‘religious coping paradigm’. Religious coping is aiming at a ‘search for significance’. Religious coping will often occur where non-religious coping fails, especially in situations involving loss of life, health and relational embeddedness. Religious activities and acts can also enable religious coping. A crucial religious act is the ritual. What are the functions of ritual, and how can a ritual contribute to the mental health of an individual in crisis?

What is, in this context, the role of myths and symbols? Several examples are given of how rit­ uals can work as therapeutic tools in the treatment of traumatic disorders. We conclude by stating that religion, being a robust form of meaning-making, is not the sole system able to contribute to working through a trauma, and that its success is far from guaranteed.

Keywords: meaning-making, myth, post-traumatic stress, (religious) coping, ritual Die Religion als Kraftquelle der Existenz: Über Sinngabe, religiöse Bewältigung und Rituale: Durch unseren Artikel möchten wir zur Behandlung der Folgen der posttraumatischen Belastungsstörung beitragen. Wir zeigen, wie die Religion als Kraftquelle der Existenz funktionieren kann. Die Religionen ermöglichen den Menschen, das Muster einer tieferen Ordnung und eines tieferen Sinnes in Bezug auf scheinbar unverständliche Beschaffenheiten des Lebens wie der Tod oder das Leiden, zu erblicken. Auf diese Weise funktioniert die Religion als ein Sinngebendes System, das die geistige Gesundheit positiv beeinflussen kann. Neulich wurden die Zusammenhänge zwischen Religion und Gesundheit im Rahmen des „religiösen Bewältigungsparadigmas“ geforscht. Das Ziel der religiösen Bewältigung ist die „Suche nach Bedeutung und Wichtigkeit“. *

orresponding author: Marinus H.F. van Uden, Faculty of Humanities, Tilburg University, P.O. Box 90153, C NL-5000 LE Tilburg, The Netherlands; m.h.f.vanuden@uvt.nl.

ISSN 1788-4934 © 2016 Semmelweis University Institute of Mental Health, Budapest

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Religiöse Bewältigung findet häufig dann statt, wenn die nicht-religiöse Bewältigung versagt, vor allem in Situationen, in denen Themen wie Verlust des Lebens, Gesundheit oder Beziehungen betroffen sind. Auch religiöse Taten und Handlungen können die religiöse Bewältigung ermöglichen. Eine der grundlegenden religiösen Handlungen ist das Ritual. Was sind die Funktionen des Rituals und wie kann das Ritual zur psychischen Gesundheit der in der Krise befindlichen Person beitragen? Welche Rolle spielen die Mythen und Symbole in diesem Zusammenhang? Wir zeigen zahlreiche Beispiele dafür, wie Rituale bei traumatischen Störungen zum therapeutischen Instrument werden können. Als Schlussfolgerung behaupten wir, dass die Religion – obwohl sie eine grundlegende Form der Sinngabe ist, aber doch nicht das einzige System, das zur Verarbeitung des Traumas beitragen kann und dessen Erfolg bei Weitem nicht sicher ist.

Schlüsselbegriffe: Sinngabe, (religiöse) Bewältigung, Rituale, posttraumatischer Stress, Mythos

1. Introduction This paper will start from the perspective of the clinical psychology of religion. Clinical psychology of religion can be defined as the branch of psychology specifically studying the relations between religion and worldview on the one hand, and mental health on the other. Drawing on this perspective, we will try to make a meaningful contribution to the treatment of the consequences of post-traumatic stress disorder (PTSD) by discussing the relationship between religion and coping. We will con­sider three aspects, namely, religion and meaning-making, religious coping, and rituals.

The relationship between religion and mental health has been studied scientif­ ically since the inception of the psychology of religion at the beginning of the previous century. Questions like these were asked: Can conversion be considered a pathological phenomenon, or does it, on the contrary, advance the psyche’s integration? To what extent do profound religious and mystical experiences contribute to a mentally healthy existence? The antithesis between Freud and Jung is well known. Freud saw religion as an illusion that kept people immature and, hence, mentally unhealthy. According to Jung, however, religious rites, myths and symbols were indispensable for a healthy existence. Most present-day authors believe that religion can have positive as well as negative effects on mental health (Uden 1996).

Religion can have therapeutic effects. Participating in rituals can add considerable value to recovery. Religion can also function as a refuge in which one can escape from the tensions of daily life. However, religion can also cause mental dysfunction or exacerbate existing mental problems. For instance, violating religious do’s and don’ts can generate excessive guilt feelings and an inflated awareness of sin. A survey by Pargament and Brant (1998) shows that religion contributes to coping with problems in 32% of cases; in other cases it makes no a difference (47%) or even makes problems worse (21%).

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2. Religion and meaning-making When we talk about the meaning of life, religion never is far away. Pargament (1997, 32) defines religion as ‘a search for significance in ways related to the sacred’.

Seen in this way, religion has a central importance in many people’s broad system of meaning-making, although its importance varies strongly among individuals. It is often said that religion originates from people’s need to understand the existential problems with which they are confronted. Religions enable people to perceive an underlying pattern of order and purpose below the surface of life’s incomprehensible inevitabilities, such as death and suffering. Compared with more secular nonreligious systems (such as humanism), humans’ long-standing and almost universal dependence on religious systems of meaning has to do with the fact that religion is more comprehensive and can provide answers that are existentially more satisfactory. Moreover, religious systems of meaning are less susceptible to falsification; they have less difficulty in passing the test of criticism. As Pargament and his colleagues stated: The language of religion – faith, hope, transcendence, surrender, forbearance, meaning – speaks to the limits of human powers. When life appears out of control, and there seems to be no rational explanation for events – beliefs and practices oriented to the sacred seem to have a special ability to provide ultimate meaning, order, and safety in place of human questions, chaos and fear.

(2005, 676)

Religious systems of meaning can enable the individual to explain events in the world in a satisfactory way. These systems of interpretation are very import­ ant when dealing with the most threatening aspects of human existence, such as suffering, death, disasters, traumatic experiences and injustice. Religion offers the possibility of explaining commonplace events as well as the more existential and extraordinary ones.

Apart from explicitly religious convictions, such as a belief in God’s existence and in the possibility of a life after death, religion often also has a crucial influence on general values and convictions like honesty, the fundamental goodness of humans and of the world, control and vulnerability. Thus, religion is important in a much broader context. The relations between religion and meaning-making are complicated. Just like other systems of meaning-making, religion influences the individual’s convictions, goals and emotions. Religion is unique in that it focuses on what people deem to be ‘sacred’ or of ultimate importance. In this way, religion transcends the commonplace level of meaning-making.

Defining what meaning or significance is, is troublesome. Baumeister (1991, 15) suggested, ‘A rough definition would be that meaning is shared mental representations of possible relationships among things, events and relationships’, and he emphasised, ‘Thus meaning connects things’. Meaning-making is a means to adaptation, to controlling the world, to keeping oneself in hand and to belonging to something.

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Earlier, Frankl (1969) pointed to the ‘will to meaning’ as a crucial human motive. He pointed out that obtaining pleasure or power are not the most important goals in life. It is, rather, the discovery of significance and meaning in life. This meaning, however, is not inherent in life, but people have to search actively for the meaning of their existence. Hence, meaning is a central value in human existence.

People believe that they have control over their lives, that the world is reason­ able and fair, that they are good people, that unpleasant things do not happen to themselves but to bad people, and that God is good and guards and protects them. In add­ ition, people generally have the idea that they are on their way to realising their goals, and that they will acquire or retain things that they deem essential (Baumeister 1991). If, however, something tragic happens to them, then these broad convictions as well as these broad goals are called into question, and people will experience feelings of meaninglessness and aimlessness. People will then also become more aware of their broad systems of meaning-making, and their everyday worries will disappear into the background.

Meaning-making refers to a process in which people attempt to restore their broad systems of meaning-making after they have been disrupted by a major life event. Traumatising events can also precipitate or even cause a crisis in meaningmaking, because of questions arising about the meaning of life, about the meaning of suffering and about justice in the world (Lazarus 1993).

3. Coping and religious coping ‘When I find myself in times of trouble’ – many readers will be able to complete the subsequent lines of the well-known Beatles song, ‘Mother Mary comes to me / Speaking words of wisdom: let it be.’ With this, we are talking about religious coping. In other words, about the ways in which the religious domain enables people to alleviate their problems in times of trouble (Uden et al. 2014).

In a time of steadily increasing secularisation, the themes of religion and worldview have had to operate rather on the fringe of mental healthcare for years. However, it appears that recently these themes have become ‘trendy’ again. In social psychology and health psychology, attention to issues like spirituality or religion has long been unthinkable (Uden & Heck 2005). However, within the psychology of religion, studying the relations between religion and mental health has always been a major theme. Already at the inception of this discipline at the end of the nineteenth century, Leuba (1896) and Starbuck (1897) investigated the implications of conversion experiences for the converts’ mental health, and more than a hundred years ago William James (1982) explored the boundaries between profound religious and mystical experiences and psychopathology. In recent decades, these relations have been studied in particular in the context of the ‘religious coping paradigm’, articu­ lated most extensively by the American clinical psychologist K.I. Pargament (1997; 2007). Within this line of research, bridges are being built between the theory and EJMH 11:1-2, April 2016

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practice of physical and mental healthcare. Many studies focus on the significance of religion for the ways in which in-patients in general or mental hospitals in particular are coping with physical or mental problems. Within this paradigm, r­eligion is depicted as a positive force in overcoming physical and mental adversities.

3.1. Coping Coping research has flourished in particular through the advance of cognitive psych­ology, in which the process of coping is interpreted as a form of information processing. In this process, the individual is not directed by structural personality ­characteristics but enters into a dynamic interaction with the environment. Lazarus and Folkman have developed the most elaborate theory. They define psychological stress as ‘a particular relationship between person and environment that is appraised by the person as taxing or exceeding his/her resources and endangering his/ her wellbeing’ (1984, 19). Hence, stress is not an individual’s automatic response to a stimulus but is the result of a process in which the cognitive appraisal and assessment of the stressor play an important role. It should be clear that people differ in the extent to which they experience stress with respect to the same stressor. This cognitive ‘appraisal’ is a mental process in which a distinction can be made between ‘primary appraisal’ and ‘secondary appraisal’. Primary appraisal relates to the question whether a situation or event constitutes a threat to the individual’s well-being.

By contrast, secondary appraisal relates to the assessment of the resources available to the individual for meeting the demands made by the situation or event. These resources are diverse in character: material (money, accommodation, food, transport), physical (health, vitality), mental (insight, motivation, knowledge, emotional skills), social (the extent of social support, social networks) and religious (closeness to God, being part of a faith community).

After these cognitive appraisals, the individual attempts to deal with the situation, which is their actual coping. Folkman and Lazarus (1980, 223) state that coping is ‘a cognitive and behavioural effort to master, tolerate, or reduce external and internal demands and conflicts’. According to them, two forms of coping can be distinguished, ‘emotion focused’ coping, aiming at controlling the emotional response to the stressor, and ‘problem focused’ coping, aiming at solving the problem by changing the situation or by changing one’s own behaviour. Although problem focused coping, for example gathering information or seeking help, usually was seen as the more effective way of coping, nowadays it is assumed that the effectiveness of coping behaviour depends largely on the (im)possibility of taking action in a specific situation. Seen in this way, effective coping in a situation deemed unchangeable means that no problem focused behaviour will take place but that emotion regulating work will be done. Elderly people in particular use emotion regulating strategies because they have fewer of the physical, social and economic resources at their disposal that are necessary for action focused coping, because they more often consider EJMH 11:1-2, April 2016

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situations to be unchangeable and because they are confronted with more experiences of loss (loss of work, health, friends and loved ones). An important question about these coping activities is this. Why do they arise; what are the underlying motivations? This is a question about the functions of coping behaviour. A very important motive is, of course, the need to solve the problem, but emotion focused coping is specifically also about maintaining a psychological equilibrium. In this context, three motives can be mentioned: (1) the need to control one’s own life, (2) the need for meaning-making and (3) the need for maintaining or increasing one’s sense of self-esteem. Finally, in the literature about coping, much attention is paid to the effects of the coping process at the physical, psychosocial and existential levels.

3.2. Religious coping We will now turn to the religious aspect of coping. We refer here in particular to ­Pargament’s book The Psychology of Religion and Coping (1997). According to this researcher, religious coping is aiming at ‘the search for significance’ (95).

In ­coping, expression is also given to the intentionality of human behaviour. What ­matters here is the maximisation of the central values and central convictions in life rather than a quick reduction of the tensions connected with stress. Coping does not only result in the removal of the stressor, but it also produces growth and d­ evelopment in the individual who has to deal with it (accumulation of meaning). In the coping process, this ‘search for significance’ can be implemented in two ways: either the old values are maintained and will be emphasised (conservation of significance), or new values emerge (transformation of significance). Religious coping often will occur where non-religious coping fails.

Especially in situations involving loss of life, health and relational embeddedness, religious coping will often be one of the last remaining coping strategies for emotion regulation. One can ask whether there are situations that will be processed primarily in religious ways. The usual answer includes overpowering life events and boundary situations for which there are no adequate inner-worldly explanations.

In addition, situations that injure the sense of justice often lead to religious emotion management. In religious coping, a distinction can be made between individual and social/institutional coping behaviour. The former refers to private religious acts, while the latter refers to church attendance or an appeal to a pastor (institutional). In the latter case, the religious dimension is closely connected to receiving social support. Social support is a very important variable in religious coping research because the religious domain’s community function is very evident.

A study by Tepper and her colleagues (2001) provides an illustration of the prevalence of religious coping. They investigated the extent to which people with long-term mental health complaints used religious coping behaviour. Eighty percent of respondents, all from Los Angeles, reported that their faith or their religious

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activities contributed to their ability to cope with their symptoms, difficulties and frustrations.

A fifty-year-old woman, whose husband has disappeared without trace after a sailing trip on sea, explains: ‘My sister lives in America. They pray there in church, and here too. So there’s a lot of praying going on. And you notice that.

That everywhere there are people thinking of you. That gives you strength. So I can just feel peaceful, without me having to do anything myself. That’s indeed something that’s free of charge.’

Religious coping research is also very interested in the effects of religious coping on people’s physical, mental and spiritual well-being. In this way, it is linked to a long-standing research line on the connections between religion and mental health. For example, research has been carried out on the origin and development of ­depression in the elderly; coping with psychosocial problems in psychiatric ­patients; ­coping with being the victim of an assault; coping with the loss of a relative through suicide; coping with cancer; coping with losing a child through cot death; coping with parents’ divorce; coping with loss of work; dealing with experiences from the Gulf War, and so on. In general, the effects are positive. In two review studies, H ­ arrison and his colleagues (2001) and Matthews and his colleagues (1998) conclude that the majority of the published empirical data show that religious involvement has a beneficial influence on coping with mental and physical illness. The possibil­ ities offered by religion can be summarised as follows: (1) religion provides social ­integration and support from the faith community; (2) religion offers a ­framework for meaning-making; (3) religion provides a personal bond with God or other divine beings; (4) religion offers the possibility of performing private and public religious activities, and (5) religion stimulates a healthy life style.

On the basis of such considerations, these mainly American investigations ­argue that neglecting faith and religion in physical and mental healthcare leaves an important resource for promoting health unutilised. Finally, it should be noted that the coping paradigm accentuates that religion’s positive effects on well-being usually occur only if the individual’s general religious experiences can be converted into concrete religious coping activities with respect to the stressor. Religious coping then will mediate between general religiosity and well-being.

4. Rituals In the foregoing analysis, religious activities and actions have been highlighted as important elements of religious coping. In the present section, we will systemat­ ically discuss an important religious activity, namely ritual. We will consider both how rituals work and what functions they have. A concise definition of the concept understands ritual as ‘the regulated and repeatable symbolic actions of individuals

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and groups’ (Post et al. 2002, 39, our trans.).1 Examples include baptism, wedding, funeral, prayer, pilgrimage and Sunday church service.

Rituals can contribute significantly to coping with suffering (Norton & Gino 2014) and people use rituals in a wide variety of problems, for example, in loss and mourning, sexual abuse, Parkinson’s disease, pain, divorce, war trauma, psychosocial problems, important life transitions, disasters and AIDS. Rituals are effective not only for ‘normal’ adults: children, people with learning disabilities and psychiatric patients can benefit from them as well. Rituals are also beneficial for healthcare professionals who have to support people with serious problems. The efficacy of rituals is manifest in all cultures (Pargament 1997) although it has to be noted that rituals also have a dark side. For instance, the use of rituals can be accompanied by the fear of not performing them in the right way, which can result in a preoccupation with sin and guilt. Ritual practices can also be an expression of an obsessive-compulsive disorder (Spilka et al. 2003).

A large number of functions can be distinguished in the ways in which rituals work (Lukken 1999). There is the channelling function: rituals assist in providing a place and a shape for emotions. This function is linked with the expressive function of rituals: they offer an opportunity to express emotions as well as convictions.

Furthermore, rituals have an orienting function. An example of this is the wedding ritual, which marks the position that we hold in life. Closely connected to the channelling function already mentioned is the conjuring function of rituals. They assist us in getting a grip on calamities that happen to us in life, such as a loved one’s unexpected death, or a (traumatising) accident. Next, there is the condensing function.

This means that complicated situations are compressed into one action. This enables us to distance ourselves from situations that were once overpowering. For rituals to be able to exercise their healing effects, distancing is one of the conditions. We will return to this later in this paper when we discuss Scheff’s (1979) catharsis theory.

Then, there is the social function of rituals. Participation in rituals creates connectedness with a community or group. For example, a funeral strengthens the mutual bonds between those who stay behind. Finally, there is the transforming function.

Rituals mark the transition towards the next stage of life and assist in completing that transition. For example, a funeral service can help with the transition from the role of spouse to that of widower or widow. The recuperative qualities of rituals are evident from the positive connections between rituals and mental health. Koenig (1988, 1995) compiled a number of bibliographies in which he reviewed hundreds of investigations regarding the relations between the use of rituals and mental health.

Koenig’s work showed that people for whom ritual practice is part of their lives suffer less from depression and anxieties. Additionally, this group shows a lower suicide frequency. Moreover, participation in rituals shows a positive connection with well-being and with problem-solving abilities.

1

Original text: ‘het geordende en herhaalbare symbolisch handelen van individuen of groepen’.

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Many rituals take place within a group context. For that reason, it is difficult to differentiate between rituals and social activities. As a corollary, it is not easy to identify which element promotes well-being, the ritual or the social. Apart from this, the significance of rituals for mental health should not be overestimated. Many ­people experience a positive effect of rituals, but some experience no effect at all, and sometimes rituals have a contrary effect, as stated above.

Rituals, farewell rituals in particular, can be used in an instrumental way in psychotherapy, for example, with post-traumatic stress complaints (Gersons 1988; Gersons & Olff 2005). In a farewell ritual, the traumatising event is experienced again with all the pain that characterised the original incident. But as it takes place within a ritual setting, it is experienced from a kind of distance. As a result, it is not as overpowering as it was in the original event while it is also more accessible.

Herman (1992) reports the example of a Jewish woman who had lost her first husband while being transported to a concentration camp. She had never been able to say goodbye to him or to mourn him. This loss returned with a vengeance after the death of her second husband, whom she had married shortly after the war. She grieved over two husbands, one of whom had died forty years earlier. Herman helped her to design farewell rituals that enabled her to mourn two husbands. This she did by selecting two different commemoration days from the Jewish calendar. In this way, she could commemorate both husbands separately yet with dignity, and grieving over the first husband did not interfere with grieving over the second one.

With this Jewish woman, the farewell ritual had a religious character as Jewish symbols were used. However, rituals used in the treatment of traumatic disorders need not have a religious character. An example is a woman who, after her daughter’s sudden death, planted a tree and named it after her deceased daughter. In taking care of the tree, this woman took care, as it were, of her daughter. In this ritual, religion and religious language did not play any role.

Postulating a positive connection between ritual activities and coping with problems does not, in and of itself, provide insight into how rituals work. We will discuss this efficacy on the basis of the themes of myth and symbol. Additionally, we will discuss Scheff’s (1979) catharsis theory.

4.1. Rituals, myths and symbols After a shocking event, people can experience fear, uncertainty, chaos and meaninglessness. Drawing on myths can contribute to the processing of these problems.

Hart (1981, 95) defines myths as, ‘stories that – in the community in which they are told – are deemed to be a truthful report of what has happened in the remote past (how one situation changed into another one)’. Myths are stories about the cause and the course of problems, and in addition they indicate what should happen in order to take life up again. In a therapeutic treatment that uses rituals and myths, the myth of the patient’s life story often plays a significant role. In this myth, the patient’s probEJMH 11:1-2, April 2016

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lems are described as a reaction to the stagnation of their life. Life is a succession of changes and transitions, and people usually endure and complete them without too many problems. However, sometimes transitions result in a crisis, for example, when one cannot cope with the death of a child. A therapeutic treatment using myths and rituals wants to try to complete precisely this transition.

In such cases, usually no use is made of existing myths. In the course of the therapy, ad hoc and in consultation with the therapist, a myth is constructed that ­applies to the patient’s situation and in which the patient recognises themselves.

Hart (1981) calls this a ‘therapeutic myth’. He reports the example of a woman who is afraid that she will kill her young son. In therapy, her fear is traced back to an unprocessed grief over a husband and child whom she had lost earlier in a traffic accident. The woman works this through by making paintings of both loved ones and subsequently burying them in a quiet spot. During the painting activity, many memories of her husband and child emerge, and this triggers strong emotions. The therapeutic myth (unprocessed grief) is incorporated in a farewell ritual. In this ritual (making paintings and burying them) the grief is ‘worked through’.

In addition to myths, symbols and symbolic actions are important. Acting symbolically is ‘acting as if’. By removing oneself from the symbol, one also distances oneself from what is symbolised, and this ‘acting as if’ is just as efficacious as when the action is carried out in reality. Dealing with the symbol is analogous to dealing with the person who is represented by the symbol. In terms of therapy, a symbolic action is therefore sometimes called an analogous action. An example is a woman who buries a photo of her husband, who had disappeared without a trace in a disaster. The woman who was left behind had never been able to ‘really’ bury her husband, and by burying the photo it is as if she were doing just that. In this way, she is able to say goodbye to her husband, and it becomes possible for her to go on living without him.

A symbol refers to something that is not the symbol itself, but at the same time it is part of that to which it refers. For that reason, symbols are often experienced in the same way and with the same intensity as what (or the one whom) they represent.

In this context, the term ‘symbolic identification’ is sometimes used. In treatments that use rituals, the patient’s affective reactions to a symbol are identified with the patient’s feelings towards the person represented by the symbol. Symbolic actions run parallel with changes in the patient’s life. Actions with a symbolic significance evoke new experiences and shape them. For example, throwing away a wedding ring does not only express the end of a marriage, it is the severance of the marital bond.

In acting symbolically, objects that represent people and situations from the patient’s life can be connected to the patient in two ways: through similarity and through contiguity (Hart 1981). A connection through similarity is based on a resemblance between the symbol and the person represented by it, for instance, a photo of someone who has died. Contiguity refers to the proximity between the symbol and the person concerned. Objects that used to be close to the person concerned – like clothes, jewellery or toys – symbolise that person.

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The principles of similarity and contiguity are manifest in symbolic actions.

The similarity principle dominates when a patient relinquishes a symbol and experiences this as saying goodbye to a person. This is the case when a patient experiences the burial of a photo as if a loved one had died and were buried again. The action with the photo contributes to the completion of the transition from having a relationship with a living person to having a relationship with someone who has died. The contiguity principle is manifest too, namely in the shape of pars pro toto. This means that a part represents a whole. What influences a part also influences the whole. In a ritual therapy, it is impossible for patients to involve everything that still connects them to a symbolised person. One or some salient objects are therefore usually chosen. By relinquishing these special objects, people simultaneously distance themselves from all other objects that connect them to a loved one. A widow still had so many of her husband’s belongings that she took only a few of them to the farewell ritual. The rest she later put in the street in rubbish bags.

4.2. Rituals: closeness and distance The American sociologist Scheff (1979) articulated a beautiful and compact theory regarding the efficacy of rituals. In order to clarify his theory, Scheff repeatedly used the example of the ‘peekaboo’ game: the mother hides her face behind her hands, keeps a watchful eye on the time and shows the child her smiling face while exclaiming ‘peekaboo’. Children of a certain age cannot get enough of it. The mother’s timing is important. If she shows her face too early, the game does not evoke tension and also no subsequent liberating laughter. If she hides her face for too long, the child will become frightened.

According to Scheff, ‘peekaboo’ contains all the elements of a liberating or cath­ artic ritual. The mother evokes tension by hiding her face, but the child knows that she has not really disappeared, and the tension is relieved in the laughter. In the game, there is an ideal combination of involvement and distance. Involvement because the mother appears to vanish, and distance because the child knows that mother has not really gone away. It is a game for the child, too. Scheff calls the ­balanced combin­ ation of involvement and distance ‘aesthetic distance’. When ­aesthetic distance can be realised in rituals, their efficacy will be optimal. In that case, the tensions incurred in life can be relieved in the ritual and will have a therapeutic outcome.

However, one has to be a participant as well as an observer. One has to become engrossed in a ritual and at the same time to distance oneself from it. A liberating ritual demands belief as well as unbelief. An example is saying goodbye in ritual therapy. Patients say goodbye, but at the same time it is not a real goodbye. It has an ‘as if’ quality. By doing so, patients can be participants as well as observers of themselves. They suffer the pain of a goodbye because a loved one has departed from life, but this same pain does not overpower. It is an ‘as if’ goodbye. In this way, rituals

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provide an opportunity of experiencing pain, but through their structuring power they prevent patients from disappearing in their pain.

Scheff postulates a contrast between aesthetic distance on the one hand and overdistance or underdistance (too long or too short a distance, respectively) on the other. When there is overdistance, observation is dominant and the patient is not a participant but an alien to themselves. There is no re-experiencing of emotionally charged events. The affective charge of what once happened does not penetrate.

When there is underdistance, the past is overpowering. The patient is only a participant and not an observer of themselves. Flooded by memories, there is, as it were, a repetition of the event, without the possibility of distancing. Good rituals, according to Scheff, are rituals that are designed in such a way that an aesthetic distance becomes possible. They have to enable people to distance themselves as well as to be involved.

Other authors criticise Scheff in this respect and state that rituals work in a recuperative way via the connection with others, and not via an optimal balance between closeness and distance (Jacobs 1992). According to them, the crux of the matter is that, in rituals, other people will almost always be involved and that rit­uals strengthen the links with these others. They can be supernatural beings, ­spiritual leaders, communities, fellow-sufferers or whole societies. This c­ onnection with others creates an environment in which the person concerned can feel safe. This safe environment is a prerequisite for re-experiencing the past and for facing the confrontation with emotionally charged memories.

Still other authors linked Scheff’s ideas about the efficacy of rituals to elements from the theory about the working-through of traumatising events. From Scheff’s theory, Johnson and his colleagues (1995) borrowed the concepts of overdistance, underdistance and aesthetic distance. The theory about dealing with traumatising events drew their attention to the alternation between being overpowered by the past and avoiding it, which is so characteristic of trauma. According to Johnson and his colleagues, overdistance refers to avoiding the traumatic past. The past does not come to life. Underdistance refers to being overpowered, the past returning with great intensity. Good rituals offer a safe environment for re-experiencing the past, without it again being overpowering.

Based on these sources, the National Center for Posttraumatic Stress Disorder (a US government organisation for the aftercare of veterans) designed rituals that were utilised in reintegration programmes for Vietnam War veterans. An important part of such rituals is the ‘Ceremony for the Dead’. Many veterans feel guilty because they survived the war, while their mates did not. They often carry the painful memories of their mates with them. The Ceremony for the Dead enables them to express their sadness and to give it a place. The veterans write the names of the dead whom they want to commemorate on a piece of paper. They can also add comments, poems, photos, mementos and so on. At a Vietnam War memorial, and in the presence of other veterans, every veteran calls out the names of the dead whom he wants to commemorate, after which the papers are burned. The veterans often react as if EJMH 11:1-2, April 2016

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15

their comrades had died again, the letters so to speak carrying their deaths. The cere­ mony brings their deaths close, while, at the same time, through the stylisation they are put at a distance. Evaluations of the re-integration programme show that veterans consider such ceremonies to be the most valuable parts of the programme. Similar rituals continue to be utilised with veterans with PTSD (Tick 2005).

Hence, rituals, whether religious in nature or not, can be applied meaningfully in the treatment of traumatic disorders. They are efficacious because they enable the re-experiencing of what was traumatising in such a way that the patient is not overpowered by it again, and supported by the connection with others.

5. Conclusion In this paper, we have spoken in general terms about the functions of religion in the process of working mental problems through. In this context, religion can make significant contributions. However, it is necessary to have a realistic view of workingthrough. It does not mean that one ceases to suffer from a problem or a trauma. That would be too hedonistic a perspective on working-through because it suggests that it is possible to leave behind the negative consequences of a trauma once and for all. That is not true. Pain after a serious negative event will continue. A successful working-through means that one is able to live with this pain, and that suffering does not have the last word in one’s life. There will always be sorrow, and it is an integral part of life. The crux is that people do not perish through it. In this context, religion can have an important function, in particular in events with a strong impact such as a trauma.

Of course, religion, being a robust form of meaning-making, is not the sole system that can contribute to the working-through of a problem, and its success is far from guaranteed. However, we hope to have made clear that it is a system having a large meaning-making capacity. Or, as Baumeister (1991) states, religion is about the highest levels of meaning-making. Consequently, religion can provide meaning and significance to every life and every event, from a context that varies from the beginning of times to eternity. Hence, religion possesses a unique possibility of providing high-level meaning-making. Religion may not always be the best way of giving meaning to life, but in Baumeister’s opinion it is the most comprehensive one. In this context, we should also highlight the fact that there are crucial differences between the various religious traditions in the ways in which they are able to deliver a system of meaning, depending on the individual in crisis and on the trauma with which they have been confronted (Körver 2013).

Coping research in the United States predominantly indicates a positive efficacy of faith, worldviews and rituals, and proposes that a structural place be given to these themes in treatment. In the Netherlands research also shows that faith and worldviews are helpful in emotionally coping with problems in 39% of out-patients and 54% of in-patients in healthcare. However, as stated earlier, religion can also EJMH 11:1-2, April 2016

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have a contrary effect. In that case, religion has a negative influence on mental health. This applies to 36% of out-patients and 16% of in-patients (Pieper & Uden 2005). All this means that healthcare professionals in general should have sufficient knowledge of faith, worldviews and rituals. However, many therapists feel that they lack skills in this area, and almost half of them indicate a need for further training.

Patients’ judgements point in the same direction. They feel that therapists are able and willing to listen to their religious stories but that most of them do not have the skills for making appropriate interventions in this area in treatment. They often mention the therapists’ poor knowledge of Christian and non-Christian religious beliefs, rituals and customs. It would be desirable for healthcare professionals, when treating religious patients, to have at their disposal the wealth of stories, rituals and symbols which is stored in the various traditions. This wealth could then be introduced in treatment in a more directive way as well. However, in order to prevent indoctrin­ ation, healthcare professionals should be able to adapt this tradition to the patient’s personal standard. This can only be done adequately if they know and acknowledge their own religious biography. In technical terms: they should learn how to manage their countertransference reactions in the area of religion in a professional way (Uden 1996). It is, however, a fallacy to assume that religious counsellors would be the better professionals in this respect. They in particular are running the risk of promoting the religious dimension too much. Professionals who are aware of both their own religious knowledge and ignorance are probably best equipped. They are teachable as well as able to learn.

References Baumeister, R.F. (1991) Meanings of Life (New York: Guilford).

Folkman, S. & R.S. Lazarus (1980) ‘An Analysis of Coping in a Middle-Aged Community Sample’, Journal of Health and Social Behavior 21, 219–39.

Frankl, V. (1969) The Will to Meaning (New York: World).

Gersons, B.P.R. (1988) ‘Adaptive Defence Mechanism in Post-Traumatic Stress Disorders and Leave-Taking Rituals’ in O. van der Hart, ed., Coping with Loss: The Therapeutic Use of Leave-Taking Rituals (New York: Irvingstone) 135–49.

Gersons, B.P.R. & M. Olff (2005) Behandelingsstrategieën bij posttraumatische stressstoornissen (Houten: Bohn Stafleu van Loghum).

Harrison, M.O., H.G. Koenig, J.C. Hays, A.G. Eme-Akwari & K.I. Pargament (2001) ‘The Epidemiology of Religious Coping: A Review of Recent Literature’, International Review of Psychiatry 13, 86–93.

Hart, O.v.d. (1981) Afscheidsrituelen in de psychotherapie (Baarn: Ambo).

Herman, S. (1992) ‘Veertig jaar later: Rouwverwerking na de Holocaust’ in O. van der Hart, ed., Afscheidsrituelen: Achterblijven en verder gaan (Amsterdam: Swets & Zeitlinger) 87–114.

Jacobs, J.L. (1992) ‘Religious Ritual and Mental Health’ in J.F. Schumaker, ed., Religion and Mental Health (Oxford: Oxford UP) 292–99.

James, W. (1982) The Varieties of Religious Experience (Harmondsworth: Penguin).

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Johnson, D.R., S.C. Feldman, H. Lubin & S.M. Southwick (1995) ‘The Therapeutic Use of Ritual and Ceremony in the Treatment of Post-Traumatic Stress Disorder’, Journal of Traumatic Stress 8, 283–98.

Koenig, H.G. (1988) Religion, Health and Aging: Review and Theoretical Integration (New York: Greenwood).

Koenig, H.G. (1995) Research on Religion and Aging: An Annotated Bibliography (Westport: Greenwood).

Körver, J.W.G. (2013) Spirituele coping bij longkankerpatiënten (PhD diss., Tilburg University, Tilburg).

Lazarus, R.S. (1993) ‘Coping Theory and Research: Past, Present and Future’, Psychosomatic Medicine 55, 234–47.

Lazarus, R.S. & S. Folkman (1984) Stress, Appraisal, and Coping (New York: Springer).

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Lukken, G. (1999) Rituelen in overvloed: Een kritische bezinning op de plaats en de gestalte van het christelijk ritueel in onze cultuur (Kampen: Gooi & Sticht).

Matthews, D.A., M.E. McCullough, D.B. Larson, H.G. Koenig, H.G., J.P. Swyers & M. Greenwold Milano (1998) ‘Religious Commitment and Health Status: A Review of the Research and Implications for Family Medicine’, Archive for Family and Medicine 7, 118–24.

Norton, M.I. & F. Gino (2014) ‘Rituals Alleviate Grieving for Loved Ones, Lovers, and Lot­ teries’, Journal of Experimental Psychology: General 143, 266–72.

Pargament, K.I. (1997) The Psychology of Religion and Coping: Theory, Research, Practice (New York: Guilford).

Pargament, K.I. (2007) Spiritually Integrated Psychotherapy: Understanding and Addressing the Sacred (New York: Guilford).

Pargament, K.I. & C.R. Brant (1998) ‘Religion and Coping’ in H.G. Koenig, ed., Handbook of Religion and Mental Health (San Diego: Academic) 111–28.

Pargament, K.I., G.M. Magyar-Russel & N.A. Murray-Swank (2005) ‘The Sacred and the Search for Significance: Religion as a Unique Process’, Journal of Social Issues 61, 665–87.

Pieper, J.Z.T. & M.H.F. van Uden (2005) Religion and Coping in Mental Health Care (Amsterdam & New York: Rodopi).

Post, P., A. Nugteren & H. Zondag (2002) Rituelen na rampen: Verkenning van een opkomend repertoire (Kampen: Gooi & Sticht).

Scheff, T.J. (1979) Catharsis in Healing, Ritual and Drama (London: U of California P).

Spilka, B., R. Hood, B. Hunsberger & R. Gorsuch (2003) The Psychology of Religion: An Empirical Approach (New York: Guilford).

Starbuck, E.D. (1897) ‘A Study of Conversion’, American Journal of Psychology 8, 268–308.

Tepper, L., S.A. Rogers, E.M. Coleman & H.N. Malony (2001) ‘The Prevalence of Religious Coping among Persons with Persistent Mental Illness’, Psychiatric Service 52, 660–65.

Tick, E. (2005) War and the Soul: Healing our Nation’s Veterans from Post-Traumatic Stress Disorder (Wheaton: Quest).

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European Journal of Mental Health 11 (2016) 18–35 DOI: 10.5708/EJMH.11.2016.1-2.2

Jobi Thomas Thurackal*, Jozef Corveleyn & Jessie Dezutter

PERSONALITY AND SELF-COMPASSION Exploring Their Relationship in an Indian Context (Received: 23 February 2015; accepted: 30 September 2015)

The present study examines the relationship between personality and self-compassion among Indian emerging adults. Two samples of emerging adult males (N1 = 494 Catholic seminarians, N2 = 504 Catholic non-seminarians) completed the Big Five Inventory, the Honesty-Humility Subscale of HEXACO and the Self-Compassion Scale–Short Form. Primarily, we examined the mean-level differences for Big Five factors, honesty-humility and self-compassion between the samples and found that mean-levels were higher for seminarians except for neuroticism. Therefore, we treated the samples separately for further analyses. Secondly, we examined the associations between personality factors of the Big Five, honesty-humility and self-compassion. Consciousness, agreeableness and extraversion were positively associated with self-compassion. Neuroticism had a large negative correlation with self-compassion. Openness to experience had a medium positive relationship with self-compassion among seminarians and a small positive relationship among emerging adult non-seminarians. A medium positive association was found between honesty-humility and self-compassion. Thirdly, we examined the impact of personality factors on self-compassion.

Self-compassion was significantly and positively predicted by agreeableness, conscientiousness, openness to experience and honesty-humility for seminarians and by extraversion, agreeableness and conscientiousness for non-seminarians. Neuroticism was a significant negative predictor of self-compassion for both samples.

Keywords: Big Five, Catholic, emerging adults, HEXACO, honesty-humility, Indian, personality, self-compassion Persönlichkeit und Mitgefühl mit uns selbst: Erforschung des Zusammenhangs in indischer Umgebung: Diese Forschung untersucht die Zusammenhänge der Persönlichkeit und des Mitgefühls mit uns selbst am Beispiel von indischen jungen Erwachsenen. Zwei Gruppen von jungen erwachsenen Männern (N1 = 494 katholische Seminaristen, N2 = 504 katholische NichtSeminaristen) haben den Fragebogen mit dem Fünf-Faktoren-Modell (Big Five), die Unterskala Ehrlichkeit-Demut des Modells Hexaco und die Skala Mitgefühl mit uns selbst ausgefüllt. Beim *

orresponding author: Jobi Thomas Thurackal, Faculty of Psychology and Educational Sciences, KU Leuven, C Tiensestraat 102, B-3000 Leuven, Belgium; jobithomas.thurackal@ppw.kuleuven.be.

ISSN 1788-4934 © 2016 Semmelweis University Institute of Mental Health, Budapest

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ersten Schritt wurden die Unterschiede zwischen den Musterdurchschnitten in Bezug auf die fünf Faktoren des Big Five Modells, nach den Punkten von Ehrlichkeit-Demut und Mitgefühl mit uns selbst untersucht und beobachtet, dass in der Gruppe der Seminaristen alle typischen Durchschnittswerte – bis auf den Neurotizismus – höher waren. Die Gewissenhaftigkeit, Freundlichkeit und Extraversion sind positiv mit dem Mitgefühl mit uns selbst korreliert. Der Neurotizismus zeigte eine hohe negative Korrelation mit dem Mitgefühl mit uns selbst. Die Offenheit zeigte eine positive Korrelation vom mittleren Wert mit dem Mitgefühl mit uns selbst in der Gruppe der Seminaristen und eine geringe positive Korrelation in der anderen Gruppe der jungen Erwachsenen.

Drittens untersuchten wir die Wirkung der Persönlichkeitsmerkmale in Bezug auf das Mitgefühl mit uns selbst. Bei den Seminaristen ließ sich aufgrund von Freundlichkeit, Gewissenhaftigkeit, Offenheit und Ehrlichkeit-Demut das Mitgefühl mit uns selbst deutlich positiv voraussagen, bei den Nicht-Seminaristen eben Extraversion, Freundlichkeit und Gewissenhaftigkeit. Der Neurotizismus erwies sich in beiden Gruppen als eine signifikante negative Vorhersagevariable.

Schlüsselbegriffe: Persönlichkeit, Fünf-Faktoren-Modell (Big Five), Ehrlichkeit-Demut, HEXACO,­Mitgefühl mit uns selbst, junge Erwachsene, Indien, katholisch

1. Introduction 1.1. The Indian context Framed within the religious tradition of Buddhism as well as within current psychology, ‘self-compassion’ is a topic that has received increasing attention (Krieger et al. 2013). Based on the perspectives of Buddhism and founded in a social psychological framework, Neff (2003a; 2003b) developed a positive selforiented concept, called ‘self-compassion’. After publishing the first two articles on self-compassion by Neff in 2003, more than 200 journal articles and dissertations were published on this topic within a period of ten years (Germer & Neff 2013). The earliest psychological usage of the term ‘compassion’ appeared in ‘A Group Test for the Measurement of Cruelty-Compassion: A Proposed Means of Recognizing Potential Criminality’ (Hawthome 1932), where the concept is, however, not well defined. Later, Macintyre elaborated further on the concept and defined compassion as ‘to put oneself imaginatively in the place of the sufferer and to alter one’s actions appropriately either by desisting for what would have caused pain or by devoting oneself to its relief’ (1966, 22). In this process of compassion, one loses the self completely and focuses on the sufferer. Neff narrowed down the broad perspective of the other-oriented concept of compassion to a more self-oriented concept without losing the benefit of the former aspect. Self-compassion is defined as, being touched by and open to one’s own suffering, not avoiding or disconnecting from it, generating the desire to alleviate one’s suffering and to heal oneself with kindness. Self-compassion also involves offering non-judgemental understanding to one’s pain, inadequacies and failures, so that one’s experience is seen as part of the larger human experience. (2003b, 87)

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Self-compassion is determined by the positive and negative poles of three components: self-kindness, common humanity and mindfulness. Self-kindness entails being kind to and understanding of oneself rather than being overly critical to oneself at the time of suffering and failure. Common humanity implies a non-judgemental understanding that suffering and failure are part of the shared human experience.

Mindfulness is a balanced awareness of one’s suffering and failure without exaggerating, suppressing and avoiding them (Neff 2003b; Neff et al. 2007a; Petersen­ 2014). Similar psychological concepts can be found in the humanistic approach such as Rogers’s ‘unconditional positive regard’ (1961), Maslow’s ‘B-perception’ (1968) and Ellis’s ‘unconditional self-acceptance’ (1973) that concentrate on the individual. Self-compassion encompasses them with its unique focus on a sense of shared humanity without isolating the individual from other human beings and with its notion of mindfulness (Barnard & Curry 2011; Neff 2003a).

Traditionally in India, a compassionate individual is normally considered a mentally healthy person because of the inner contentment and being fair to everyone equally (Paranjpe 2002). To be compassionate with oneself aims to liberate oneself from one’s suffering and at the same time acts as a prerequisite for an advanced form of self-compassion – compassion for others (Ladner 2004). Buddhism describes compassion as Karuna, an important quality to lead a meaningful and content life (Ladner 2004). From a Buddhist perspective an ideal person is the one who is free from any negativity toward any creature and is, instead, filled with positive qualities of compassion, friendliness and selflessness (Paranjpe 2002).

Christianity is called ‘the religion of compassion’ (Walker 1979, 755) because of its teaching of compassion as a ‘homage rendered to the Lord’ (Achtemeier­ 1962, 353). But it does not mention self-compassion directly. At the same time, the higher level of self-compassion, that is, compassion for others is well explained in Christianity, and it is mainly attributed to the character of God, who is full of compassion. Every Christian is called to follow the example of God’s compassion that should not be reserved for friends and neighbours alone but extended to everyone without exception, even to one’s enemies (Walker 1979). Considering its significance in relationships, compassion is understood on three levels: family, community and dependent people like children, the elderly, the poor, orphans and widows (Achtemeier 1962).

A short historical overview can explain why self-compassion is significant among Indian Christians. Christianity is a minority group (2.5% of the total population) in India, but with a tradition dating back to the first century. Early Indian Christians, known as St. Thomas Christians, are found in Kerala, one of the southern states of India. Later, from the fourteenth century onwards, European Christian missionaries came to India and baptised many into Christianity in the Latin Catholic tradition. Therefore, three individual Churches of Latin, Syro-Malabar, and SyroMalankara constitute the Catholic Church in India.

Interestingly, Christians in India have never separated themselves from others except in their strong Christian faith, and they have been following indigenous trad­ EJMH 11:1-2, April 2016

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itions and incorporating interreligious elements in their religious practices (Brown 1982; Collins 2007). During different stages of life, every Catholic in India is religiously trained through different religious programs. For example, during the school and college years, a Catholic receives religious education through a system of Sunday school classes that take one and a half hour a week. The non-seminarians in this study are those who received a nominal Catholic formation in such terms.

A Catholic seminary is a place for the spiritual, moral, and intellectual formation of priests (O’donohoe et al. 2002). According to the Indian worldview, an individual acquires qualities like compassion in the first stage of human life called Brahmacarya Azram (student life) in order to lead the other three stages of life (Grhastha Azram – household stage, Vanaprastha Azram – retired life, Sanyasa ­Azram – renounced life) successfully. For this reason, one has to leave the family and live with the teacher (Bhawuk 2011). This tradition of student life is incorporated into the Catholic ­seminary system in India, where candidates leave their family and live in an institution with many scholar priests who specialise in different religious disciplines and serve as examples for the novices.

At different stages of seminary formation, a candidate allows oneself to be formed by the social, cultural and religious realities in which he lives (Padinjarekuttu­ 2005). The entire training in a major seminary is intended to the formation of true pastors. Candidates are trained for the ministry of the word of God, which has to be expressed in words and in example. The capacity to relate to others is fundamental for them since they are responsible for a community. Therefore, genuine compassion is considered to be an important quality of a pastor (John Paul II 1992, 43). Being a shepherd, a Catholic priest continues the work of compassion, incorporating truth, love and life (82).

1.2. Personality traits and self-compassion The following empirical findings provide a basis for an analysis of the relationship between personality and self-compassion in an Indian Christian context. In a sample of 177 undergraduates, Neff and her colleagues (2007a) found a significant positive relationship between self-compassion and three personality constructs of the Big Five, more precisely agreeableness (r = 0.35, p ˂ 0.05), extraversion (r = 0.32, p ˂ 0.05), and conscientiousness (r = 0.42, p ˂ 0.05). Self-compassion seems to improve interpersonal relationships (Crocker & Canevello 2008; Neff & Beretvas­ 2013) and is significantly associated with the personality factors of the Big Five (Ayodele 2013). It plays an important role as a predictor of psychological health (Gilbert & Procter 2006; Neff 2003a; Neff et al. 2007a, 2007b; Sbarra et al.

2012) especially among younger people (Barnard & Curry 2011; Neff 2011).

Self-compassion, furthermore, has a strong positive relationship with well-being (Macbeth & Gumley 2012), life satisfaction (Neff et al. 2005), and happiness (Neff & Vonk 2009). A meta-analysis of 19 studies (between 2003 and 2011) pointEJMH 11:1-2, April 2016

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ed out significant negative association between self-compassion on the one hand and anxiety, depression and stress on the other hand (Macbeth & Gumley 2012). The relationship between self-compassion and performance level shows that individuals with higher levels of self-compassion evaluate their performance more accurately than those with low self-compassion, who underrate their abilities, or those with high self-esteem, who overestimate their performance (Leary et al. 2007).

Self-compassion has a negative association with neuroticism (r = –0.65, p ˂ 0.05; Neff et al. 2007b). Gilbert and Procter (2006) found that self-compassion acts as a buffer to the markers of maladjustment such as depression, anxiety, self-criticism, shame, inferiority and submissive behaviour significantly. Neff et al.

(2007a) also supported the buffering hypothesis with their findings, indicating that at the time of ego-threat, self-compassion acts as a buffer against anxiety. A multicultural study confirms this association in both eastern and western societies (Neff et al. 2008). Also Leary and his colleagues (2007) described that individuals high in self-compassion expressed less extreme reactions, less negative emotions, more accepting thoughts and were more likely to take responsibility in a negative situ­ ation. Finally, Schanche and her colleagues (2011) found in a sample of psychiatric patients that a gradual increase in self-compassion from early to late in therapy was accompanied with a significant decrease in psychiatric symptoms, interpersonal problems and personality pathology.

In the field of personality research, the Big Five model is the most widely used model, which includes five dimensions of personality traits, namely openness, con­ scientiousness, extraversion, agreeableness and neuroticism (Costa & McCrae 1992; Paunonen & Ashton 2001) and is very effective in categorising personality (Kajonius­& Daderman 2014). Although not many studies have been made in the area of personality and self-compassion, Neff and her colleagues (2007b) noticed a positive relationship of extraversion, agreeableness and conscientiousness, and a negative relationship of neuroticism with self-compassion. However, a strong criticism against the Big Five model was that it excluded any other possible trait as a predictor (Paunonen & Ashton 2001). To overcome this limitation, we also relied on a new model, the HEXACO model, to fully examine the impact of personality on self-compassion.

The HEXACO model has emerged as a newly recognised model of personality research (Aghababaei & Arji 2014) with six dimensions of personality: honesty-humility, emotionality, extraversion, agreeableness, conscientiousness, and openness to experience. The HEXACO model has similarities with the Big Five model of personality in terms of the subfactors, except for the honesty-humility subscale of HEXACO (O’Neill & Paunonen 2013; Rolison et al. 2013). The uniqueness of this model is the introduction of this new factor, which is a tendency to be fair and genuine in dealing with individuals to the extent of being exploited without retaliation (Ashton & Lee 2007). The Big Five model lacks this dimension of personality (Vries et al. 2009).

The new factor, honesty-humility, has a significant negative correlation with behaviour related to deceit, self-monitoring and individualistic gains (Ashton et al.

2000). Exploitative behaviour such as Machiavellianism or psychopathic personality EJMH 11:1-2, April 2016

PERSONALITY AND SELF-COMPASSION

23

traits is also negatively correlated with this factor (Ashton & Lee 2005; Jakobwitz & Egan 2006; Paulhus & Williams 2002). The honesty-humility factor is proved to be a more active trait than agreeableness (Hilbig et al. 2013). Moreover, due to its predictive validity with different types of behaviour (Ashton & Lee 2005), the honesty-humility factor of HEXACO is considered to be an active and egotistical part of personality (Kajonius & Daderman 2014).

1.3. The current study The study mainly aimed to examine the relationships between self-compassion and personality traits, especially the five factors of the Big Five and the honesty-humility factor of HEXACO. Therefore, our first hypothesis was that conscientiousness, agreeableness, extraversion, openness to experience and honesty-humility would have a significant positive relationship, and neuroticism would have a significant negative relationship with self-compassion. Because the concept of self-compassion emerged from Buddhism, an ancient religion which originated in the Indian culture, and the higher level of self-compassion, that is, compassion for others has a strong foundation in Christianity, we aimed to study this association in an Indian Christian population. Moreover, we wanted to examine the relationship between personality and self-compassion in Indian emerging adults (Arnett 2004). Emerging adulthood is a life stage in between adolescence and young adulthood, characterised by the age of identity explorations, instability, self-focus, feeling in-between and possibil足 ities (Arnett 2011). We selected the samples of emerging adulthood specifically because of the distinctiveness of the process of this stage to develop qualities, skills and capacities of character to complete the transition to adulthood (Arnett 1998).

In addition to the focus on this specific life stage, we were particularly interested to explore the role of compassion for individuals who were enrolled in an intensive Christian training with a focus on compassion within the Indian Christian context.

We therefore selected a sample of young Catholic seminarians from India who share the same life period with a sample of Catholic non-seminarians.

Since personality factors could describe the characteristics of individuals from different domains, we assumed that they could predict self-compassion due to its close association with personality. Therefore, our second hypothesis was that personality factors of the Big Five (extraversion, agreeableness, conscientiousness, openness to experience and neuroticism) and the honesty-humility factor of HEXACO would predict self-compassion among seminarians and non-seminarians due to their Christian faith and Indian tradition. We also hypothesised that, due to their many years of intensive Christian formation which would focus on personality development and human values both theoretically and practically, seminarians would score lower than non-seminarians in neuroticism and higher in the personality factors of extraversion, agreeableness, conscientiousness, openness to experience of the Big Five and honesty-humility of HEXACO as well as in self-compassion.

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J.T. THURACKAL & J. CORVELEYN & J. DEZUTTER

2. Method 2.1. Participants and procedure The study was conducted on two samples of emerging adult males, between 18 and 30 years of age. All participants in the study had completed their pre-university certificate course and hailed from the geographical region of Kerala, one of the southern states of India, where the Christian population is 19% (2.3% in India). Participants of the first sample were 494 Catholic seminarians (mean age = 23.18, SD = 2.95), who belonged to one of the three different Catholic churches present in this area (13.6% to the Latin Church, 83.8% to the Syro-Malabar Church and 2.9% to the Syro-Malankara Church). To make it convenient, the sample will be referred to in the study as “seminarians”. All participants were enrolled in a bachelor program of either Philosophy or Theology. The majority came from villages (91%) and a minority from cities (9%). To get an access to the first sample, we contacted the authorities of the major seminaries in India and got permission from eight seminaries.

Participants of the second sample were 504 Catholic non-seminarians (mean age = 20.74, SD = 3.24). To make it convenient, they will be referred to in the study as “non-seminarians”. They belonged to three churches of the Catholic faith in this area (9.2% to the Latin Church, 88.2% to the Syro-Malabar Church and 2.6% to the SyroMalankara Church). Among the participants, 63.9% were from villages and 36.1% from cities. They had completed the pre-university certificate course and were unmarried at the time of the data collection. In order to reach the Catholic emerging adult population, we approached different institutions, namely one private university, eight colleges (including a medical college and an engineering college), two Catholic youth organisations, five parishes and three Catholic youth program centres in South India.

All subjects were asked to give informed consent to participation in the study.

We used a generally accepted form of informed content that included the purpose of the study in general (to explore personality factors in early adulthood), confidentiality and the anonymity of the participant. Participation was voluntary and was allowed to discontinue at any time with no penalty. Once they had expressed their consent in writing, each participant completed a demographic survey consisting questions of age, education, place of living, rite (identifying church affiliation; in our study, Latin, SyroMalabar or Syro-Malankara), education of father and education of mother. They were given proper guidelines both orally and in writing before administering the tests.

2.2. Measures Self-Compassion Scale–Short Form (SCS-SF) (Raes et al. 2011). The twelve-item instrument was completed in order to measure self-compassion. Participants had to rate each item on a five-point Likert scale ranging from (1) ‘almost never’ to (5) ‘almost always’. The items were prefaced with the following statement: ‘How I typically act EJMH 11:1-2, April 2016

PERSONALITY AND SELF-COMPASSION

25

towards myself in difficult times’. Each item (such as ‘I try to see my failings as part of the human condition’ or ‘when something upsets me I try to keep my emotions in balance’) had to be assessed on the basis of ‘how often you behave in the stated manner’. The scale was a shorter version of the original Self-Compassion Scale with 26 items (Neff 2003a), having an adequate internal consistency. The English SCS-SF total score (Cronbach’s alpha = 0.86) had a positive correlation (r = 0.98) with the long SCS total score (Cronbach’s alpha = 0.93). Confirmatory factor analysis supported the same dimensions as found in the long form (see Raes et. al. 2011).

Big Five Inventory (BFI) consists of 44 self-report items and assesses the five dimensions of personality: extraversion, agreeableness, conscientiousness, neuroticism, and openness to experience (John et al. 1991). The items were prefaced by a phrase, ‘I am someone who . . .’ and followed by the item statement such as ‘. . . is talkative’ or ‘. . . is reserved’. Participants assessed each item on a five-point Likert scale from (1) ‘disagree strongly’ to (5) ‘agree strongly’. The scores of reliability and validity were high across age, culture and gender (Soto & John 2009). The scale had substantial internal consistency, retest reliability and a clear factor structure. It had also considerable convergent and discriminant validity with longer Big Five measures. The content coverage was not affected by its brevity (Benet-Martínez & John 1998; John et al. 2008).

The 60-item HEXACO-PI-R (HEXACO-60). To measure the honesty-humility factor, we used the honesty-humility subscale of the HEXACO-60, which is a shorter version of the HEXACO-PI-R (Ashton & Lee 2009). The HEXACO-60 measures six dimensions of personality such as honesty-humility, emotionality, extraversion, agree­ ableness, conscientiousness and openness. It contains ten items for each factor that collectively cover a wide range of content, with at least two items representing each of the four narrow traits of each scale in the longer HEXACO-PI-R. Participants were asked to rate each item (such as ‘If I knew that I could never get caught, I would be willing to steal a million dollars’) on a five-point Likert scale ranging from (1) ‘strongly disagree’ to (5) ‘strongly agree’. The instrument shows moderately high internal consistency reliability, low interscale correlations and a factor structure in which items of the same broad scale would show their primary loadings on the same factor of a six-factor solution.

3. Results 3.1. Preliminary results Initially, we conducted a MANOVA for both samples to examine the significance of mean-level differences of the socio-demographic variables. The multivariate results were significant for the socio-demographic variables of age, level of education, place of living, education of father and education of mother (Wilks’ Lambda = 0.71; F(5,961) = 77. 83; p < 0.001; multivariate η2 = 0.29) in the study. Therefore, we examined the univariate ANOVA results. They indicated that both samples were EJMH 11:1-2, April 2016

26

J.T. THURACKAL & J. CORVELEYN & J. DEZUTTER

significantly different for socio-demographic variables of age (F(1,965) = 146.10;­ p < 0.001; η2 = 0.13), level of education (F(1,965) = 19.60; p < 0.001; η2 = 0.02), place of living (F(1,965) = 117.33; p < 0.001; η2 = 0.11), education of father (F(1,965) = 137.77; p < 0.001; η2 = 0.13) and education of mother (F(1,965) = 158.88; p < 0.001; η2 = 0.14). Means and standard deviations of both samples are given in Table 1.

To test the significance of the mean-level differences of Big Five factors, honesty-humility and self-compassion between seminarians and non-seminarians, a oneway MANOVA was done. The result showed significant differences among the study variables (Wilks’ Lambda = 0.86; F(7,982) = 23.40; p < 0.001, η2 = 0.14). Follow-up univariate ANOVAs indicated significant differences between the two samples for the Big Five factors of extraversion (F(1,988) = 10.32; p < 0.001; η2 = 0.01), agreeableness (F(1,988) = 29.61; p < 0.001; η2 = 0.03), conscientiousness (F(1,988) = 87.14; p < 0.001; η2 = 0.08), neuroticism (F(1,988) = 48.75; p < 0.001; η2 = .05), honestyhumility (F(1,988) = 121.08; p < 0.001; η2 = 0.11) and self-compassion (F(1,988) = 10.32; p = 0.001; η2 = 0.01), but not for openness to experience (F(1,988) = 0.589; p < 0.10; η2 = 0.00). The mean-level differences showed that seminarians scored higher in extraversion, agreeableness, conscientiousness of the Big Five and the honestyhumility factor of HEXACO and lower in neuroticism (see Table 1).

Since the mean-level differences of the majority of the socio-demographic variables and study variables were statistically significant, we treated the two samples separately in our study.

3.2. Correlations We conducted a series of Pearson’s correlations to test the relationship between personality and self-compassion for both samples separately. Table 1 shows descriptive statistics and correlations among the variables. The socio-demographic variables of age, education (see Table 1) and year of study (r = 0.16, p < 0.001) had a positive correlation with self-compassion of seminarians. It showed that seminarians who were higher in age, education and year of study expressed a higher level of self-compassion.

Results also indicated that neuroticism had a large negative relationship with self-compassion among both samples. Meanwhile, conscientiousness had a large positive association with self-compassion among seminarians and a medium positive association among non-seminarians. Extraversion, agreeableness and honestyhumility had a medium positive relationship with self-compassion among both samples. Interestingly, openness to experience had a medium positive association with self-compassion among seminarians, whereas it had a small positive association among non-seminarians (see Table 1).

Results described that higher levels of conscientiousness, agreeableness, extraversion and openness to experience were related to higher levels of self-compassion, and lower levels of neuroticism were related to higher levels of self-compassion among both samples.

EJMH 11:1-2, April 2016

3.25

Sample 2

0.10* 0.12** 0.07

Agreeableness

Conscientiousness

Openness to experience

7

8

9

p ˂ 0.05;

p ˂ 0.01;

–0.04

***

11 Honesty-Humility

**

–0.04

10 Neuroticism

p ˂ 0.001.

–0.08

Extraversion

6

0.06

0.10*

0.06

–0.05

0.05

–10.00* –0.04

0.05

0.15**

0.12**

–0.04

0.07

0.06

0.13

0.11

Self-compassion

5

0.64

**

–0.07

*

–0.15

Education of Mother

4 **

0.15 1

–0.09

Education of Father

3

1 –0.02

0.55

Education

2 **

**

1

Age

*

0.00

0.50

0.57

3.17

3.36

5

0.02

0.01

–0.02

0.02

0.00

0.01

–0.04

1

0.42**

0.51**

0.43**

1

0.34

**

–0.09

**

0.42**

0.58**

1

0.26**

0.38

**

0.03

0.06

0.06

0.12

0.63

0.69

0.50

0.50

3.62

3.79

7

**

0.49**

1

0.31**

0.37**

0.38

**

–0.12

**

–0.08

0.07

0.18

0.71

0.76

0.56

0.56

3.30

3.63

8

**

0.33**

0.26**

0.47**

0.41**

–0.52

0.09

**

*

0.13

**

0.03

–0.01

0.73

0.80

0.63

0.68

2.83

2.54

10

1

0.24** –0.33**

1

–0.13**

0.19** –0.39**

0.24** –0.45**

0.35** –0.38**

0.14

**

0.13

**

**

0.16

0.11

*

0.12

0.58

0.59

0.46

0.46

3.35

3.40

9

–0.61** –0.52** –0.59** –0.62** –0.40**

0.41**

0.56**

0.49**

0.39**

1

–0.07

*

–0.08

–0.04

0.70

–0.10

–0.03

*

**

0.12

–0.07

0.62

0.62

0.55

0.53

3.40

3.51

6

*

0.05

0.65 0.06

1.18

1.20

4.15

3.18

4

Sample 2 0.58

1.27

1.19

3.98

3.06

3

0.78 **

0.80

0.82

0.59

0.82

2

Sample 1

**

2.93

Sample 1

20.76

Sample 2

1 23.16

SD

Sample 1

M

1

Cronbach’s α

SD

M

Group

Table 1 Correlations between Big Five factors, honesty-humility and self-compassion in the seminarians (below diagonal) and non-seminarians (above diagonal) (seminarians: N = 489; non-seminarians: N = 502)

1

–0.25**

0.10*

0.33**

0.38**

0.19**

0.29**

–0.05

–0.01

–0.10

0.04

0.62

0.67

0.58

0.54

3.40

3.79

11

PERSONALITY AND SELF-COMPASSION

27

EJMH 11:1-2, April 2016

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J.T. THURACKAL & J. CORVELEYN & J. DEZUTTER

3.3. Hierarchical regressions 3.3.1. Sample 1 (seminarians) To determine whether Big Five and honesty-humility scale scores could predict self-compassion among seminarians, a hierarchical multiple regression analysis was conducted (see Table 2). In step 1, we examined self-compassion with the Big Five factors as regressors. Result showed that conscientiousness (β = 0.22, p ˂ 0.001), openness to experience (β = 0.12, p ˂ 0.01) and agreeableness (β = 0.10, p ˂ 0.05) were significant predictors of self-compassion. Neuroticism was a significant negative predictor of self-compassion (β = –0.37, p ˂ 0.001). In step 2, we added honestyhumility factor to the Big Five factors as a possible predictor of self-compassion.

Results indicated that conscientiousness (β = 0.15, p ˂ 0.01), openness to experience (β = 0.11, p ˂ 0.01) and agreeableness (β = 0.11, p ˂ 0.01) remained positive predictors and neuroticism (β = –0.37, p ˂ 0.001) a negative predictor of self-compassion.

Furthermore, the honesty-humility factor (β = 0.11, p ˂ 0.05) of HEXACO also predicted the level of self-compassion of the seminarians.

Table 2 Multiple regression analysis with self-compassion as the criterion of Sample 1 – seminarians (N = 489) Predictor BFI extraversion BFI agreeableness BFI conscientiousness BFI openness BFI neuroticism Honesty-humility (HEXACO) DR2 DF Total adjusted R2 *

Self-compassion Step 1

Step 2

–0.02 0.10* 0.22*** 0.12** –0.37***

–0.01 0.10* 0.15** 0.11** –0.37*** 0.11* 0.45 65.70*** 0.44

0.44 76.98*** 0.44

p ˂ 0.05, ** p ˂ 0.01, *** p ˂ 0.001.

3.3.2. Sample 2 (non-seminarians) We repeated the same procedure with sample 2 (see Table 3). Results indicated that agreeableness (β = 0.15, p ˂ 0.001), conscientiousness (β = 0.14, p = 0.001) and extraversion (β = 0.12, p ˂ 0.01) were significant positive predictors of self-compassion. Neuroticism remained a significant negative predictor of self-compassion EJMH 11:1-2, April 2016

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PERSONALITY AND SELF-COMPASSION

(­ β = –0.35, p ˂ 0.001). Results of step 2 showed that agreeableness (β = 0.14, p = 0.001), extraversion (β = 0.12 p ˂ 0.01) and conscientiousness (β = 0.10, p ˂ 0.05) were significant positive predictors, and neuroticism (β = –0.35, p ˂ 0.001) was a negative predictor of self-compassion. Meanwhile, the honesty-humility factor had no predict­ive value on the level of self-compassion of non-seminarians.

Table 3 Multiple regression analyses with self-compassion as the criterion of sample 2 – non-seminarians (N = 502) Predictor BFI extraversion BFI agreeableness BFI conscientiousness BFI openness BFI neuroticism Honesty-humility (HEXACO) DR2 DF Total adjusted R2 *

Self-compassion Step 1

Step 2

0.12** 0.15*** 0.14*** –0.01 –0.35***

0.12** 0.14*** 0.10* –0.03 –0.35*** 0.09 0.33 40.55*** 0.32

0.33 47.74*** 0.32

p ˂ 0.05, ** p ˂ 0.01, *** p ≤ 0.001.

4. Discussion The current study was one of the first in which personality factors of the Big Five and honesty-humility were examined in relation to self-compassion within an Asian context. Results were mainly in line with our hypotheses. To support the first hypothesis, we found significant positive associations of the personality factors of conscientiousness, agreeableness and extraversion with self-compassion that supported earlier findings (Neff et al. 2007a). Additionally, we found a medium positive association between openness to experience and self-compassion among seminarians and a small but significant positive association among non-seminarians. This association was contrary to the past study of Neff and her colleagues (2007a). Openness to experience was characterised by feelings, fantasy, aesthetics, actions, ideas and values (Costa & McCrae 1992; Mischel et al. 2008). Raad (2000) described it as a trait where feelings run highest, and it might be one of the reasons for the close association of openness to experience with self-compassion. Another reason might be the cultural or demographic differences between the Indian samples of the pres­ ent study and the American samples of the past study. The sense of feeling good is mostly associated with participation in the group for Asians, whereas it is more indiEJMH 11:1-2, April 2016

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vidualistic in the West. The Indian self is considered to be part of a larger whole and more intuitive, whereas the American self is a unitary free agent and more reasoning (Nisbett 2003; Seiter & Nelson 2011). A significant and medium relationship of the honesty-humility factor of HEXACO with self-compassion among both samples was a unique finding of this study.

Results of the current study supported our second hypothesis that personality factors of the Big Five and honesty-humility would predict self-compassion. Impact of openness to experience and extraversion on self-compassion differed between seminarians and non-seminarians. We found that openness to experience predicted self-compassion among seminarians, but no such impact was found among nonseminarians. In earlier studies, openness to experience was closely associated with Goldberg’s construct of ‘Intellect’ and Norman’s construct of ‘Culture’ (Costa & McCrae 1985; Raad 2000). We therefore assumed that one of the reasons might be an overemphasis on intellectual formation in the seminaries (Lee & Putz 1965).

Another reason might be based on the correlation between femininity and openness to experience (Hatchett & Han 2006). Hagmaier and Kennedy (1965), after reviewing different studies, concluded that seminarians were more feminine in their interests than the common men, and therefore the factor of openness to experience predicted self-compassion among seminarians.

Extraversion was a predictor of self-compassion among non-seminarians. The possible explanation of the predictive value of extraversion on self-compassion among non-seminarians might be due to their outgoing nature, personal involvement in the events of the external world (Raad 2000) and their response to stress by trying to lose themselves among people (Mischel et al. 2008). This resembled the basic qualities of self-compassion, where individuals could find their painful experiences as part of the larger human experience (Neff 2003b). Interestingly, extraversion was not a predictor of self-compassion among seminarians. It might be due to the enclosed life of seminarians that modified their personality in the direction of greater introversion and submissiveness (Hagmaier & Kennedy 1965). The nature of training in the seminary might have formed a personality that perceived the constructs of extraversion and self-compassion differently. Future research could explore more of this area of study. Neuroticism predicted self-compassion negatively in both samples, supporting past findings of the association of neuroticism in general (Krieger et al. 2013; Neff 2003a; Neff et al. 2007b; Pauley & Mcpherson 2010; Phillips & Ferguson 2013; Raes 2010; Shapira & Mongrain 2010; Terry et al. 2012). Results showed that self-compassionate seminarians and non-seminarians could experience lower levels of neuroticism.

Honesty-humility, which was characterised by sincerity, modesty, fairness and greed avoidance, predicted the self-compassion of seminarians significantly, though with a low impact. The goal of seminary training, just like that of training in a military academy, is, focusing on external deportment, to achieve exactness in every detail however small and to build a character straight and true (Lee 1965). Living in such a controlled environment can in fact form seminarians’ character in line with EJMH 11:1-2, April 2016

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the goal of their training. That might be a reason why honesty-humility was a predictor of self-compassion for seminarians.

Results of the current study also supported the third hypothesis that seminarians would score higher in personality factors (extraversion, agreeableness, conscientiousness, openness to experience of the Big Five and honesty-humility of HEXACO) and self-compassion, and lower in neuroticism than other merging male adults. We found that seminarians scored higher in extraversion, agreeableness, conscientiousness of the Big Five and in the honesty-humility factor of HEXACO and lower in neuroticism. Neff and Pommier (2013) found that practitioners of meditation could score higher levels of self-compassion than other undergraduate students. The limitation of their study was that the meditators were from the West alone. We expected that, due to the daily practice of meditation and religious training, seminarians would score higher than non-seminarians. The results of the current study in the eastern context also support the past study (Neff & Pommier 2013) that self-compassion could be developed through special training. To substantiate this, results of the current study showed that seminarians who were in the higher level of religious training showed a higher level of self-compassion. Moreover, we also noticed that seminarians who were progressed in age and higher in educational level expressed higher levels of self-compassion than their juniors and less educated seminarians.

5. Conclusion 5.1. Limitations and future directions Apart from the limitations of self-report and cross-sectional studies, the current study had other limitations that highlighted the need for further research, and should be considered when interpreting the results. Primarily, the selection of samples was limited to an emerging adult male population who belonged to a particular languagespeaking group in India. Therefore, the results cannot be generalised to other populations. Future studies should consider additional samples of multicultural, multilinguistic and multi-ethnic backgrounds. Through longitudinal studies of different age groups of both genders, future research could explore the nature of the relationship of personality and self-compassion.

Secondly, the study was limited to a minority religious group in India (Catholics). The samples therefore represented only a smallest section of the Indian population. Future studies should consider different segments of society, for example, believers and non-believers, or they should focus on Buddhist emerging adults. Thirdly, we could not explore the subscales of the Big Five factors, the honesty-humility of HEXACO and self-compassion, which limited the scope for our understanding of the relationship between the constructs. Future studies should consider the subfactors of personality factors and self-compassion to explore in detail the nature of

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the association between the constructs. Specifically, longitudinal studies could be used to get the directionality of the constructs distinctively.

5.2. Summary The present study was an attempt to explore the relationship of personality, understood in terms of the Big Five factors and honesty-humility, with self-compassion.

Overall, the results showed that personality had a close association with self-compassion, and the former could predict the latter. In this sense, individuals who enjoy a healthy personality are more likely to express high levels of self-compassion. Apart from the positive relationship of conscientiousness, agreeableness and extraversion, openness to experience also showed a positive relationship with self-compassion, and neuroticism had a significant negative relationship with self-compassion. Honesty-humility showed a significant relationship with self-compassion, whereas its predictive value on self-compassion was different.

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European Journal of Mental Health 11 (2016) 36–59 DOI: 10.5708/EJMH.11.2016.1-2.3

Gellért Gyetvai* & Judit Désfalvi

CHANGING ROMA IDENTITY A New Kind of Double Identity and How To Model It (Received: 29 September 2014; accepted: 31 December 2014)

The Roma Revival Movement, which started in the mid-20th century, exhibits several peculiar features as a social phenomenon, each of which contributes to the formation of a new identity of the Romani people, both individually and on the group level. One of the most important results of the Roma Revival Movement is the birth of a new religious Roma identity. In this new identity form, in contrast to earlier known ethnic identity forms, religion (through conversion and community membership) operates as a filter, as a new frame which can eliminate several handicaps of the ethnic or double identity (which are laden with negative feelings on the personal and group level), and establishes a new, mainly positive, identity form, the Religio-Roma Identity (RRI). In our study based on representative data, we first present the two sources of the new identity form, the rapidly growing ethnic movement as a social phenomenon and the radical change in the lives of newly joined community members. We then describe the new identity form and compare it to other known forms of ethnic double identity.

Keywords: ethnicity, Gypsy, identity, integration, religion, Romani Veränderung der Roma-Identität: Eine neue Art der doppelten Identität und wie dieses Phänomen modelliert werden kann: Die am Anfang des 20. Jahrhunderts beginnende Roma Erweckungsbewegung, als gesellschaftliches Phänomen, dient mit mehreren Eigenschaften, die zur Neubildung der Identität der Zigeuner beitrugen, sowohl auf der Individual- als auch auf der Gruppenebene, und auch als Ganzes betrachtet. Eine der größten Errungenschaften der Bewegung ist die Geburt der neuen, religiösen Roma-Identität. In der erwähnten Identitätsform funktioniert Religion – im Gegensatz zu den bekannten ethnischen Identitätsformen – als eine Art Filter (durch Bekehrung und Angehörigkeit zur Gemeinschaft), als Deutungsrahmen, der fähig ist, die erschwerenden Komponenten zu überschreiben, die aus der ethnischen oder doppelten Identität der Betroffenen folgen (und die mit unzähligen negativen persönlichen und Gruppengefühlen beladen sind), zugleich zu einer neuen, hauptsächlich positiv beschreibbaren Selbstbehauptung führt, zur religiösen Roma-Identität. In unserer Studie zeigen wir erst zwei Quellen der neuen Identitätsform, *

orresponding author: Gellért Gyetvai, National Office for Rehabilitation and Social Affairs, Damjanich u.

C 48., H-1071 Budapest, Hungary; gyetvaig@caesar.elte.hu.

ISSN 1788-4934 © 2016 Semmelweis University Institute of Mental Health, Budapest

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durch repräsentative Daten (die schnell wachsende ethnische Bewegung als gesellschaftliches Phänomen und die radikalen Veränderungen im Leben derer, die sich der Gemeinschaft anschließen). Demnach skizzieren wir Charakteristika der neuen Selbstbehauptung, im Vergleich zu weiteren bekannten ethnischen Doppel-Identitätsformen.

Schlüsselbegriffe: Roma, Zigeuner, Identität, Religion, Integration, Ethnizität

1. Introduction When we speak about the identity of Romanies, we are in fact speaking of a double or multiple identity. This type of identity, however, significantly differs from the known identity structure of other ethnic groups in Hungary. The most significant common characteristic of previous studies on this question has been that they have routinely considered the dual identity of Romanies as conflicting (or interfering) with their singular identity as ‘a Roma’, while such conflict is not even mentioned when writing about other dual ethnic identities (e.g. Slovak- or German-Hungarians), or if it is mentioned, less emphasis is placed on it. The most important reasons for this difference can be attributed to differences in integration levels and cultural embeddedness.

When studying Romani identity, it is important constantly to bear in mind that, while the dual knowledge of self and environment inevitably develops on the basis of the representation of the majority society and of their own ethnic group, there is almost always an irreconcilable conflict between the two identities. According to Bindorffer (2001), the reason for this is due to the two sources (Roma and Hungarian) of identity of the Gypsies, which contain conflicting and competing elem­ents. While there are exceptions, they are rare.

2. Different Romani identities: theoretical basics Researchers have almost always focused on the dual identity of the Roma in two ways. First, they consider it an identity form which derives from their ethnic existence – that is, the base case, consisting of the double image of the innate cultural self-image and the image taken over from the majority society – formed from the duality of the majority society and the minority existence within that society. We will call this the Basic Roma Identity (BRI).

In this situation, the individual understands that he/she does not belong to one group only but to another as well, and it will also be obvious for him/her that the two groups differ from each other in many ways. The individual realises where they belong. They can feel their ‘otherness’. In the case of Romanies, they almost certainly feel how incompatible the two groups are, their practices, ways of thinking and culture.

The second important characteristic is that research is directed toward an analysis of what role the dual identity of Romanies (mostly those who are already or EJMH 11:1-2, April 2016

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will be artists or intellectuals) plays within the differing conflicting identities to affect achievement; typically, where Romanies have excelled in a variety of ways.

Accordingly, we will call this the Intellectual Roma Identity (IRI). These studies are typically carried out in universities or vocational colleges where there are people from different family backgrounds who possess different social capital, examining Romanies who somehow emerged and stood out from this conflicting environment.

The results and conclusions of these studies always emphasise the severity of the internal and external conflicts that accompany the participants’ new social status. This is especially true of those who choose the intellectual path.

This is important to understand because every such study also emphasises the need to raise the educational level as the most important element in dealing with the identity conflict resolution, and as the primary element in achieving the desired integration of the Gypsy community. Nevertheless, these studies show that although raising the education level can go hand in hand with the desired development from the former system of practice and behaviour, the process of changing to the Intellectual Roma Identity exacts a huge cost (Szabóné Kármán 2012).

By contrast, our research, which began in 2012, found that there exists another dual identity structure that significantly differs from these two general identity forms.

It is the changed dual identity of the Romanies in the Romani, or mostly Romani, churches, which we will call the Religio-Roma Identity (RRI). An important characteristic of the RRI, for example, is that it does not necessarily have a conflict and can significantly mitigate the negative impact of the inner conflict of the other two identity forms, while it contains positive elements that have been rarely observed previously, if at all. In this study we will describe and analyse this ‘new kind of’ double identity, the RRI, and offer a model of its structure and compare it to known multiple (Romani) forms of identity (and their models).

2.1. Identity Before presenting our results, it is important to clarify how we interpret the concepts of identity and dual identity in this study. Identity is the sameness or oneness with ourselves, the awareness and the idea of where we belong. According to Erikson (1963), by our early twenties we have a consistent self-image and inner norms, by which we can evaluate ourselves to develop our individual identity; in other words, we can place ourselves in the world. Erikson (1968) drew the inference by observing entitativity, one of the major characteristics of the group – that one’s life is determined by the group environment in which he or she was born because this indicates certain common social and cultural patterns. Group identity teaches them to become one with the identity of the group and shows their place in the world at the same time (Révész 2007).

According to Tajfel (1978) the awareness that we belong to a group has a significant value – and it bears upon us with an emotional determination which bears EJMH 11:1-2, April 2016

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upon our identity. We systematise our environment into social categories by these values, and our and other people’s place in this system determines the assessment of ourselves and others. Of course, different groups continually compare themselves to each other. In terms of identity, the most important dimensions of intra-group comparison pertain to cultural values.

Ethnic groups often distinguish themselves from other groups by their origin, common culture, behaviour and habits, religion, and the common spoken language.

Bell (1975) listed the five most important reasons of forming group identity: nation, religion, ethnicity, class, and gender.

2.2. Dual identity Dual identity is a construction in which a minority adopts those identity elements of the majority which are missing from or can be partially found in their own identity (Szabó 2007). According to Bindorffer (2001), dual identity means the combin­ ation of individual and complementary identity elements from two different sources (ethnicity and nationality).

As we can see in both definitions, the sources on the one hand complement, and on the other hand correspond to each other. This is true generally in the case of non-Romani identity. However, the two sources of Romani identity (Hungarian and Romani) contain competing and inconsistent elements. Consequently, Romani identity can be described only partially with these definitions. In the case of Romanies, the conflict has a frequent occurrence (see Bindorffer 2001; Bokrétás & Bigazzi 2013; Szabóné Kármán 2012). Moreover, every type of dual identity contains ­value aspects and emotional aspects as well (Szabó 2007). For Romanies, it means negative emotional situations again and again. This dominant power (the negative effect) of dual identity is particularly strong in the case of Romanies.

Báthory (2011) differentiates three kinds of identity strategy: the assimilative, ethno-central (mentioned by Bindorffer 2001 as the dissociative strategy), and double or multiple identity. The first, assimilative, occurs when the individual begins to ‘shape into’ the majority; the second, ethno-central identity strategy, when he/she rather prefers his/her own group; and the third, double or multiple identity, when individuals picture themselves as members of both groups and try to balance between the two sides.

Bindorffer (2001, cited from the definition by Erős 1998) speaks about four basic and two other (complementary) strategies: in addition to those just mentioned, the marginal identity and the long-lasting identity crisis. In the case of an identity crisis, the elements of the identity are manifold and not compatible, which may lead to cognitive dissonance. What can an individual do then? He/she may choose a positive strategy to solve the problem, or, with the multiple dichotomies and perspectives, he/she literally cannot choose a successful solution, and thus long-lasting disharmony may occur.

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One speaks about hidden identity if the individual, although he/she does not give up his/her minority identity, in some situations hides his/her ethnic identity.

Hancock (1999) and Okely (1997) speak about this as a strategy that was sometimes used by Romanies for survival in England. Silvermann (1988) registered the same in the USA (they change their clothes, language and names, to hide themselves). This phenomenon is well known in Hungary in the context of the Gábor Gypsies. When the Gábor Gypsies cross the border they change their clothes. They dress up in more conventional clothes to hide, at least partially, their ethnic characteristics. According to Sutherland (1975), in such cases the Romanies remain hidden for the public. It is only possible, however, if the racial tags of the minority do not differ significantly from the tags of the majority, or the original racial tags are not already so accented (because of racial admixture, for instance), as in England (Hancock 1976).

Identity is thus a kind of self-characterisation, a self-vision which is affected by our environment, and it also shapes the way our self-image develops. That is why we call identity social identity (Tajfel & Turner 1986). However, in the process of developing ethnic (dual) identity, we see, feel, think of ourselves on the basis of not only one particular group (nation, religion, class, culture, etc.) but we see, feel, and think of ourselves based on the interaction of at least two groups. Thus, this form of identity is nourished by at least three sources: 1. the majority of society’s relation to, and value judgement of, the minority, and the way this relationship is expressed; 2. the self-image of the ethnic group and the value judgement that imposes on the group; 3. the self-image of the individual and the value judgement that imposes on the self.

Of course, identity itself is created and built from the interaction of these three essential sources.

3. Roma religiosity: a brief historical introduction The Roma mission or Roma revival movement can be best understood from a historical perspective. Before the 1970s, no religious and/or church movement was able significantly to influence the religiosity of the Roma. It seems that mainstream churches did not put a big emphasis on this matter.

To understand the case presented, we will now briefly review earlier literature about Roma religiosity. Hungary was one of the first countries to publish scholarly material about the Roma minority. Augustini’s article series (2009) about the Roma was the first in the world to sum up what was known about this community in his time (1775–1776). This was followed by the works of György Enessei in 1798 (2002). Later, Henrik Wlisloczki (1893) and Antal Hermann (1895) also wrote about that issue, but by their time, there were Gypsy-related publications in other countries as well (e.g. Heinrich M.G. Grellmann, 1807, or later Rodney ‘Gypsy’ EJMH 11:1-2, April 2016

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Smith, 1902, who himself was Roma, in fact, a missionary among Gypsies, and wrote a book about Roma religiosity, largely based on his own religious experience).

Although no researchers in the modern sense, they were the first writers to comment about Roma religiosity. Their books included religion-related references, sometime even entire chapters, giving some insight into the then prevalent view on Roma religiosity. Among these, Augustini’s article series became foundational for the field. He describes the issue in a separate chapter, stating, ‘they do not have a separate religion; hereabout they follow the traditions of the country and of those people among whom they live. . . . [A]s far as its contents are concerned, however, it lacks science and awareness as well as a true sense and experience of divine doctrines and regulations’ (2009, 245, our trans.).1 These lines and the whole chapter played a foundational role in what later authors had to say about Roma religiosity (see, e.g., the oft-quoted Grellmann 1807), while the question remained virtually unexplored in research. Not surprising, then, that 200 years later in his comprehensive work, Vekerdi still wrote the following: ‘It is certain, however, that there is no separate Roma religion and there never has been. . . . Religion does not play a significant role in their way of thinking; it is practically limited to participation in spectacular church ceremonies (christening, jamboree)’ (1974, 30–31, our trans.).2 Since direct data on Roma religiosity is scarce from previous centuries, it is difficult – but not impossible – to argue against such views. We must be careful at this point. As Acton also notes, ‘Gypsy irreligion is only the classical gajo academic view’ (1997, 38); it is not the actual case. It seems certain, however, that there has been a largely ambivalent relationship between Romanies and Christian religiosity. The relationship is defined not only by the image that the majority society has of them but also by their self-image. The image is almost entirely negative in both cases. Historically as well as practically, therefore, both what there is of their written history and their negative cultural perspectives had a detrimental effect on the reconstruction of their identity both individually and on the group level.

Things, however, started to change in the middle of the twentieth century. The first well-documented religious initiative in Hungary was Miklós Sója’s mission in Hodász in 1942. The young Greek Catholic priest began to evangelise at the Gypsy settlement (actually a ghetto), and established the first Gypsy church in Hungary.

The first significant change impacting the RRI was recorded here. Miklós Sója’s effort to bring ‘repentance’ – or, in other words, a turning away from the past life to a new Christian life as defined by his Greek Catholicism – had a great effect on the RRI. For the same reason, after 1972, Jenő Kopasz’s mission in Uszka and the neighbouring villages received a lot of publicity.

1

2

riginal text: ‘különálló vallásuk nincs, errefelé az ország szokásait követik, illetve azokét a népekét, akik O között élnek. . . . [A]zonban, ami a belsőt illeti, a tudomány és a tudatosság éppúgy hiányzik belőle, mint az isteni tanok és előírások igaz átérzése és átélése.’

Original text: ‘Az mindenesetre bizonyos, hogy önálló cigány vallás nincs, és nem is volt. . . . A vallás nem játszik jelentős szerepet a gondolkodásukban; gyakorlatilag kimerül a látványos egyházi szertartásokon (keresztelő, búcsú) való részvételben.’

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We know about other initiatives as well, for example in the Methodist Church in Alsózsolca and surroundings, from 1952, or the Pentecostal Roma Mission in Békés in the 1970s, which became the most effective evangelisation among Romanies in Hungary to this day. These were the beginnings, but the fastest growth in number and scale of Romani churches occurred in the post-1989 period because the former Socialist system had merely tolerated this phenomenon (‘It is still better for them to go to church than to a pub’; Rajki & Szigeti 2012, 358, our trans.).3 The process accelerated after the end of the twentieth century when Romani churches started to mushroom. Most of them are about ten years old. It is clear that it is not just an outward appearance but a very real new phenomenon. It is so new that Török (2004) refers to only two Romani denominations although his book is a full catalogue of churches in Hungary.

There are several reasons (which we cannot discuss in detail due to lack of space) why Christian missions among the Romanies developed dramatically under charismatic sponsorship. According to our database, 85.7% of Romanies belonged to charismatic communities in 2012. And in the light of developmental trends, this rate is likely to have further increased by now. Acton writes, hat is distinctive about Romani Pentecostalism? Precisely that it has become distinctively W Romani. This is not to say there is not authentic Romani participation in other faith groups, because there is. Nor am I arguing that the Romani Pentecostal churches are ethnically exclusivist, because most are not, but only within the Pentecostal stream of Christianity do we see denominations that are primarily Romani in their ethnic character and leadership.

This chapter will argue that such a social innovation was only possible because of the way 20th century Pentecostalism effectively challenged the ecclesiastical authority structures that had arisen from the Protestant Reformation and opened the way (perhaps jointly with 20th century Socialism), to deconstruct the very roots of Roma exclusion in Europe. Unlike Socialism however, Pentecostalism proved capable of effectively being a vehicle of Romani ethnic identity.

(2014, 11)

By 2012, there were 168 registered congregations in Hungary which may be considered a part of this movement. Thus, it is a very rapidly growing, specific movement which has a major impact on the self-image of Romanies.

4. Method In the research, we used three data collection methods: participant observation, interviews, and quantitative questionnaire surveys. Over a three-year period between 2012–2014, we visited many churches, took part in worship services, took many notes, and recorded a number of interviews with members, leaders, pastors and missionaries. This was an important addition to the data collected in questionnaires, which constituted the main line of research. The main goal of the research 3

Original text: ‘Még mindig jobb nekik, ha templomba mennek, mint a kocsmába.’

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was to collect representative nationwide data, to see how the phenomenon of the Romani church in Hungary can be interpreted from a sociological point of view.

The reason for the expansion of research beyond questionnaires is that there has not been any similar research with representative sociological data collection.

Therefore our research was conducted and interpreted as basic, primary, descriptive research.

Data collection took place in Christian Romani churches. For methodologic­ al reasons, however, not every single denomination was included but only what are called New Protestant churches. The main reason for this is the significant difference between traditional churches and new Protestant (or Free Christian) ones. While in New Protestant (or Free Christian) churches church attendance and church membership are mostly the same, the two factors barely overlap in the cases of large denominations. The study focused on New Protestant (or Free Christian) churches because of the high correlation between church membership and church attendance. In the churches involved, 83.9% of respondents attend weekly, 9.4% fortnightly, 5.8% monthly, and only 0.9% go to church only on ­major occasions. While in the case of traditional churches, the majority go to church only on special occasions.

First, we searched for those churches whose profile met the inclusion criteria.

By the end of 2012, there were 168 Romani Christian churches that answered to the research description, with mostly Roma members with the proper criteria. The sampling was carried out by using the order of church memberships or rosters, with a systematic sampling method. The churches were not always fully Roma-member churches. During the sampling, however, we considered only the Roma membership. Thus, the research is representative of the Roma community within the 168 congregations visited – approximately 6,500 people.

5. Results To understand the new identity form we need to speak about two factors as sources of RRI: the movement as a specifically Roma phenomenon and the change after conversion in members’ lives. This new form of identity, the RRI, and references to it by the participants, repeatedly came up during our research. It was impossible not to notice because, as it turned out later, this was the most distinctive aspect of this new phenomenon, the Romani church movement. As we questioned members of the Roma community, those progressing toward integration consistently justified their new form of consciousness and way of thinking (self-image) as arising from the existence of this movement and the radical life change it had occasioned. We came to the conclusion while observing the participants and during the interviews (and the questionnaire also supported these arguments) that these two key elements lead to change. We ultimately identified them as the two main sources of the RRI. We are, therefore, going to focus on these issues.

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5.1. The movement’s impact on the Romanies’ self-image The movement (as a phenomenon) that the churches are involved in is called by several names (‘Gypsy/Romani mission’, ‘Gypsy/Romani revival’), and it strongly shapes the self-image of the membership, the image of the Romani community and the image of their place, role and values. The movement has a specifically ethnicreligious characteristic – targeting expressly the Romanies. The leading pastors and missionaries (who include more and more Romanies) – the driving force of the movement – only reinforce this impact. By the evaluation of the leaders, it appears particularly important to emphasise a specific sense of Romaniness with and for them. Thus, assessing the movement, they gave an absolutely positive feedback to members. This unique aspect of the movement reshapes the image of Romanies in the membership.

The movement and its rapid spread have such a decisive impact on the group image of the people involved that it can be interpreted as a semi-nationalist Romani movement. The fact that the movement is uniquely Romani can significantly affect and intensify the Romani image. They see this rapid spread as God’s special blessing to the Romanies (Romani revival). Since the movement is predominantly ethnic-religious, this aspect has a very strong influence on the identity of those involved. Thus, the Roma revival movement, within this context, is absolutely positive in their eyes, reshaping the images of the group and themselves. These churches often mean a new cross-cultural connection system (90% of the membership belongs to churches that are recognised religious denominations in the country) in which Romanies worship with non-Romanies (and perhaps this is the only place where it is possible). The perception of this is also positively evaluated by those involved. Thus, the movement reshapes the image created of themselves and of the majority society.

An ethnically mixed in-group is often created as well. This has a very strong effect since in the current situation Romanies and non-Romanies can be in the same group at the same time, and Romanies do not have to give up their ethnicity. In fact, they can be proud of it. The denomination serves as a common denominator with other than Romanies. The evaluation of this aspect is also positive, and all this reshapes the image of the majority society and themselves. It is clear that Roma mission, and the Roma revival movement within it, becomes a very powerful source of identity formation.

5.2. Radical change The other main source of RRI we identified is the radical transformation of personal life. Due to the radical change which Romanies undergo when they become members of the greater community, they almost rewrite their self-image and their personal image about the Gypsy community.

Our results indicate that, when converted Romanies report a radical change, it is not an isolated but rather a general phenomenon. This is the first time this has EJMH 11:1-2, April 2016

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been observed in a representative sample. Previous research had already drawn attention to change. However, they were either locally concentrated research projects without sufficient external data to draw generalised conclusions, or broad surveys carried out with interviews and some personalised data but lacking representative sampling (e.g., Atanasov 2008; Blasco 2002; Gog 2008; Lukács 2008; Péceli 2013; Péceli & Lukács 2009).

We asked, What kind of changes can be seen in the life of Gypsies after their conversion? We received the answers as displayed in Figure 1.

Changing ethnic identity

0.6

Freedom from addiction Healing (charismatic healing)

34.9 1.5

Better family relationships

2.8

Morality and conversion

13.4

Lifestyle and behaviour

45.8 1.0

There is no change 0.0

5.0

10.0

15.0

20.0

25.0

30.0

35.0

40.0

45.0

50.0

Figure 1 Changes in the lives of converts (%, N = 705)

The most conspicuous is that only 1% reported no change among Romani converts. In other words, there is an overwhelming 99% of converted Romanies with serious life change. Perceived changes can be categorised into one of six groups.

Among these, the two most dominant categories were Lifestyle and behaviour (45.8%), and Freedom from addiction (34.8%). These were open questions; none of the specific categories was given in the questionnaire. Rather, we asked respondents to tell us, in a generalised sense, what kind of changes they were able to see in the lives of converted Romanies. Figure 1 shows the distribution of their responses.

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In the category of Lifestyle and behaviour, we found answers such as new ways of thinking, not swearing anymore, transforming, changing their lifestyles, becoming friendlier, not quarrelling and fighting anymore, not tending to drop out, more hard-working, cleaner clothes and environment, more peaceful and so on. In the case of Morality and conversion we found answers such as crime-free life, less theft and burglary, honesty, godly life, moral life and the like. Successfully ending an addiction to drinking and/or smoking was mentioned frequently in the case of Freedom from addiction, as was successfully quitting drugs and gambling. Healing (charismatic healing), which is a general phenomenon in charismatic churches, was mentioned in only 1.5% of the answers. In the case of Better family relationships, they always reported positive changes and improvement: ‘Family life has become much better.’ The answers concerning Changing ethnic identity referred directly to the changes of ‘Gypsy thinking’; for example, ‘the progress of moving forward from the Gypsy lifestyle and behaviour’.

Discussing social identity, Tajfel (1970) says that when constructing our identity, it is vital that people seek after a positively considered social identity, and for this purpose they compare themselves and their groups with each other and other groups. It is typical among Romanies to categorise within their groups as well: good versus bad Gypsy (Pálos 2010). This is an important part of building identity personally and is a factor in belonging to certain groups. During our fieldwork, we frequently encountered representations of the ‘good Gypsy’. Converted members repeatedly emphasised that they were not the same as they used to be.

Their lives had changed. They had achieved something. As we have already pointed out, their RRI developed and that changed their identity and self-image completely. However, their perception of Gypsies, including themselves, also changed.

They mentioned all this in a humble way. They saw all this change as the result of conversion. Conversion was so important to them that we did not even have to ask about their conversion because they always mentioned it among their initial responses. Sometimes they volunteered the information even when we were asking questions not remotely related to it. It seems that religious conversion is a major motor of change.

The change that comes with church life creates a new situation in the minds of individuals, which is likewise mirrored in their families and later in the broader community as well (Romani ghetto, street, village). Along with it, the ‘I’m a good example’ image is formed. Thus we have the catalysis for RRI in conversion. The reason for this is that when, in their post-conversion situation, Romanies start to analyse their environment and compare their old self to the new, they see the difference. Moreover, the religious environment expects them to lead a consistent religious, moral life and to set an example, which is an important part of spreading the religious message (mission) (see also Gog 2008). The foundation of all is an unquestioned authority: the Bible, the word of God. In the language of social representation, this phenomenon can be understood as the Romani community’s anchoring of this new image in the ‘good Gypsy’ image.

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By this, the self-image and group-image change radically, and, as a result, so does their identity. In other words, their RRI takes hold. Here we can see the big role of the Romani-majority churches targeted in this study.

5.3. Religious commitment We have seen that conversion is the most important element of the RRI, and in fact appears to be its major catalyst. To understand the new identity manifested in the RRI, we have to discuss briefly what kind of religious commitment is associated with this conversion. We asked, ‘Looking back on the time when you joined your church community, what was the most important thing that made you decide to join the church?’ Results are shown in Figure 2.

42.0

Bible message Personality of priest/pastor

5.4

The atmoshpere of worship

35.5

Attractive membership

6.4

8.0

Family calling

Other things

2.7 0.0

5.0

10.0

15.0

20.0

25.0

30.0

35.0

40.0

45.0

Figure 2 What attracted Romani converts to the church? (%, N = 705)

We chose this question format because it was a widespread view that even if they join a religious community, Romanies would be motivated only by some external cause (obtaining benefits or a forced integration in society – so-called mimicry EJMH 11:1-2, April 2016

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religiosity) or it could be a kind of faith mixed with superstition (rather pagan), etc.

Unfortunately, this idea is still widely held about Christian Romani communities.

In the light of this mimicry religion it is particularly notable and illuminating that 42% of respondents admitted that they had joined a congregation because the Bible’s message had touched them. This is almost half of those interviewed.

In this way, a content of a spiritual-cognitive impact is clearly demonstrable. Not their mood or friends, nor family members made them go, but ‘the message’, the religious content is the primary element that ‘touched them’. And this refers to the inner religious content rather than mimicry religiosity. It is clear that a genuine personal, cognitive decision underlay the conversion experience for the largest part of those converted. That is no mimicry religiosity, whose sole purpose is to hide in the great jungle of religion (that is, that under the guise of religion converts find their shelter among the difficulties of identity submerged in the majority population). When answering the question, respondents were allowed to mark only one answer. Now what we know is that almost half of the respondents considered the cognitive content of religion to be the main (or at least the initial) reason why they had joined a church. From our experience, however, we can clearly assume that for those who marked this answer first, it still may not have been the primary factor in their conversion. Our fieldwork shows that for the majority of those who had not considered the Biblical message a priority in the beginning, it still became one of the most important reasons later on.

The second most dominant reason is the mood/atmosphere experienced in church. This was the primary reason for 35.6%. Objectively, it would seem, however, that the mood/atmosphere can only be partly attributed to Romani characteristics because the specific atmosphere, music targeting the emotions, the sermon, the mood and emotional fervour, and emotional self-expression are all part of charismatic ­communities. Yet an undeniably significant difference among the targeted churches is that the Romanies incorporate their own music into the liturgy, which makes the services specific and more attractive to other Romanies. This unique musical atmosphere rooted in Romani culture, together with a liturgical schedule equally rooted in Romani culture and integrated with Romani social concepts, created a unique worship atmosphere. This, in turn, became the vital first reason to join the community for approximately ⅓ of the converted members.

The impact of the family is also significant, and so is the influence of the pastor (who is often also Romani) and members of the congregation. This proves that respondents’ religiosity is significant not only in its content but also in terms of the commitment to the Romani community. It is particularly noteworthy in terms of the RRI, in which the commitment is increased not just through the liturgy but through a sense of belonging to the community. Church attendance figures, cited above, clearly reveal the importance of this factor. According to Rosta (2011) the frequency of church attendance has been decreasing in Hungary since the 1990s. By 2008, only 9% of the population said they were weekly church goers (or even alternate or fewer weeks); monthly attendance stood at only 15%, and 42% did not go to church at all.

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In the field, we found that this factor was interpreted by church goers as a factor of moral superiority, which would obviously have a significant impact on their self-image. The result can be that the RRI is creating an ever-rising religio-moral basis over the general population, quite opposite to general perception. We asked, ‘How close can God come to a Romani’s life?’ ‘Very close’, the majority answered.

The ratio of those believing in more distance was very low: ‘He can watch only from the outside’: 0.4%; ‘He can have a say only in religious matters’: 1.5%. Meanwhile, 18.6% think that God has the authority to interfere in non-religious matters. 71.1% say that God can even ask a converted man for the greatest sacrifice. Only 8.4% were unsure of the answer. More than two thirds of the respondents can be considered deeply religious based on their answers.

By contrast, in 2008, only slightly more than one in three Hungarian people (39%) said that they always believed in God, while only 12% considered themselves converted (Gerécz 2009). And the ratio of steady believers had decreased from previous surveys (from 48% in 1998 to 39% in 2008). Thus, neither the practice of religion nor the religious content are strengths of the Hungarian population, and the trend is decreasing. The inverse direction of these trends is a topic for future evaluation.

We also probed respondents’ praying routine. 91.6% of them pray daily (even several times), which strengthens the religious content. 5.4% pray at least once a week, and only 2.8% pray occasionally. Based on Bible reading habits, we came to similar conclusions. Approximately two thirds (65.5%) of the respondents read the Bible daily. About a quarter (23.8%) read it at least once a week; 8.5% only occasionally, and a total of 2.1% said that they did not read it at all.

A good indicator is the habit of listening to Christian music. 77.2% of church members listen to Christian music daily. Our own experiences suggest that it is even more prevalent to listen to Christian music in charismatic churches (and the majority of Romani churches are charismatic). 14.2% marked on the answer sheet that they listened weekly, and only 6.4% said they did not listen regularly, while 2.1% said that they typically did not listen to such music at all.

Their changed lifestyle, changed way of thinking (and especially the most important fruit of their conversion, the good Gypsy image), their growing RRI guarantee a moral superiority in their own judgement. The ‘I was able to make such a big change’ way of thinking is extremely important in the case of identity, to which religious conversion leading to the RRI made a significant impact.

5.4. The impact of conversion on identity The individual and radical change is positive in their value judgement, and it reshapes their self-image. It develops and consolidates the ‘good Gypsy’ image, thus establishing a unique RRI and creating a value system that underlies positive personal change. Since the change brought about by the RRI is not just individual but a EJMH 11:1-2, April 2016

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community-based experience as well, the Roma group image is also reshaped. Their value judgement of the present state becomes absolutely positive against the background of pre-conversion life. Many non-Romanies consider this change positive, which makes the image of the majority society appear more accepting, less judgemental, and more sophisticated toward the Roma community, which is the beginning of a feedback loop reinforcing the RRI. The changing RRI forces a stronger contrast in the good versus bad Gypsy dichotomy. However, due to the moral demands of the new RRI (‘love your neighbour as yourself’) a new standard of self-identity is developing as well – the ‘I have to set a good example’, which strengthens the self-image and a sense of belonging to ‘my own group’ within the context of the larger society.

Before we start drawing the model, we must briefly introduce how others see the phenomenon. However, due to lack of space, we can only mention a few appropriate examples. Rózsahegyiné Juhász cites an experience written down by parish priest Miklós Sója: I n my early days in Hodász, naked children clothed in mucilage ventured from Lake Scabby to me on the shore. Forty years later, at the door of the chapel built on the shore of Lake Scabby, little Gypsy girls, dressed up as Sleeping Beauties, are waiting, like lovely fairies and water lilies of the lake and holding bouquets in their hands and poems in their minds, for the bishop and representatives of the UN, and they say their poems and give their flowers.

Compare them with the children covered in hair-weed. Only the outside! Let alone comparing the inside, what distance we can see!

(Our trans.)4

Romani Pentecostalism in Blasco’s interpretation (2002) is the Romanies’ attempt to recreate the meaning and experience of Romanies for the Romanies themselves, and for others as well. It can be perceived as an emerging lifestyle.

In his view, there is an obvious parallel between the activist Romanies (diasporatype activist) and the movement. He registered a similar change among Spanish gitanos: more common outer-relative relationship; dramatic forgiveness of irre­ concilable relationships (and later they are even proud that they were able to solve the conflict by a conversation), questioning traditional Romani community values.

The new order can override the material, kinship hierarchy; which is a positive change in the converts’ lives.

According to Péterfi and Szűcs (2004), one reason for responsiveness to faith can be found in the process of searching for identity. Because of the rootlessness of the ethnic community, Christianity can be a new canon in the everyday life of Romanies, and it lays new cornerstones for self-interpretation. They write, ‘In the 4

riginal text: ‘Kezdő hodászi napjaimban a Rühes-tóból meztelen, illetve nyálkaruhájú gyerekek merészkedtek O ki hozzám a partra. Negyven évvel később pedig a Rühes-tó partján épült kápolna ajtajában Csipkerózsikának öltözve, mint a tó csodás tündérei, tavirózsái, cigánylánykák, kezükben csokrot, eszükben köszöntő verset szorongatva a püspökre, ENSZ képviselőkre várnak, verselnek, csokrokat adnak át. Hasonlítsuk össze a hínáros gyerekekkel! Csak a külsejüket! Hát még a bensőjüket összehasonlítva, mekkora távolságokat fedezhetünk fel!’ (E. Rózsahegyiné Juhász, ‘Sója Miklós öröksége Hodászon’, manuscript, 2003, 23, retrieved 29 April 2015 from the http://docplayer.hu/3380672-Rozsahegyine-juhasz-eva-soja-miklos-oroksege-hodaszon.html).

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free Christian churches the requirement of moral commitment is extremely significant’. Expectations fall into one of three categories: ‘1. devoting more and more time to matters of faith, prayer, reading the Bible, and building and serving the community; 2. secular pastimes must not become addictive (like watching TV); 3. what is harmful to health must be refrained from’ (158, our trans.).5 A 55-year-old man says, ‘The past two years of my life have been better than all the rest before. May the Lord keep me for the remainder of my life that I may follow Him because then I will have a new life. I gave 53 years to the devil’ (159, our trans.).6 Another Romani person says, ‘At that time, there was a lot of drinking here, and theft too. It is amazing what got stolen: chickens, vegetables, fruits were all picked. There was no evidence against those who had done it, but people were angry. After Jenő Kopasz’s mission, it all changed’ (164, our trans.).7 Solt (2009) reports the following: their lives significantly changed after the appearance of the Church of Faith. Drinking and theft declined, people behaved differently, they liked to live there. In another village, where people went to the free Christian Church, the same was reported. In every one of the 14 villages studied, the most important negative features included violence, marital discord, cheating, theft, fighting, hopelessness, dirtiness, disorder, alcohol abuse, smoking, usury and increased segregation. According to the report, these all significantly declined every­ where where religion appeared.

‘The main point in revitalisation theory is the need for people “to find a dynamic equilibrium in which they may achieve mutual harmony and dreams of a new tomorrow” ’ (Burnett, cited by Atanasov 2008, 23). It c an give them a greater satisfaction in life and better coping skills. They may have different beliefs and cultural nuances, but their basic structure is the same. . . . If successful, the movement reduces the stress, provides hope and a more meaningful existence, and becomes part of the social order.

(2008, 23–24)

What is the secret? he new faith should be somewhat adaptable and compatible to the old family structures, T emotions, worldviews, mentality, and religion. If the new religion is extremely or radically opposed to the convert’s original one, then he/she is not likely to become a stable follower.

(Rambo 1993, 60–63)

5

6

7

riginal text: ‘A szabadkeresztény gyülekezetekben rendkívül jelentős az erkölcsi elkötelezettség kívánalma.

O . . . 1. minél több időt szentelni a hit dolgainak, az imádkozásnak, a Biblia olvasásának, a gyülekezet építésének és a szolgálatoknak; 2. a világias időtöltések egyike sem válhat szenvedéllyé (tévénézés); 3. tartózkodni kell mindattól, ami káros az egészségre.’

Original text: ‘Ez a két év az életemből jobb volt, mint az összes előző. A hátralévő életemben tartson meg az Úr, hogy tovább is őt követhessem, mert akkor lesz új életem. 53 évet az ördögnek adtam.’

Original text: ‘Abban az időben nagy volt itt az italozás, meg a lopás, fantasztikus, milyen lopások voltak: a tyúkot, a zöldséget, a gyümölcsöt felszedték. Rájuk bizonyítani nem lehetett, de dühösek voltak az emberek.

Kopasz Jenő térítése után mindez megváltozott.’

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This is one of the explanations why the liturgy containing Romani elements is so important to the success and stability of the movement, and why Romanies have not been able to join other denominations in a similar fashion and to a similar degree as in the churches surveyed. Lukács, studying the role of religiosity in the integration of Romanies (2008), found similar changes. She studied the Baptists in Tuzsér (in NE Hungary) and concluded that among the Romungroes, who did not have strong traditions and language, the Baptist religion served as a framework for creating a new identity.

After all, the new religious identity can be so strong that members sometimes would rather choose a financially detrimental situation with losses attending, because of religiosity, and even to be the objects of ridicule, than to abandon their religious principles. After reviewing our results, we will now show how the model of new Roma double identity can be developed.

6. Discussion 6.1. Models of double identity How can we model the new double identity and describe its features? As we have mentioned earlier, ethnic or double identity comes from three sources and, ne­ cessarily, from their interaction: – the evaluation of the majority society (out-group); – the evaluation of the subject’s own group (in-group, now the ethnic group); – the evaluation of self.

What follows is a reconstruction of their interaction, schematised in Figure 3.

Figure 3 A simple model of Basic Roma Identity without moderating influences

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In Figure 3, we can see a simple portrayal of dual ethnic identity. We can see the three sources of identity, and the arrow indicates a conflict between the two groups of identities, which is (almost always) an integral part of the ethnic identity of Romanies. The two dominant groups (in-group and out-group) contain competing elements (Bindorffer 2001). The typical relation between them is repulsion. Between the two, in the centre of the conflict, stands the individual (directly experiencing the dichotomy of the situation in his or her two opposite mirror images). Typically, the closer the individual gets to their group, the farther they move from the majority group, and vice versa. There is no overlap between the two groups; nothing attracts the groups towards each other. Separation is the most typical position; hence, a situation of constant tension and even conflict persists.

What happens if, for example, a new dual identity is created by education or, in other words, an Intellectual Roma Identity is established (Figure 4)?

Figure 4 The effect of education on identity (Intellectual Roma Identity)

A new frame of reference is established, in which, however, the group of origin does not fit in most of the time. Most often, the ethnicity is excluded. The strings connecting the individual to their own group, to the past, present and future, snap in the process of their advancement towards an intellectual life – instead of a stable reality, they find themselves in a vacuum. Frequently, the old community marginalises them, and the new one, toward which they are gravitating, does not accept them (Bokrétás & Bigazzi 2013). According to Jovchelovitch (1996), this negative social representation determines the identity of Romanies so much that he no longer considers it a dual identity but rather a threatened identity.

According to Fleischmidt, EJMH 11:1-2, April 2016

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G. GYETVAI & J. DÉSFALVI I n the subjective reading of the main characters of the stories, the demand for a rejection of identification (both subjectively as identifying oneself and objectively as being identified) becomes increasingly stronger. Mobility goes hand in hand with acculturation and therefore with an accompanying exclusion from the Romani community and relationships, with an evasion of inherited or received identity categories, which may be realised in different ways: from self-stigmatisation through concealment to a denial of Gypsy origins. The cause of identity conflicts in most such cases is the tension between the desire of assimilation and a rejection, encoded in institutional discrimination and/or everyday racism, by the majority.

(2008, 97, our trans.)8

Lewin (cited by Fleischmidt 2008) considers it vital that those who come from lower status groups, while trying to identify themselves with groups of higher status, devalue their origin and lower status groups. The border crossing is rarely trouble free, he warns. There is a price to pay to fit in the majority society. And that is the root of conflict. Szabóné Kármán’s findings on the overall mental status of Romani intellectuals (2012) can be better understood in this light: 8% did not have any positive goals; 20% of men and 33% of women were affected by neurosis; 57% of men and 72% of women were in mild depression; 2% of women had moderate depression.

What changed when the Romanies converted? This can be seen in Figure 5.

Figure 5 A model of the new identity type, the Religio-Roma Identity

8

riginal text: ‘A történetek főszereplőinek szubjektív olvasatában egyre erőteljesebb az azonosulás és az O azonosítás elutasítására való igény. A mobilitás akkulturációval és a cigány közösségből, kapcsolatokból való kiilleszkedéssel, az örökölt vagy kívülről kapott identitáskategóriák „kijátszásával” jár együtt, ami különféle formákban valósul meg: az önstigmatizációtól a rejtőzködésen keresztül a cigány származás tagadásáig. Az identitáskonfliktusok oka legtöbb esetben az asszimilációs szándék és az intézményi diszkriminációba és/ vagy mindennapi rasszizmusba kódolt többségi elutasítás.’

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The most important characteristic of the new identity, the RRI, is a new frame of reference. This, our study finds, is religiosity. Its central element or, rather, catalyst is conversion, but it also includes religion, experience of God and community, and a novel, re-shaped experience of Romaniness. Through all these, a new frame of reference is established, which includes all areas of the convert’s life and thinking. The new reference system is so dominant that it overrides the former points of reference and framework. Everything that happens, everything that comes from any source of identity formation is made sense of within this framework and interpreted through this filter. Positive feedback is self-contained in the new frame (there are no perceived conflicts). The new frame therefore mitigates ongoing conflicts and contradictions. Through the subjects’ new group (their church community, new religion in which they are generally together with others, including non-Romani members) a new common ground is created with the majority society, which reduces tension between the two identity-creating groups (this is the common ground of the in-group and out-group). The tension between the majority group and the minority and/or ethnic group, in a practical sense, is not completely eliminated. However, what is important is that the tension is often marginalised because another element with the capacity to dominate the social transactions and tensions has become more important (and that is religion). The new frame, RRI, now operates as a filter; it creates a new benchmark system and becomes a new behaviour, thinking and ethical frame.

6.2. Key features of the new identity (RRI) Its centre part or catalyst, as we have previously called it, is (religious) conversion which creates a new frame of reference that affects the individual’s entire life, way of thinking, decisions and moral choices. In almost every case, it strengthens converts’ attachment to the new group (the non-Romanies). It does not normally make for conflict between the different sides of dual or multiple identities, but, on the contrary, tends to neutralise the conflicts existing in the two previous models, creating a situation where positive feedback loops can be created within the frame. Similarly, the RRI tends to mitigate ongoing conflicts with the subject’s own group, so prominent in the IRI model. In fact, it often creates a unique new commitment to the ‘in-group’, the Romanies. Otherwise the rapid development of the movement within the Roma community at large could hardly be explained.

It creates a ‘good Gypsy’ image in the individual, reinforcing self-acceptance and acceptance of the subject’s own group. It also reinforces the ‘I am a good ex­ ample’ image. It reinforces bonding to and within the majority society. About 90% of Romani church members belong to congregations which are organised and accepted in non-Romani communities, thereby resulting in many non-Romani relations and, more importantly, in explicitly accepting and tolerant relationships, creating positive feedback loops. The majority society establishes a joint own-group with another prominent group, which strengthens the self-representation of Romanies and their EJMH 11:1-2, April 2016

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bonding to the majority society. The significant change in lifestyle and morals has a positive impact on families and non-religious Romani communities as well.

According to Jovchelovitch (1996), social representations are interwoven with the processes of identity formation. Creating social representation includes an identity statement and a reality interpretation. Both identities and representations, says László (2005), arise from the overlapping space of self and non-self.

The change elicits a totally new identity statement and interpretation of reality – and, along with them, a new representation. The religious experience in question divides converts’ lives into two strongly distinct parts: the periods, phases before and ­periods, phases after their religious conversion. (These two parts stand in irreconcilable contradiction.) The supreme God is the key actor of the new experience, who accepts them as they are, without any judgement, and who at the same time is above all of those who might discriminate against them. The God experience (among the Romanies we identify this as the catalyst, religious conversion) serves as a kind of bridge that reduces tension between the Hungarian-Romani identities. Their iden­ tities were, in the pre-RRI period, anchored in the Hungarian and the Romani sides (and in the conflict which occurred between them). Now, in the post conversion period, it is anchored in the supernatural, in a God who loves every one of them.

As they confess, before conversion they lived without any moral guidance, sinfully.

Now, however, after conversion, they stand on a solid moral base on which they judge themselves and others. It is important to note that this moral base is absolute; it does not change with time, space, ethnicity. It is firm and strong – so strong, in fact, that it overrides the innate conflict of two opposite identities in the BRI. Technically, converts test and evaluate everything through this RRI filter after conversion, and that is the final word. It legitimises their decisions and life; it even overwrites some previous customs, traditions of the Romanies and negative feedback from the majority group (e.g. prejudicial job situations, unjust persecutions, etc.)

The two most important elements in the construction of new identity are not the things of the world (e.g. the non-Romanies) and the self, but the supernatural and the self. It is a new kind of partnership. Hence, the identity is constructed not from other pre-existing sources in which there was inherent conflict, but from a new evaluation system, a frame, the RRI with a dominating new catalyst, conversion.

And this evaluation system promises that the subject will never be deceived (which was previously quite possible due to the tension and imbalance caused by the conflict of the previous models, in persons or churches or institutions, etc.). In this way, the supernatural is a determining principle which feeds the catalyst, religious conversion, which results in the RRI. In this religious frame, Romanies accomplish everything that was previously denied to them by religions, denominations, communities, institutions (even their previous denominational and/or ethnic-centred churches), pastors, religious experience, acceptance and the like. The religious togetherness creates a strong bond, a sense of community, which then gives them a kind of power and influence among

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the local Romanies. Egalitarian communities are established where the importance of kinship and previous hierarchical systems are substantially mitigated.

7. Conclusion The Roma revival movement (as Romanies call it) is unprecedented in history. It is unparalleled not just in terms of its rapid pace of growth or its strong ethnic characteristics but also in terms of its impact that rewrites the lives of the Romani from one day to another. Nor did we find another example of the conflict-filled Romani (dual) identity (BRI) changing so radically, especially as the observed change was so consistently positive. The speed and power of change in the minds of the subjects of this study are also exceptional. Studies, carried out in other fields, did not detect such changes.

The new identity construction, the RRI, creates an absolutely dominant new frame of reference and life management, after which a ‘new life’ begins. It is like a person who draws a line and says that from now on everything is going to be different. This does not mean that what we have tried to describe briefly always happens, nor does it mean that results are always positive. However, the results, objectively quantified, are indeed positive most of the time; even if the change observed is not always lasting. However, by now we can clearly state in a general sense that the movement has made a significant, lasting change, even passing this new form of identity, the RRI, on to several generations.

In this study we have presented a new form of identity, the RRI, which has an unprecedented impact among Romani converts. It comes with a radical change in the majority of people’s lives who are affected by this identity. The change is so overwhelming that the previously known Romani identity hardly compares. Similarly, earlier those strategies by which Romanies tried to reduce tension arising from their dual origins pale into insignificance against the effectiveness of the new RRI. References Acton, T.A. (1997) ‘Mediterranean Religions and Romani People’, Journal of Mediterranean Studies 7, 37–51.

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European Journal of Mental Health 11 (2016) 60–78 DOI: 10.5708/EJMH.11.2016.1-2.4

Olga Shek*, Kirsi Lumme-Sandt & Ilkka Pietilä

MENTAL HEALTHCARE REFORMS IN POST-SOVIET RUSSIAN MEDIA Negotiating New Ideas and Values (Received: 5 March 2014; accepted: 8 December 2014)

After the collapse of the Soviet Union, democratic principles began to enter into different ­branches of Russian social and health policy. As part of these changes, the country demonstrated an intention to develop a new mental health policy based on approaches consonant with the principles of the World Health Organization. This study analyses how these new policy ideas and values are reflected in the Russian mass media, and in particular whether media discourses build upon those ideas or oppose them. It is based on a qualitative analysis of newspapers from the late Soviet ­period (1980s) through the transition period (1990s) to the present (2000s). The analysis focuses on (1) the protection of patients’ rights, (2) the reorganisation of mental healthcare services and (3) activities preventing stigmatisation. While there was an absence of discussion of mental health problems in Soviet newspapers, the democratic changes of the 1990s triggered the recognition of the existence of mental illness, critiques of Soviet psychiatry and calls for reform. The media response to the new policies was quite ambivalent. Support for patients’ rights and the social integration of the mentally ill was accompanied by fear about the detrimental effects of the reforms on public safety. Articles that challenged stigmatisation also contained negative images of mentally ill people. The media were sceptical about the success of the reforms due to the particularities of Russia’s socio-economic situation and history.

Keywords: media, mental health policy, patients’ rights, Post-Soviet transformations, social integration, stigma Reformen im Zusammenhang mit der psychischen Gesundheitsförderung in den postsowjetischen russischen Medien: Diskussion neuer Ideen und Werte: Nach dem Zusammenbruch der Sowjetunion erschienen langsam die demokratischen Grundsätze in den verschiedenen Bereichen der russischen Sozial- und Gesundheitspolitik. Als Teil dieses Prozesses zeigte das Land seine Absicht, seine Politik in Bezug auf die psychische Gesundheit aufgrund des entsprechenden *

orresponding author: Olga Shek, School of Health Sciences, University of Tampere, Kalevantie 4, SF-33100 C Tampere, Finland; Shek.Olga.X@student.uta.fi.

ISSN 1788-4934 © 2016 Semmelweis University Institute of Mental Health, Budapest

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Ansatzes der Grundsätze der Weltgesundheitsorganisation zu erneuern. In unserer Studie untersuchen wir, wie diese neuen sozialpolitischen Ideen und Werte in den russischen öffentlichen Medien erschienen, insbesondere hinsichtlich dessen, ob die Diskussionen in den Medien auf diese Ideen bauten oder gegen diese Ideen waren. Die Untersuchung basiert auf der qualitativen Analyse der Pressemitteilungen von drei Zeitabschnitten: der Sowjetzeit (die 80er-Jahre), der Übergangszeit (die 90er-Jahre) und der Zeit bis zur Gegenwart (nach dem Jahr 2000). Die Analyse fokussiert sich auf den (1) Schutz der Rechte der Patienten, (2) die Reorganisation der Einrichtungen der psychischen Gesundheitsförderung und (3) die Aktivität gegen Stigmatisierung. Während in den Zeitungen der Sowjetzeit die Probleme im Zusammenhang mit der psychischen Gesundheit noch fehlten, wurde durch die demokratischen Veränderungen der 90er-Jahre das Wesen der psychischen Erkrankungen anerkannt, begann die Kritik an der sowjetischen Psychiatrie und das Drängen auf Reformen. Die neuartige Regelung wurde von den Medien ziemlich ambivalent empfangen. Neben der Unterstützung der Rechte der Patienten und der sozialen Integration von Menschen mit psychischen Störungen erschien auch die Angst, die die negativen Auswirkungen der Reformen auf die öffentliche Sicherheit betonte. Die Artikel, welche die Stigmatisierung infrage stellten, vermittelten zugleich ein negatives Image über die psychisch kranken Menschen.

Mit Bezug auf die russische sozial-wirtschaftliche Lage und die Besonderheiten der Geschichte und in den Medien wurde der Erfolg der Reformen bezweifelt.

Schlüsselbegriffe: postsowjetische Umwandlung, Politik zur psychischen Gesundheit, Medien, Patientenrechte, soziale Integration, Stigma

1. Introduction The major transformations in Russian society after the collapse of the Soviet ­Union had an impact both on mental health policy and services in the country and on ideologies regarding mental health and illness in general. As part of this process, postSoviet Russia has demonstrated an intention to follow international standards of patients’ rights in its mental health service system, which has been sharply criticised for its obvious ineffectiveness and political abuse (Jenkins et al. 2007). Simultaneously, the democratic reforms have influenced the mass media. During the Soviet period the task of the media was to lead the promotion of propaganda, and in order to fulfil this role the media were controlled by the Communist Party (De Smaele 2007). Becker (2004) notes that democratic media began to emerge in Russia at the end of the 1980s under Soviet leader Mikhail Gorbachev, and this development continued in the 1990s under Russia’s first president, Boris Yeltsin. The mass media received substantial freedom compared to the pre-glasnost period, and this gave journalists an opportunity to openly discuss different kinds of social problems in Russia (Becker 2004).

We started our study on the assumption that media discussions of mental health/illness were influenced by democratic changes in Russia thanks to the extensive discussion of human rights in general and the emergence of new mental health policies in particular. In our study we monitored media discussions from the Soviet period (1980s) through the transformation period (1990s) to the present (2000s), aiming to understand how the mass media reflect the ideas and values EJMH 11:1-2, April 2016

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of the World Health Organization’s (WHO) mental health policies. We analysed whether mass media discourses built upon these ideas or opposed them, and what signs there might be of further mental health policy development. In this study we focus on three aspects of mental health policy: (1) the protection of patients’ rights, (2) the reorganisation of mental healthcare services, and (3) activities preventing stigmatisation. We focus our analysis on areas that were neglected during the Soviet era and that have therefore been the target of changes based on internationally recognised principles to achieve positive transformations in mental health policy and the lives of the mentally ill. We also pay special attention to the issue of stigmatisation, which has lacked recognition in post-Soviet mental health policy (Shek et al. 2011), with the aim of understanding whether the media have a greater influence than policy on awareness of the problem.

We take the WHO recommendations as the starting point of our analysis because these principles for action are widely respected and reflect ideas and opinions generally accepted by the international community. In addition, they have served as the basis of mental health policy reforms in post-Soviet Russia (Jenkins et al. 2007).

We do not, however, mean to present them as perfect ideals to be adhered to without question. Rather, in this study these principles are taken as a point of comparison with the Soviet historical context, in order to outline the main developments in post-Soviet media discussions of mental health issues. Although our main research interest was the post-Soviet period, we considered it necessary to start with newspapers from the late Soviet period in order to find out how the discussion of mental health issues has developed. We are aware that the WHO mental health policy is not restricted to the above-mentioned principles, but widening the scope of research to include other aspects would have significantly increased the amount of research material. We believe that the analysis of media reflections on other mental health policy topics, such as preventive action (for example, suicide prevention) or mental health promotion, constitutes a fruitful area for further research.

We approached the media discussion from a constructionist perspective (Burr 2003), according to which terms such as mental health and mental illness are constructed by means of social interpretations, attitudes and values. They are thus culturally and socially relative categories subject to contestation, the precise boundaries and meanings of which vary by time and place (Busfield 2001). The journalistic discourse used in the media not only reflects but also creates dominating ways of perceiving mental health and illness. Fairclough (2003, 18) argues that the media, as a cultural industry, are increasingly important because they construct and circulate ‘representations, values and identities’ that form the substance of our culture and society. The mass media are frequently named as a source of information on mental illness for the general public (Lalani & London 2006; Cross 2004; Harper 2005). Political discourse is closely tied to culture (Chilton & Schäffner 2002).

The media thus create cultural attitudes and values that have a further effect on mental health policies (Cutcliffe & Hannigan 2001). In this paper we not only study

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reflections on policy ideas in the media but also draw some conclusions about the possible influence of media discussions on mental health policy development.

2. The Soviet past and mental health policy reform in post-Soviet Russia During the Communist era, Soviet science was isolated from Western countries, and the scientific discussion of mental health/illness was strongly influenced by Communist ideology (Buda et al. 2009). The existence of mental health problems was officially almost denied or described as a remnant of the previous class society ­(Korolenko & Kensin 2002). Because mental health was not considered a problem, little attention was paid to the development of mental health policy ­(Jenkins et al. 2007). There was therefore no special mental health legislation, and the work of psychiatric services was regulated by administrative instructions issued by the Ministry of Health (Appelbaum 1998). Patients’ rights were severely restricted (McDaid et al. 2006), and the dominant approach to mental healthcare assumed a paternalistic orientation (Polubinskaya 2000). Critical analyses of Soviet psychiatry have pointed to the social exclusion of mentally ill people, and to negative images of psychiatry and mentally ill people (Korolenko & Kensin 2002). Soviet psychiatry has also been strongly criticised for its political abuses, which constituted an infringement of human rights when involuntary hospitalisation and treatment were used to suppress behaviour that was designated political dissidence (Spencer 2000; Lavretsky 1998). The practice of political abuse resulted in the expulsion of the USSR from the World Psychiatric Association in 1982. The country returned to the Association in 1989 after openly admitting that psychiatry had been abused for political purposes (Polozhij & Saposhnikova 2001).

The democratic reforms of the early 1990s had a significant impact on the country’s mental health policy. After the collapse of the Soviet system, the discourse on human and patients’ rights became a central component of mental healthcare reform.

The basis for the mental health policy of post-Soviet Russia was initially formulated in 1992 by a law enitled ‘Psychiatric Care and Guarantees of Citizens’ Rights in Its Provision’. This document proposed new principles in line with international standards for citizens’ and patients’ rights, and sought to overcome the ‘old’ approaches that had led to the ineffectiveness of the existing mental health service. This basic law on mental health took a stand on patients’ rights, stipulating that diagnostic or therapeutic measures and hospitalisation can be carried out only with the consent of the person concerned (Supreme Soviet of the Russian Federation 1992, article 4).

Psychiatric care can be compulsory only on certain conditions: if the individuals pose a threat to themselves or others, if they are not capable to take care of themselves, and if it is predicted that they will be subject to considerable harm without psychiatric care (article 29). Involuntary hospitalisation and treatment require court approval (article 33).

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Thereafter several special laws, orders and programs were approved to regulate the scope and quality of mental health services in accordance with this basic law (Shek et al. 2011). The first national mental health program of the Russian Feder­ ation (Government of the Russian Federation 1995) aimed mainly to improve conditions of care within psychiatric hospitals. The next program (Ministry of Health of the Russian Federation 2002) called for the optimisation of psychiatric services by arranging more effective and cheaper outpatient services than those provided by hospitals. New positions were established in psychiatric institutions for psychologists, psychotherapists and social workers (Gurovich 2007). The latest program (Government of the Russian Federation 2007) proposes further action to reduce hospital involvement in mental healthcare, such as reducing the period of hospitalisation in psychiatric facilities, decreasing the number of repeated hospitalisations and creating a system of community-based mental health services.

The policy documents call for the integration of mental health services into general services to help overcome patients’ social exclusion (McDaid et al. 2006).

However, the strengthening of the social inclusion of mentally ill people is mainly proposed through improvements to institutional services rather than by helping the community to accept mental health problems as part of human life. Previous research on Russian mental health policy documents has shown that although the WHO mental health policy principles constitute the basis of post-Soviet legislation, Russian mental health policy still lacks attention to the stigmatisation of mentally ill people (Shek et al. 2011).

3. Materials and methods of research In order to study the discussion of mental health issues, we selected key national-level newspapers from each period for analysis. The research material comprises articles published in Известия (Izvestia, I), Труд (Trud, T), Аргументы и Факты ­(Argumenty i Fakty, AiF), Российская газета (Rossiiskaya Gazeta, RG) and Комсомольская Правда (Komsomolskaya Pravda, KP). Newspapers were selected on the basis of their circulation and popularity. Newspaper samples were collected from the years 1982, 1987, 1992, 1997, 2002, 2007 and 2012, for the periods 7–20 March, June, September and December of each year. Altogether 883 individual newspaper issues were covered by the search for articles on mental health issues. The materials from Soviet newspapers, and some of the materials from the 1990s, were collected from the library in St. Petersburg, while the materials from post-Soviet newspapers (the 1990s and 2000s) were gathered using the electronic database Integrum, which is one of the leading Russian information companies providing users with specialised databases of media materials.

The research started with a search for articles that covered mental illness ­topics.

In this search, the keywords were: психич* (psychic*, i.e. mental), психиатр* (psychiatr*), психопат* (psychopat*), and психотерап* (psychotherap*). The EJMH 11:1-2, April 2016

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word психол* (psychol*) was not used in the search terms because articles with this word could be found in abundance in discussions of mental health promotion to the general population, while the focus of our research was mainly on mental healthcare and rehabilitation. However, references to psychology were analysed when they appeared in discussions of the WHO principles in question. The research material included news stories, short reports, articles and editorials. We excluded commercial advertisements, TV programs and short descriptions of films from the research material because these materials are not the journalistic products of the newspapers themselves. We also excluded publications that included the keywords but did not ­refer to mentally ill people or mental health services/specialists. For example, articles in which the keywords were used figuratively (e.g. ‘mental attack on the opponent’; T 10 Sep 1997, our trans.)1 or appeared in astrological predictions (‘these cosmic factors can lead to strong mental tension’; RG 18 Sep 2007, our trans.)2 were not included to the analysis. After this selection procedure, a total of 364 articles were available for further analysis.

The mass media data were analysed using qualitative content analysis ­(Mayring 2000; Hsiu-Fang & Shannon 2005). The media text units identified were analysed using a coding table with reference to the selected categories. The categories for analysis reflected aspects of WHO mental health policy: 1. Protection of patients’ rights, including key empowerment rights (such as information, consent, freedom of choice, privacy and confidentiality); the right to be protected from cruel, inhuman and degrading treatment; and the provision of a safe and hygienic environment (World Health Organization 2005).

2. Reorganisation of mental healthcare services, entailing the accessibility, comprehensiveness, coordination, effectiveness and equity of mental health services; the integration of mental health services into general services; and deinstitutionalisation and community-based activity (World Health Organization 2003b).

3. Activities preventing stigmatisation, implying the promotion of positive i­ mages of mentally ill people, with a focus on recovery from mental disorders and social integration; the debunking of myths and prejudices about mental illness, and increasing public awareness of mental health issues; and community education on mental health problems (World Health Organization 2003a; 2005).

A total of only 43 articles from the original sample of 364 included discussions of one or more of the chosen categories. In the rest of the articles the search words appeared in contexts that did not relate to the principles in question. A significant number (152) of the articles in the original sample were crime stories or representations of mentally ill people as dangerous. Most texts describing crimes only mentioned that the suspect had been referred to a psychiatric board for an examination of their mental health status. The negative representation of the mentally ill is not 1 2

Original text: ‘психическая атака на соперника’ Original text: ‘Это космическое влияние может привести к сильному психическому перенапряжению.’

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exclusive to post-Soviet Russian media. Studies from other countries have also noted that the trend in journalism is to focus on threats related to mental illness, creating negative images of mentally ill people (Angermeyer & Schulze 2001; Granello & Pauley 2000; Link & Cullen 1986; Sieff 2003). Therefore in our study we decided not to analyse such representations in detail, but rather to focus on how the new mental health policy ideas were reflected in newspaper coverage. We paid attention not only to what was said but also to what was not said, and to the aspects of the principles that were not discussed. Following a qualitative approach and staying as close as possible to the texts, we revised our categories on the basis of the research material. We then summarised the ways in which the principles were presented, interpreted and formulated in the newspapers in each historical period. The categorisation process and research results were regularly discussed within the research group.

4. Results and discussion 4.1. The missing mental health discussion in the Soviet press Although our sample of newspapers does not allow us to make generalisations based on statistical analysis, it indicates a significant increase in the number of published articles that touch upon mental illness during the period covered by our study. While in the samples from the 1980s we found only two articles discussing mental illness (I 8 Sep 1982; I 9 Jun 1987), from the 1990s onwards the number of articles gradually increases. The main topic of the one single article from 1982 was unemployment in the USA. The article drew on statistical data to demonstrate that unemployment in the USA had led to a high level of mental illness, and contrasted this with the full employment in the USSR frequently described in newspapers of this period. The article thus exemplifies how during the Cold War the Soviet state attempted to demonstrate the USSR’s prosperity, using Soviet newspapers as an important resource for the creation of a positive image of the USSR. The absence of discussion of mentally ill people might be explained by the symbolic danger posed by this social group to the prestige of the Soviet state. The conception of a healthy society with full employment and no mental illness was manifest in the media.

Our findings demonstrate that the Soviet mass media completely excluded even brief references to mental health problems in the USSR. Another article from the 1980s (I 9 Jun 1987) briefly mentions mental health problems as one of the factors leading to alcoholism and drug abuse. The article appeared in the context of an antialcohol company initiated by Gorbachev in 1985 (Ministry of Health of the USSR 1985). However, it is also striking that there was no increase in the discussion of mental health and illness during the Gorbachev era. Although this era was characterised by ‘openness’ (glasnost) and many new democratic principles, these did not result in wider media discussion of psychiatry and mentally ill people. The topic was closed for public discussion until official recognition in 1989 of the use of psych­ EJMH 11:1-2, April 2016

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iatry for political purposes in the USSR (Polozhij & Saposhnikova 2001). At the beginning of the 1990s the newspapers openly recognised that mental illness had been underreported in the USSR (I 7 Mar 1992), and revealed data on the country’s mental health (I 17 Sep 1992; AiF 12 Sep 1992; AiF 17 Jun 1992). The recognition in newspapers of the existence of mental health problems might be considered a first step towards the open public discussion of mental illness.

4.2. Patients’ rights: the issue of involuntary mental healthcare The democratic reforms of the 1990s triggered a problematisation of the social pos­ition of mentally ill people, which appeared in the context of a broader public discussion of citizens’ and patients’ rights. As mentioned above, in 1992 the basic law on mental health, ‘Psychiatric Care and Guarantees of Citizens’ Rights in Its Provision’, was approved (Supreme Soviet of the Russian Federation 1992), and it was widely considered an innovation in the field of psychiatry and mental health services. Newspaper articles from the 1990s (RG Jun 1992; I 8 Jun 1992; I 17 Sep 1992) and the beginning of the 2000s (AiF 11 Dec 2002; RG Jun 2002) frequently reminded readers that during the Soviet period psychiatry had been used for political purposes, and that patients’ rights had been abused. In the context of this critical discussion of psychiatry, mentally ill people were represented as victims whose right to be treated with respect and dignity had been violated. This was evoked with expressions such as ‘patients are behind bars’3 (I 17 Sep 1992) and ‘patients are tortured by injections’4 (KP 7 Dec 2002). Not only mentally ill people but also their relatives were represented as powerless against the staff in psychiatric services (RG 19 Sep 1997). Other studies have also highlighted anti-psychiatric public attitudes during the early post-Soviet period, when psychiatrists faced accusations from patients, patients’ rela­tives, journalists and the public at large (Polozhij & Saposhnikova 2001). While this critical discussion might be taken as creating negative images of psychiatry, it simultaneously also increased awareness of the importance of patients’ rights, and hence supported reform in this area.

Some aspects of the new policy, such as the consensual nature of diagnosis, hospitalisation and treatment, required by the new law of 1992, were questioned by journalists. The author of one article (I 11 Sep 1997) noted that patients’ willingness to seek help, which the new law designated a prerequisite of psychiatric treatment, might lead to negative consequences such as delayed visits to psychiatrists. While the article acknowledges the importance of protecting patients’ rights as a sign of progress over Soviet times, the impact of the Soviet legacy simultaneously gives cause to doubt the consequences of the new law. The article notes that because Soviet psychiatry created negative images of the mental health services and because 3 4

Original text: ‘пациенты за решетками’ Original text: ‘пациенты замученные уколами’. .

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information about mental health/illness was not then available to the general population, people nowadays might not be capable of seeking help voluntarily. References to the avoidance of mental health services due to the low level of mental health culture among post-Soviet citizens also appeared in the sample of newspapers from 2012 (KP 16 Mar 2012).The media regretted the cancellation of the compulsory checks on children’s mental health that had been characteristic of the Soviet period (I 11 Sep 1997), noting that while adults have the right to make a choice, the situation with children is complicated because parents often reject hospitalisation or consultation with mental health specialists (I 10 Sep 2002; T 14 Sep 2002; KP 16 Mar 2012). The author of one of the articles notes that a visit to a psychiatrist is ‘something shameful’ in Russia, while in the West it is normal to have a personal psychiatrist or psychotherapist (I 10 Sep 2012, our trans.).5 Taking the assumed differences between Russia and ‘the West’ for granted, the author thus does not realise that being a mental health service user means belonging to a stigmatised group in Western countries as well. People with mental health problems often meet fear and prejudice from others that may prevent them from seeking help for fear of being labelled (European Commission 2005).

Another line of criticism of the new policy links the consensual nature of hospitalisation with dangerous activity by mentally ill people (T 13 Sep 1997; KP 18 Jun 2007; RG 7 Jun 2007). One article explains that due to the new law of 1992, ‘there are more crazy people in our proximity lately . . . because hospitalisation and even treatment may be carried out only with the consent of the person concerned’ (T 13 Sep 1997, our trans.).6 The article clearly emphasises the distance between ‘us – healthy people’ and ‘them – the mentally ill’, who have come into proximity with ‘us’. The article also tells the story of a mentally ill man who killed his brother, thus implicitly connecting the liberalisation of psychiatry with crime. In another article from the later 2000s (RG 07 Jun 2007), a high-ranking police officer directly links an increase in violent crime with the liberalisation of psychiatry. Discussing different types of crime, he says: Tragic cases should be divided into three groups. First, crimes committed by maniacs and other mentally ill people. Such people have always existed, but their number has significantly increased in recent years. The reason for this is the closure of special hospitals, and the liberalisation of this area of the healthcare system so that the consent of the person concerned is necessary for hospitalisation.

(RG 7 Jun 2007, our trans.)7

This article connects patients’ rights under the new policy regarding hospital admission and treatment, and also the reorganisation of services towards commu­ 5 6

7

Original text: ‘чем-то компрометирующим’.

Original text: ‘сумасшедших рядом с нами стало больше . . . на госпитализацию в стационар и даже на лечение также нужно разрешение человека с нарушенной психикой.’

Original text: ‘Трагические случаи надо разделить на три категории. Первая – преступления, совершенные маньяками и прочими психически больными. Такие люди были всегда, но в последние годы их стало намного больше. Причина – закрытие спецбольниц, либерализация в этой отрасли здравоохранения, когда на госпитализацию такого человека часто нужно согласие самого больного.’

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nity-based care, with an increase in violent crime. It opposes the reforms, representing the liberalisation of psychiatry as a source of public danger. The mental health services are portrayed in this case as a means to secure social safety and stability.

The majority of media discussions of patient rights’ found in our sample focus on voluntary/involuntary care and do not take other patients’ rights issues into consideration. Although our sample included a few articles that referred to the confidentiality of information about illness and treatment (T 11 Dec 2002) and to psychiatric hospital patients’ right to vote (T Mar 2007; RG 13 Mar 2007), these issues were touched upon only very briefly, with no problematisation of the topics. Included in our sample is an article criticising the involuntary sterilisation of mentally ill people in Sweden and France after the Second World War (KP Sep 1997). This article can be considered an important example of the advocacy of mentally ill people’s right to a private life. However, the article discussed the problem only from a historical perspective, with no reference to the contemporary situation in Russia. In conclusion, the media discussion of patients’ rights centres on voluntary/involuntary care, whereas other rights, such as the rights to vote, to have access to information or to communicate with other people, receive marginal attention in the post-Soviet media.

4.3. Reorganisation of mental health services: selective support for the reforms In our samples from the 1990s and early 2000s, we found several articles describing the poor material and hygienic conditions of post-Soviet mental health facilities (I 17 Sep 1992; KP 14 Jun 1997; KP 7 Dec 2002). In one of the articles the journalist criticises the lack of funding, and notes that the problem is not the poverty of the state but the low priority of mental health issues (T 18 Jun 1997). Pointing to a significant increase in mental illness in the country, articles criticise the underdevelopment of mental health services (AiF 20 Mar 2002), especially in small towns and villages (KP 11 Mar 2002). An article from 2012 also mentions poor access to mental health services in rural areas (AiF 19 Dec 2012). A special group discussed in the mater­ ials is children and young adults with mental health problems. The media advocate a comprehensive mental health service system for this social group (AiF 13 Mar 2002; I 10 Sep 2002; T 14 Jun 2002; I 18 Jun 2012). While the violation of patients’ rights in Soviet psychiatry is strongly criticised by the media, the discussion of the organisation of Soviet mental health services is not so univocal. Although the media recognise such positive post-Soviet innovations as the appearance of psychotherapy and art therapy (I 17 Sep 1992; KP 19 Mar 1997), they also lament the destruction of the Soviet system of vocational rehabilitation (RG 19 Sep 1997) and regular checks on children’s mental health (I 11 Sep 1997).

The articles from the 1990s mainly referred to the treatment of mentally ill people within psychiatric institutions but did not say anything about the deinstitutionalisation of psychiatric services and community-based care. Discussions of this topic appeared only in articles from the 2000s. An article (RG 15 June 2007) describEJMH 11:1-2, April 2016

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ing a regional program to combat depression noted that the program suggested the integration of mental health services into general healthcare and a close collabor­ ation between primary health services and psychiatrists. An article called ‘Reform of Psychiatric Care: Happiness from the Mind’ (‘Реформа психиатрической помощи: Счастье от ума’, I 17 Sep 2007) informed readers about reforms in psychiatry initiated by the program of 2007 (Government of the Russian Federation 2007). In this article the possibility of recovering from a mental disorder was used as an argument for the deinstitutionalisation of psychiatry. The journalist presented several stories of mentally ill people and demonstrated that after hospitalisation in a mental health facility they had been able return to ‘normal life’. According to one of the stories, (I Sep 2007) a non-governmental organisation (NGO) called New Opportunities helped one man to overcome despair and to interact socially after his treatment in a psychiatric hospital. It helped him to return to university and not to lose his friends.

We should mention that it was the first and only reference in our research material to an NGO active in the mental health field.

However, the discussion of deinstitutionalisation is accompanied by negative views of psychiatry and methods of treatment in psychiatric hospitals (I 17 Sep 2007; T 14 Jun 2002; T 14 Dec 2012). The patients in these cases are represented as victims who ‘seek to escape psychiatric hospital and start a new life’ (I 17 Sep 2007, our trans.).8 One man describing his treatment in a psychiatric hospital says that ‘huge doses of medicine put me to a vegetative state, . . . but I was able not to lose my job’ (I 17 Sep 2007, our trans.).9 A psychiatrist arguing for the social integration of mentally ill children illustrates his argument with a story about a boy with learning disability who attended a mainstream school. He concludes that the boy has much better prospects of social integration because he has never been treated with psychotropic drugs (T 14 Jun 2002).

The articles voice some doubts about the success of deinstitutionalisation due to the lack of an infrastructure that might make community-based care possible. One article (I 17 Sep 2007) cites the success of deinstitutionalisation policies in the UK and Finland, acknowledging that for the moment there are very few such community-based services for mentally ill people in Russia. Evgenii Lubov, a leading researcher at the Moscow Research Institute of Psychiatry, whose opinion is presented in the article, notes that many chronically mentally ill people apply for admission to a psychiatric hospital because they cannot earn a livelihood in the community. This reflects the concern that patients discharged from psychiatric hospitals can became poor or homeless without proper community-based services and support. The journalist also suspects that certain people have commercial interests in psychiatric hospitals’ land and buildings and that the reforms will take those away so that ‘mentally ill people will be outcast again’ (our trans.).10 8 9

10

riginal text: ‘стремление вырваться из ‘психушки’, попытаться начать новую жизнь.’

O Original text: ‘большие дозы лекарств забили меня до растительного состояния, . . . но мне удалось не потерять работу.’

Original text: ‘люди с психическими отклонениями вновь будут брошены.’

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A special group described in the material is old people who reportedly often a­ pply for admission to a psychiatric hospital because of their poor material living conditions. They are therefore referred to as the ‘healthy’ elderly patients of psychiatric hospitals, where they can get basic care and support such as food and medicine. The article says that an increasing tendency towards ‘hospitalisation for social reasons’ (AiF 20 Mar 2002, our trans.)11 was observed at the beginning of the 1990s and still exists in the 2000s. One article states that a mother killed her 58-year-old learning-disabled son because she was afraid that he would not receive any social support after her own death (KP 8 Jun 2007). Similarly, another article (RG 16 Mar 2007) relating the story of a 38-year-old mentally ill man noted that it was awful to think what would happen to him after his mother’s death. Although these articles do not speak explicitly about the underdevelopment of community-based social services for mentally ill and learning-disabled people in Russia, we suggest that they point to this problem in an implicit way.

Media calls for the improvement of material conditions in mental health services and for an increase in their funding thus demonstrate restrained support for reforms towards the deinstitutionalisation of psychiatry. While criticising psychiatric treatment methods and recognising the possibility of recovery from mental disorders, the media nevertheless point to the absence of the social support and communitybased services that would make such deinstitutionalisation possible.

4.4. Reproducing the stigma of mental illness while also arguing against it Arguments against the stigmatisation of mentally ill people appeared as early as the beginning of the 1990s. One of the articles from 1992 concluded that mentally ill people did not commit crimes more often than healthy people. The article says that stereotyped images of the mentally ill as criminals are wrong and provides readers with statistical data to prove this (AiF Sep 1992: 34). In our research materials there were also articles stating that people can recover from mental illness (KP 18 Sep 1997; I 17 Sep 2007) and that psychiatric patients can live normal lives and be socially active (T 11 Dec 2002; KP 13 Mar 2012). However, in many cases art­ icles that ostensibly seek to change negative attitudes to the mentally ill also include statements and images that might increase their stigmatisation (I 17 Sep 1992; T 13 Sep1997; I 11 Sep 1997; KP 19 Mar 1997). For example, an article titled ‘…Like a Madman with a Razor in His Hands’ (T 13 Sep 1997, our trans.)12 mentions that very few crimes are committed by mentally ill people, and that most such people are not dangerous in everyday life. Yet the title of the article may make a stronger impression on readers than its content. Another article (KP 19 Mar 1997) on the positive results of art therapy in psychiatric hospitals is illustrated with a humorous picture 11 12

Original text: ‘Госпитализация по социальным показаниям’.

Original title: ‘…Как сумасшедший с бритвою в руках’.

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from a theatrical production, showing a patient with an aggressive facial expression wearing a straitjacket, with two male nurses behind him, thus reproducing stigma in a visual way.

Interviews with mental health specialists also included contradictory statements reproducing the stigma of mental illness. For example, in an article titled ‘All of Us Want to Be Napoleon’ (T 11 Dec 2002, our trans.),13 a psychiatrist answers the journalist’s question about the risk of psychiatrists being attacked by mentally ill patients: ‘The probability of being targeted by bullies in the street is higher than of being attacked by patients. Furthermore, psychiatrists’ sense of danger is slightly reduced, which of course is wrong, taking into account the specifics of our work’ (our trans.).14 At the beginning of the answer the psychiatrist tells readers that working with mentally ill people is no more dangerous than walking down the street, but at the end of his statement he criticises the reduced sense of danger typical of psych­ iatrists, because their job is in fact dangerous.

An article (I 10 Jun 2002) on a German photographic exhibition about disabled people, including the learning disabled, claims that the exhibition aimed to challenge the image of disabled people as recipients of support and objects of compassion but argues that such a goal would be premature for contemporary Russia. It states that disabled people still need a lot of compassion and support in Russian society due to the economic and social difficulties they face. Such opinions may be taken to reflect a paternalistic approach to learning-disabled and mentally ill people. Similar signs of paternalistic attitudes to the mentally ill were found also in other articles. One article (RG 19 Sep 2007) describing a community home notes that mentally ill people are taught to live there ‘like small children’ (маленькие дети) controlled by a social worker, ‘a babysitter’ (нянька). Paternalism can be understood as an attempt to access and address the needs of individuals or groups in the same way as a caring parent who nurtures and protects a child without waiting for permission (Breeze 1998).

The same tone was found in descriptions of psychoneurological boarding facilities, with adult patients being referred to as ‘our wards’ (подопечные, AiF 7 Mar 2012) or ‘our children’ (наши дети, KP 13 Mar 2012). Although such expressions do not connect mental illness with violence or danger, they contribute to the stigmatised, passive image of mentally ill people as incapable of active participation in social life.

Articles promoting the public understanding of mental health and illness can significantly contribute to anti-stigma activity (World Health Organization 2005).

As early as the beginning of the 1990s, there were articles recognising the need for educational activity on mental health issues. One article (T 12 Dec 1992) argued for a special television program on mental health issues. Another (AiF 20 Mar 2002), calling for the organisation of information campaigns about mental health/illness for the general public and special groups such as young adults, the elderly and pregnant 13 14

Original title: ‘Все мы метим в Наполены.’

Original text: ‘Вероятность пострадать на улице от хулиганов выше, чем подвергнуться нападению больного. Более того, чувство опасности у психиатров даже несколько снижено, что, конечно, неправильно, учитывая специфику нашей работы.’

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women, referred to Western countries, where information brochures are distributed to the population. There were also several articles in our research material explaining the causes and symptoms of mental health disorders: depression (KP 12 Sep 2007), schizophrenia (T 11 Dec 2002) and post-traumatic stress disorder (I 10 Sep 2002).

A special focus was placed on the mental health problems of children and young adults (I 11 Sep 1997; AiF 13 Mar 2002; T 14 Sep 2002; I 18 Jun 2012). Most of the educational articles as well as articles with positive images of mentally ill people were based on interviews with mental health specialists, which demonstrates their significance in the support of anti-stigmatisation activity. However, their voices were drowned out by negative representations of the mentally ill, which were abundant in the research material. As we mentioned in our description of the data, almost half of the articles represented mentally ill people as dangerous, and even articles that sought to work against stigma often contributed to its reproduction.

5. Summary and conclusion In this study we have analysed how the media reflect the ideas and values of the WHO mental health policies, which served as the basis of post-Soviet Russian reforms in this area. In this last section, we summarise our main findings about support for and opposition to these reforms, and make some suggestions about the possible effect of media representations on mental health policy development.

As reported above, the public discussion of mental health and illness was strongly restricted in the Soviet Union, and problems pertaining to the USSR’s mental health situation were very seldom addressed in the mass media (Korolenko & Kensin 2002; Richardson & Taraskin 2006). Their discussion was ultimately triggered by democratic changes in post-Soviet Russia in the 1990s, enabling the public recognition of the existence of mentally ill people in Russian society, of violations of patients’ rights and of the deficiencies and failures of mental health services.

Our study demonstrates that particularly at the beginning of the 1990s, mentally ill people were represented as victims of the old Soviet mental healthcare system with its ineffective treatment and its denial of patients’ rights. This may be interpreted as a reaction to the social changes underlying the new democratic principles, and as a sim­ultaneous distancing from the Soviet past. The criticisms of Soviet psychiatry and calls for change in this area can be considered important factors supporting mental health policy reforms.

However, attitudes to the Soviet past were not so straightforward. There were also positive comments on some elements of the Soviet mental healthcare system, such as regular checks on children’s mental health and the vocational rehabilitation of the mentally ill. Other researchers have also noted that the system of vocational rehabilitation for mentally ill people was well organised in the Soviet Union (Polozhij & Saposhnikova 2001; Tiganov 1999). There were special workplaces in industry and agriculture for people with mental illness. Workshops and rehabilitation units for EJMH 11:1-2, April 2016

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mentally ill people existed in outpatient and inpatient psychiatric clinics. The critical view claims that this ‘work therapy’ served to mask the exploitation of the labour of mentally ill patients (Korolenko & Kensin 2002, 61). Such inconsistencies in how Soviet healthcare is described may be explained by the need to manage the ambivalence of attitudes about the Soviet period. The Russian sociologist Kustarev (2007) suggests that nostalgia for the Soviet period serves to manage Russians’ relationship to the past. He notes that the rapid decrease in the welfare of the Russian population in 1990s resulted in a tendency to emphasise the best aspects of the Soviet period, and to recast what had been ‘bad’ by discovering the ‘good’ sides of the past.

The media’s perspectives on the Soviet past also serve to legitimate doubts about the success of the new policy. While the requirement of consent in mental healthcare is recognised as an important development compared to the Soviet period, the articles also point to the ‘low level of mental health culture’ among post-Soviet citizens, which makes patients incompetent to make ‘well-timed decisions’ about their own diagnosis and treatment. Psychiatric clinics and treatment methods were subject to criticism not only in the early post-Soviet period but also in discussions of the deinstitutionalisation of psychiatry. Although such critiques promote awareness of the problems and thus open a window of opportunity for change in this area, they simultaneously contribute to negative images of psychiatry. Activity to shape positive attitudes towards mental health services and specialists seems to be necessary in post-Soviet Russia, due to the negative images of psychiatry formed in the Soviet era (Polozhij & Saposhnikova 2001).

The new ideas in mental health policy were also opposed because of fears over public order and safety. Our results demonstrate that, although policy papers call for the integration of the mentally ill into society, the media encourage more exclusionary and controlling policies, representing the mentally ill mostly as criminals or as people with strange behaviour whose integration into society poses a risk to public safety. We found that the principle of voluntary hospitalisation and measures for the deinstitutionalisation of psychiatric care were connected by the media with a depiction of mentally ill people as dangerous. Thus the media discussion reflected the conflict between the individual’s right to autonomy and society’s obligation to prevent danger to all citizens. Other researchers also note that a move towards community care in countries of the former Eastern Bloc was opposed by the widely held belief that the primary purpose of the mental healthcare system is the safety of citizens (Tomov et al. 2006).

In Western European countries and the USA, an awareness of the influence of the mass media on mental healthcare policy came only after increased negative ­media representations of the mentally ill had contributed to a shift to a more controlling policy in the 1990s (Cutcliffe & Hanningan 2002; Hallam 2002; ­Holloway 1996). Kamerāde (2005) claims that Central and Eastern European countries still have an opportunity to use the mass media to strengthen public awareness of the rights of mentally ill people and to prepare the general public for community-based mental healthcare policies in advance of policy activities. However, our research EJMH 11:1-2, April 2016

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demonstrates that in Russia a negative media response to the reforms preceded pol­ icy programs for deinstitutionalisation.

NGOs, including service users’ organisations, are considered important actors for developing activities against stigmatisation and for community-based care (World Health Organization 2005). However, there were no news stories whose author was a representative of such an organisation. NGOs have been the organisational form on which scholars have focused their attention in the civil societies of transitional states (Sundstrom 2002). A number of studies claim that civil society has remained weak and underdeveloped in Russia (Cook & Vinogradova 2006; Howard 2002; Maltseva 2011). The results of our research demonstrate that NGOs are not actively engaged in media discussions of mental health reforms. Our previous study of mental health policy documents (Shek et al. 2011) similarly showed that the role of NGOs was not considered in mental health policy documents. It thus seems that associations of people with mental disorders, their relatives, and advocacy organ­ isations representing the interests of mentally ill people are not regarded as active agents in either policy reforms or mass media discussions of this topic.

The voices of people with mental health problems were missing from the art­ icles. All of the stories were told by mental health specialists or journalists on behalf of people with mental health problems. This absence of service users’ participation is reminiscent of the Soviet healthcare system, with a typically passive role assigned to ordinary people. Paternalistic expressions in media representations of mentally ill people are also a sign of such attitudes. Inglehart and Baker (2000) claim that cultural values can and do change, but also that they continue to reflect a country’s cultural heritage and are in this sense path-dependent. Hence it seems that postSoviet media partially reflect Soviet attitudes to mental health and illness.

The discussion of mental healthcare reforms often involved comparison of ‘our society’ with ‘Western society’. Several articles throughout the study period referred to successful examples of mental health policies from the West. Although some ­studies claim that negative attitudes to the Western model of society have recently increased in Russia (Guriev et al. 2009), the results of our study demonstrate that the media represent Western mental health policies in a rather positive way, albeit noting that some practices might be premature and difficult to implement in Russia due to the particularities of Russia’s current socio-economic situation and historical context.

Blumler and Kavanagh (1999) suggest that debates conducted in public spheres, including newspapers, constructed by the media reflect a process in which policy is increasingly made in the media. Policy and the media can both be considered im­ portant actors in the creation of ideologies and values regarding mental health and illness. Our research reveals only some hints of the interconnections between these two areas and suggests that this relationship warrants further investigation.

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European Journal of Mental Health 11 (2016) 79–96 DOI: 10.5708/EJMH.11.2016.1-2.5

Jakub Doležel*

CATHOLIC CHARITABLE SOCIAL WORK IN THE FORMER CZECHOSLOVAKIA With a Focus on the Czech Lands (Received: 3 February 2015; accepted: 30 September 2015)

Roman Catholic Charity, an organised and community-centred form of volunteer activity in social and healthcare services exceeding the framework of individual and private benevolence, had seen years of abundant and – in many aspects – still unrivalled development between the founding of the independent state of Czechoslovakia (1918) and the onset of the totalitarian Communist regime (1948). As the Communist Party took control of the country, the entire system of charity was dissolved, in contrast to the neighbouring countries of the Soviet Bloc (East Germany, Poland and Hungary) where some forms were allowed to function. The objective of the present study is to map out those dramatic changes and highlight individual key events and dates. The opening sections outline the well-developed system of charity that existed before the Communist seizure of power. The final sections present the developing trends of charitable work after the fall of Communism in 1989.

Keywords: Caritas practice, church social work, civil society, communism, Czechoslovakia, ­diaconate, dictatorship, helping profession, history, retrospect Karitative soziale Arbeit in der ehemaligen Tschechoslowakei: Tschechien im Fokus: Katholische Caritas als organisierte und gemeindebezogene Form der sozialen und gesundheitlichen Wohltätigkeit, die eine rein individuelle und private Wohltätigkeit überragt, erfreute sich in der Zeit zwischen der Gründung der souveränen Republik im Jahre 1918 und dem Antritt des totalitären kommunistischen Regimes in der Tschechoslowakei im Jahre 1948 einer Entwicklung, die bis heute in vielen Aspekten für vorbildhaft gehalten werden kann. Die Machtergreifung der Kommunisten verursachte im Vergleich zu anderen Ostblockstaaten (DDR, Polen, Ungarn) eine faktische Destruktion des ganzen karitativen Systems. Das Ziel dieser Studie liegt darin, diese dramatische Veränderung in einzelnen Schlüsselereignissen und Daten zu fassen. Einleitend wird kurz das ent-

*

J akub Doležel, Palacký University Olomouc, Sts. Cyril and Methodius Faculty of Theology, Department of Christian Social Work, Na Hradě 5, CZ-771 11 Olomouc, Czech Republic; jakub.dolezel@upol.cz.

ISSN 1788-4934 © 2016 Semmelweis University Institute of Mental Health, Budapest

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wickelte karitative System vor dem Antritt der kommunistischen Regierung und zum Abschluss die Richtung der Erneuerung der Caritas nach der politischen Wende im Jahre 1989 dargestellt.

Schlüsselbegriffe: Diakonie, Tschechoslowakei, Kommunismus, Diktatur, Geschichte, Rückblick, helfender Beruf, kirchliche Sozialarbeit, Caritaspraxis

1. Introduction The charitable activity of the Catholic Church in the Czech Republic has a rich and varied history, yet it is poorly covered by historiographical resources (Doležel 2010). The history of charitable activity before and during the totalitarian Com­munist regime is even more poorly documented. The objective of this study is to fill a gap in historiography. The central goal is to describe the key events and processes that Czech Catholic Charity (Charita) went through after the Communists seized power in February 1948. The history of the Charity should be seen in the context of the studies on Catholic and non-Catholic charitable work in the neighbouring ­countries of the former Soviet Bloc that have been published on the pages of this journal (Biel 2009; Török et al. 2010; Tymkova 2008; Puschmann 2008). By showing the impact of the Communist regime on church-based charity work in different countries, these studies provide a background for the present historical sketch.

1.1. Limitations of this study First, it should be noted at the outset that the author is not a historian by profession. The methodology used for this study is a consequence of this fact. The author has reconstructed the subject matter largely from secondary literature; no primary sources have been used. The historical image outlined here is a preliminary sketch and should be substantiated by more detailed historiographical research.

Another factor that has significantly influenced the content, extent and quality of this study is the quantity of secondary literature concerning the history of Cath­ olic charity in the era of socialist Czechoslovakia. In comparison to parallel studies on the state of Catholic charity work in Poland (Biel 2009), Hungary (Török et al. 2010) and East Germany (Puschmann 2008), the absence of historiographical documentation of Czech origin on the Catholic Church’s charitable work in the socialist era was found to be fatal.

It has been demonstrated that this lack of documented history is due to historians’ marginal interest in the topic (Doležel 2010). Unlike previous contributions to the ‘Common Past’ section of this journal, the present study had no direct reference sources to draw on. The author had to depend on recovering relevant data from works primarily focused on other areas like the relationship between church and state before and during the socialist era (Balík & Hanuš 2007; Kaplan 1993; Vaško 1990; Vlček 2003; Weis 2011). Limited data without references is provided EJMH 11:1-2, April 2016

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by two articles posted on the website of the Diocesan Charity in Brno.1 More thorough data is given in the book by Kučera and Jemelka (2012), yet it speaks of the era under discussion only to a limited extent.

The most accurate data from an academic point of view is provided in two studies by Svoboda (2013; and Svoboda & Hendrych 2013) although these only cover the years 1946–1951 and depict only the processes of change and the termin­ ation of the professional magazine Charita as a consequence of the seizure of power by the Communists. The lack of literature represents, on the one hand, the limitations of research on the period, but, on the other hand, it legitimises the efforts to carry out preliminary explorations without mobilising a substantial body of primary sources.

The last limiting factor of this study is its narrow geographical focus on only half of the former Czechoslovakia, that is, Bohemia, Moravia and Czech Silesia.

Even in the period of the joint state of Czechs and Slovaks, I had only limited access to data concerning the condition and development of Catholic Charity in Slovakia.

Further, my descriptions of the changes that took place in the sphere of charitable work after the collapse of Communism in 1989 do not include a Slovak perspective, for both nations decided to take their separate paths to build their own autonomous states (1993) and independent Charity organisations.

2. Catholic Charity in Czechoslovakia before 1948 The history of Catholic Charity practice in the territory of Czechoslovakia has a long and varied past. In the first half of the 20th century, the new programme of churchorganised Charity was established along the same lines as in Austria, Switzerland, Germany, France and the United States, concentrating fragmented and uncoordin­ ated individual elements into a joint organisation with a national headquarters and regional branch offices within various dioceses. In the territory of Czechoslovakia, this modernisation process took place in several stages. First, a diocesan associ­ ation of Charity was established in Olomouc (February 1922), followed by the other dioceses. A Slovak counterpart was established in 1927, named Ústredná Karita na Slovensku (Charity Centre in Slovakia). The country-wide network was established in 1928 when the individual provincial associations (Czech, Moravian-Silesian and Slovak) joined together to form the Říšské ústředí Svazů charity v Československu (Empire Centre of Charity Associations in Czechoslovakia).

The modernised Charity focused on several different areas.

1. Parish poor relief institutions and foundations. These institutions, representing so-called outdoor relief, arranged for parish collections and for the distribution of financial support to the local poor and elderly; sometimes financing charitable 1

J . Kopřiva, Z. Havrdová & D. Horáková, ‘Deset let práce a směřování České katolické charity’, manuscript (undated) retrieved 24 October 2014 from www.dchbrno.charita.cz/www/historie.htm; P. Zelinka, ‘Historie charity před rokem 1990’, manuscript (undated) retrieved 5 December 2014 from http://dchb.charita.cz/ diecezni-charita-brno/historie-charity-pred-rokem-1990/.

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institutions such as shelters, workhouses, etc. The name of the parish institutions for the poor refers to the institution taking care of the poor, established by law in the Czech lands in 1783 and 1785 (D’Elvert 1858). With the right of domicile introduced in the Austro-Hungarian Empire in 1863, the parish institutions lost a lot of their areas of influence, yet they continued their operations, at least to a limited degree, in many parishes.

With the lack of any comprehensive information available, this article can only ­offer two sets of data from different areas and periods of the Catholic Church in the Czech lands: (1) Ladenbauer (1899) depicted a precise image of social action of the Catholic Church in the diocese of České Budějovice. In the late nineteenth century, this diocese was the home for 374 foundations of outdoor and indoor poor relief. (2) The conditions in both Moravian-Silesian dioceses (Olomouc and Brno) were mapped by Brejcha in 1930. According to his account, there were only 18 Catholic parishes not providing parish institutions for the poor.

2. Ludmila,2 parish charitable departments. These local institutions represented the smallest organisational units of charitable networks within individual dioceses. They conjoined the local charitable Catholic societies, coordinated char­ itable activities, arranged for promotion and implementation of charitable work ‘in all areas of human misery and poverty, particularly where the other humanitarian institutions have failed to intervene’ (Brejcha 1930, 54, my trans.).3 There is no comprehensive data available, but there is evidence that there were 308 charitable units operating within the Catholic parishes in Moravia and Silesia as of 1930, and 16,144 people were engaged in the provision of help to an estimated 5,000 poor, vulnerable and needy people (Brejcha 1930).

3. Benevolent Catholic societies. These societies were a follow-up to the popular medieval and baroque brotherhoods,4 which were disbanded collectively as a ­result of the reforms in the era of Enlightenment (1783) and eventually re­ instated in 1856. Again, data is scant, but Ladenbauer (1899) mentions fourteen charitable societies in the diocese of České Budějovice towards the end of the nineteenth century, whereas Brejcha (1930) documented seven in Moravia and Silesia. A popular charitable form was the so-called ‘conferences’, that is, local branches of the Society of Saint Vincent de Paul, founded in France by Frederic Ozanam (1813–1853). In Slovakia, Rašlová (2006) identified a total of 422 charitable societies of a similar nature in 1922.

4. S ocial-medical institutions. This classic form of implementing charitable activities was provided mainly by monks and nuns. According to Brejcha’s typology (1930, 373), these institutions include: orphanages; workhouses; 2

3

4

amed after St. Ludmila, one of four Czech patrons and grandmother of Saint Wenceslaus, traditionally N considered a willing helper of the poor.

Original text: ‘ve všech oborech lidské bídy a utrpení, hlavně v těch, v nichž ostatní humánní instituce dosud nezakročily’.

The area of Bohemia (exclusive of Moravia and Silesia) was served by a total of 652 brotherhoods over the years 1620–1780 (Mikulec 2000, 23).

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infirmaries; care homes for children; day nurseries; institutions for the dis­ abled, epileptics, intellectually disabled; shelters for au-pairs, domestic workers and students; sanatoriums; hospitals; home care stations, and homes for the visually impaired. Data from 1935 mentions 328 institutions in the Czech lands (Formánek 1935, 67). In 1938, the number slightly increased to 338.5 Information concerning Slovakia is provided by Rašlová (2006, 11), who claims that there were 26 social, medical and teaching facilities formed by the year 1946.

3. Charity between 1945–1948 The period between the end of the Second World War and the establishment of the Communist regime is an important aspect of the present study. Czechoslovakian society after the Second World War was made up of a predominantly Catholic popu­ lation as it had been since the end of Hapsburg rule (1918). Based on the countrywide censuses, the proportion of people who registered as Roman Catholics in the years 1921, 1930 and 1950 was consistently around 75% of the entire population.

This fact was by no means affected by the expulsion of nearly three million German nationals after the Second World War.6 The Eastern Catholic Church, which had existed in Eastern Slovakia and remained activity until 1950, was forcibly disbanded by the Communist regime. (Strictly speaking, it was ‘incorporated’ into the Orthodox Church.) The percentage of the population affiliated with the Eastern Catholic Church (Greek rite) stabilised slightly below 4%. In 1948, the Catholic Church of both rites (Roman and Greek) had 7,042 clergymen, 2,856 monks and 12,095 nuns (Kaplan 1993).

With the end of the war Charity work was allowed to return to its full pre-war scope and develop further. Petr Zelinka (cf. n.1) categorises the activities during this period in four areas: 1. Supportive care activities, aimed at relieving the consequences of war. This mainly involved the distribution of material aid. An important source of this support was the international aid of the Catholics in the USA,7 United Nations Relief and Rehabilitation Administration (UNRRA) aid, rations provided by the Red Cross and donations by the French government. Thus, between the years 1946–1949, Charity was able to work as a mediator of food distribution, infant nutrition, distributor of blankets, clothes, boots, medicine and even cig­ arettes (Kučera & Jemelka 2012).

5 6

7

ee Kopřiva et al. (cf. n.1).

S In 1950, Protestant churches of various denominations had slightly over one million members. The third most populous denomination was the Czechoslovak Hussite Church with nearly one million members (Kaplan 1993, 225).

War Relief Services – National Catholic Welfare Conference.

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2. Activities of institutional care continued old traditions of care in the medicalsocial institutions. Before the war, Charity ran 338 of these institutions. By 1948 the number had increased to 379.8 3. Activities of recreational care for children and youth with dangerous and declining health conditions were carried out using a network of their own9 or foreign sanatoriums.10 4. Activities of home care services, referred to as ‘nursing and medical service in families’. Charity considered this model of services to be the most pro­ductive.

In Bohemia and Moravia, this service was managed and performed by 125 agencies, employing 125 nuns and 105 nurses. As evidence of the strategic importance of this service, Charity administered a network of eleven nursing schools in 1947, of which seven were based in Moravia, three in Bohemia and one in Slovakia (Vaško 1990, 190).

In this context it is necessary to mention the brief, though not negligible, existence of the Eastern Catholic Church Charity with its registered office in Prešov, Slovakia.

This constituent part of Ústredna Karita na Slovensku was established as late as Nov­em­ ber 1947 on the initiative of Bishop Pavel Gojdič (1888–1960) of the Eastern Cath­olic Diocese in Prešov, who was beatified in 2011. During its short existence, permitted under the contemporary political conditions, this charitable organisation succeeded in building a network of local branch offices, to organise urgent material aid to the people living in the war-torn areas (Potáš 2001) and to carry on the running of the diocesan orphanage established in 1935 (Šturák 2007). Bishop Gojdič was a living example of a profound charitable mentality and played a key role in the short life of the Eastern Cath­olic Church’s charitable work. In May 1950, the existence of the Eastern Cath­olic Church Charity was terminated along with the disbandment of the entire Diocese of Prešov.

4. The destruction of Charity between the years 1948–1968 The events that paved the way for the Communist coup in Czechoslovakia have been extensively documented, even in the context of the relationship between church and state (Balík & Hanuš 2007; Kaplan 1993; Vaško 1990). In summary, the Communist Party of Czechoslovakia won the largest mandate in legitimate elections in 1946. After a while the Party succeeded in inducing a governmental crisis, which led to the resignation of non-Communist ministers. President Beneš, pressed by the circumstances, approved the resignations on 25 February 1948 and appointed a new 8 9

10

ee Kopřiva et al. (cf. n.1).

S In Moravia, there were three institutions of this kind (Brejcha 1930). After1930, the national central office of Charity also owned a sanatorium on the island of Veli Lošinj in Italian territory on the Adriatic. After the Second World War, the territory passed over to the control of Yugoslavia, and the building of the sanatorium was nationalised without any compensation (Kučera & Jemelka 2012).

In 1947, twelve children threatened with tuberculosis spent their recovery course in Switzerland (Zelinka, cf. n.1).

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government in line with the proposals of the leader of the Communists, ­Klement Gottwald. The Communists’ seizure and consolidation of power also required that the Party take control of church institutions, primarily those managed by the Roman Catholic Church, which the Communists regarded as one of their key ideological ­enemies (Svoboda & Hendrych 2013). Part and parcel of this political strategy was the ideological ‘domestication’ and the effective control of Catholic Charity work, the side effect of which was a material liquidation of church-organised ­activities.

The liquidation strategy thus included both qualitative (ideological) processes and processes that were (at least partially) reflected in quantitative data. This differenti­ ation provides a framework for arranging the available data.

Although the process of the Catholic Charity’s liquidation ran effectively for the first few years following the change of the political regime, it should be mentioned that this short period was also characterised by several different stages in the relationship between the Communist Party and the church. Kaplan (1993) suggested a three-stage periodisation. At first, the Communists attempted to subdue the Catholic Church through agreements with the hierarchy. As this attempt ended in failure, they tried to exclude the church from public life using power politics (after April 1949).

The last stage (after 1953) was dominated by an all-out offensive against religion as a false worldview.

In order to set the events of February 1948 in Czechoslovakia in a wider context, it should be pointed out that the repressive policy of the Communist Party was used in this country probably ‘more consistently and steadily’ (Balík & Hanuš 2007, 8, my trans.)11 than in other Central and Eastern European countries – with the exception of Albania.

4.1. Ideological liquidation of Charity After the February coup d’etat, the events noticeably quickened in pace. Early on, the Communists – despite protests – terminated the publication of the majority of 133 Czech and Slovak Catholic-oriented periodicals (Svoboda 2013). One of the few magazines that were allowed to enjoy their (rather short) life was Charita.12 By installing the so-called ‘National Administration of the Headquarters of Charity Associations’ in April 1948, the clergy loyal to the Communist Party started their ideological purge of personnel. After a short period of hesitancy, caused by the protests of the Inter-Nunciature in Prague, the infiltration was finished in 1951 with the appointment of apparatchiks to the management positions of all (remaining) charitable institutions.13 This change also affected the content of the magazine Charita. It only took three years for the collaborators to transform the magazine into a pure Communist 11 12

13

Original text: ‘nejdůsledněji a nejvytrvaleji’.

Its full name, adopted in the first edition (1946) translates as Charity: Magazine for Medical and Social Work (Svoboda & Hendrych 2013, 35).

See Kopřiva et al. (cf. n.1).

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propaganda tool. Subsequently, as there was no further reason to keep the magazine in existence, it was disbanded in late 1951 (Svoboda & Hendrych 2013).

4.2. Liquidation of Charity’s activities ‘Political domestication of Charity’, the term used for the aforementioned processes, was also confirmed by (1) gradual restriction of the range of services provided, and (2) the elimination of the principal agents of charitable services, that is, monks and nuns.

Initially, in 1950, the government nationalised all the institutions of Charity that specialised in children and youth work and supportive care for civilians. Simultan­eously, the government transferred the network of home care services to the Czechoslovak Red Cross. Charity was still allowed to operate the institutions that provided for the elderly, the physically and mentally disabled, clergy, nuns and parson’s cooks and charladies.

The number of those institutions was, however, rapidly declining, as illustrated in Table 1. Before 1948, Charity operated a total of 379 institutions.14 The beginning of 1949 saw a slight decrease to 370 institutions with a total capacity of approximately 15,000. From these 370 institution, 84 are children shelters and care homes; 83 children’s homes; 28 homes for the physically and intellectually disabled, hearing-impaired, visually impaired, encephalitic; 94 homes for seniors and people unable to work; 59 student dormitories; 14 hospitals and medical institutions; 13 recreation centres, and 14 youth institutions (Vaško 1990, 190). Nevertheless, as early as 1950, the number of Charityoperated institutions was drastically reduced to 268 (Kaplan 1993, 6), and towards the end of the same year to only 108 institutions for seniors and people with physical and mental disability, with a total capacity of 7,500 beds, employing about 1,000 nuns (Vaško 1990, 191). Larisch (2012, 42) recorded a total of 105 institutions between the years 1952 and 1959.15 Table 1 Reduction in the number of Charity-operated social-medical facilities after the Communist coup Number of Charity-operated institutions Until 1948 1949 1950 End of 1950 End of the years 1952–1959

14 15

379 370 268 108 105

See Kopřiva et al. (cf. n.1).

Of this number, forty-three institutions were located in the Archdiocese of Olomouc (Kučera & Jemelka 2012, 29) and twenty in the Archdiocese of Brno (Zelinka, cf. n.1).

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CATHOLIC CHARITABLE SOCIAL WORK IN THE FORMER CZECHOSLOVAKIA 87

A definite extinction of the original spectrum of helping activities took place on 1 January 1960, when the remaining charitable institutions were transferred to the local authorities (known as ‘people’s committees’) (Kučera & Jemelka 2012).16 At the same time, the diocesan centres of Charity were disbanded, with only the headquarters in Prague preserved. Regulations coming into force in 1963 restricted the activities of Charity, which were divided into the following three areas: (1) social charity, that is, care for superannuated clergy, nuns, parson’s cooks and charladies, (2) sanctuary-related services, that is, production and distribution of devotional art­ icles and liturgical objects, and (3) editing and distribution of religious literature for the Roman Catholic Church (Mára 1989).

Catholic charitable societies constituted an important form of Charity practice in the interwar and post-war periods. As mentioned above, their significance was predominantly local or regional. A new act on the right of association, issued in July 1951, stipulated that all societies without a national headquarters should either merge with the Czech Catholic Charity17 (currently under the control of the Communists) or disband (Kučera & Jemelka 2012; Larisch 2012).

A significant moment and tool in the liquidation of Charity was the isolation of monks and, even more importantly, nuns. For centuries, members of religious orders had been a distinctive and often predominating element of any charitable institution and service. The disconnection of Charity from the regular clergy would probably have led to the collapse of charity work even if the church had been allowed to exist undisturbed and still enjoyed all freedoms. In a situation when the proclaimed aim of the regime was to liquidate both of those elements, the prospects were so much the darker.

The security forces led by the Communist regime plotted two actions which actually paralysed Czech and Slovak monasteries and convents. As regards the monasteries, the hostile action of the regime was called Operation K (from a Czech word klášter for monastery). During this hostility, which took place on two nights in April 1950, 2,376 monks were interned into camps18 (Vlček 2003, 75), where they were unlawfully retained until 1955, being exposed to forced labour and ideological indoctrination.19 Operation K also affected the Brothers of Hospitaller Order of Saint John of God, who, as indispensable caregivers, were allowed to continue their char­ itable work in hospitals. Eventually those hospitals were also nationalised and the monasteries disestablished (Balík & Hanuš 2007, 167).

Monasteries were followed by convents. The action against them was called Operation Ř (from a Czech word řeholnice for nun), which took a similar course to Operation K, that is, it progressed through several stages from July to September 1950. As suggested by data in Table 2, this time the number of internees was 16 17 18

19

hese regulations were set out in the governmental decree of 9 December 1959 (Larisch 2012).

T The new name effective by virtue of the Ministry of the Interior decree of 27 January 1949 (Zelinka, cf. n.1).

These were often large monasteries. In the Czech lands they were located in sparsely populated areas of Sudetenland (where the original German population had been expelled from).

This way, the state seized 219 monasteries (Vlček 2003, 75).

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considerably higher than in the case of monasteries. A total of 4,362 nuns were interned (Kaplan 1993, 121), two thousand of whom were forced to work in the textile industry and agriculture (Vlček 2003). Members of the Apostolate of St. Francis20 were saved from the labour camps as they were allowed to return to civil life in order to pursue their practical apostolate. They joined the Czechoslovak Red Cross and worked as caregivers and nurses in hospitals. From the religious orders, the Red Cross also adopted the outreach nursing service in households (Balík & Hanuš 2007, 179).

Table 2 Number of nuns in Czechoslovakia before 1950 Religious orders

Convents

32 24 56

502 168 670

Czech lands Slovakia Czechoslovakia

Nuns 7,643 4,253 11,896

Source: Balík & Hanuš (2007) 177.

As the main goal of the oppressive actions was to force the nuns to leave the convent for civil life, the high number of nuns working in hospitals and social institutions posed an obstacle to the regime’s intention. It is well known that in 1950 there were 9,748 nuns working in Czechoslovak hospitals (Balík & Hanuš 2007, 179, 188). Early in 1953, the state registered 10,169 nuns, of whom 6,471 served in hospitals and surviving charitable institutions (Kaplan 1993, 154).

Elimination of nuns from the social-medical sector could not be made on a one-off basis. Thus the regime decided to pursue a strategy of their gradual dismissal and replacement by civil workers. This personnel replacement took place in the late 1950s and was completed in 1962. Nuns were allowed to stay in several areas of public service where the atheistic state found them indispensable to carry out its own social policy. The types of participating institutions were defined by the 26 August 1967 decree of the government, and they included care facilities for children with learning disability and for people with intellectual disabilities, retirement homes, charitable facilities for the clergy, and places for the manufacture of devotional articles and liturgical objects. The fate of nuns has been aptly described

by Balík and Hanuš, who stated that ‘nuns were sent to the least whom no one had shown any interest in. Paradoxically, the atheist state enabled them to show the utmost love to God through their service to the sick, elderly and disabled’ (2007, 189, my trans.).21 20 21

postolatus III. Ordinis S. Francisci, founded in Prague in 1927.

A Original text: ‘sestry byly poslány k nejposlednějším, o něž nikdo jiný nestál. Ateistický stát jim tak ­paradoxně umožnil až do krajnosti projevovat lásku k Bohu skrze nemocné, staré a postižené’.

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CATHOLIC CHARITABLE SOCIAL WORK IN THE FORMER CZECHOSLOVAKIA 89

5. Attempted revival of Charity in 1968–1970 The years 1968 to 1970 saw an attempt to revive the activity of Charity. For a short period in 1968, also known as ‘the Prague Spring’, the ruling Communist Party experimented with liberalisation and democratisation. This attempt created a temporary opportunity for the churches in Czechoslovakia. While the very reforms of the Communist Party were halted as early as on 20 August of the same year, when the Soviet Union and other members of the Warsaw Pact invaded the country, prac­ tical benefits faded away with some delay. The number of Charity-operated facilities increased slightly. In late 1968, there existed twenty-two charitable homes with a capacity of 2,880 beds, two recreational centres and one housing facility. An attempt was also made to re-establish the diocesan headquarters and international contacts.

Even the national management changed for a short period, yet in August 1970 all these changes went up in smoke (cf. n.1).

6. Charity on the eve of the Velvet Revolution (1989) Although only after the political transformation was it possible to resurrect Charity fully, the foundations of a revival were laid shortly before 1989.

The cornerstone was laid by the project ‘Decade of the spiritual restoration of the nation’ promulgated by the pastoral letter of Cardinal Tomášek in 1987. The adherents of the Roman Catholic Church were encouraged to prepare themselves spiritually – following ten central ideas – for the millennium of St. Vojtěch (Adalbert), the first Czech Bishop of Prague. The whole initiative gave believers a impulse to prayer and reflection, study of the Bible and tradition, sermons, lectures, publication activities and discussions but above all – what is most relevant for this study – ‘to participate in initiatives focused primarily on the service to the needy’ (Balík & Hanuš 2007, 100, my trans.).22 The first fruits of this spiritual preparation were tested towards the end of 1988, when on 7 December Armenia was affected by a disastrous earthquake. Cardinal Tomášek immediately founded an initiative called Výbor křesťanské pomoci (Christian Help Council), whose branches were soon established in local parishes throughout the country. Here, people enthusiastically participated in organising the collection of material help for the earthquake-affected communities. Although the existence of the councils was not approved by the Communist authorities,23 they generated the very first experience of regime-independent charity practice.

Further, they also became a place to train the first generation of the future staff of a renewed Charity.

22 23

Original text: ‘k iniciativám zejména ve službě potřebným’.

See Zelinka (cf. n.1).

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7. Charity after the restoration of freedom The closing chapter of this study presents a brief survey of the processes and events that have characterised the development of Charity and its activities since 1989.

7.1. Building organisational structures24 Immediately in 1990, state control was removed from the Christian Help Councils, and they were incorporated in Charity. Charity was given new statutes which returned it under the auspices of the Czech Catholic Bishops’ Conference. Beginning in the year 1991, the network of diocesan headquarters, local and regional centres of Charity was renewed. In 1993, new statutes had to be adopted. Due to the dissol­ution of Czechoslovakia into two independent countries, the Slovak Charity separated ­itself and became independent. Since 1995 the Czech Charity has been a member of Caritas Europa and Caritas Internationalis. Today Caritas Czech Republic includes the headquarters in Prague and eight diocesan centres, supported by an association of 15 Charity homes for clergy and nuns, and the Eastern Catholic Church Charity with a country-wide competence. In 2013, individual entities within Charity administered resources amounting to nearly CZK 3 billion (Charita Česká republika 2013).

7.2. Building a portfolio of charitable services25 Following the massive presidential amnesty of January 1990, Charity had to react to a range of social problems previously unknown to Czech society. The first homeless shelters were founded along with advice bureaus, clothing banks and food dispensing facilities. After a while, some charitable facilities – which have since become common – started to appear for the first time, such as homeless shelters, homes for seniors, homes and day care centres for the disabled. Later preventive services were also developed. Emerging new facilities included advice bureaus for women, refugees and homeless; drug prevention programs at schools, and low-threshold clubs for youth. Since 1994, work with asylum seekers and migrants has been increasing.

With the introduction of a new Social Services Act in 2006, the portfolio of existing charitable services had to be adapted to the catalogue of services defined by the law such as social activation services for families with children, seniors or the disabled.

In several segments, Charity performs pioneering work on a par with the competitive service providers. Above all, it is necessary to mention the outreach care service in households, where Charity was able to revive its long tradition and thus become the initiator of home care throughout the country. Medical services have 24 25

For data used in this section, See Kopřiva et al. (cf. n.1).

See Kopřiva et al. (cf. n.1).

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gradually been supplemented with the household assistance, and for a long time these services accounted for one third of all charitable services. The same pioneering role was played by Charity in the programs for Roma children and hospice care.

Another important segment of charitable services is humanitarian help. It was initially generated by the situation in the former Yugoslavia (1991). Charity centres provided aid to children in Bosnia, medical care to the wounded and help for refugees. Since 1992, humanitarian help has also been focused on the Ukraine.

Since then, international programs have been steadily growing and now extend to 29 ­countries where humanitarian help as well as development aid is provided. The ­program called Adopce dětí na dálku (Sponsorship of children) is very popular among donors, who cover the school cost for an individual child. Another strong impulse for the further development of humanitarian help was the experience of massive floods in 1997 and 2002.

The number of charitable facilities and agencies providing individual social and medical services has dramatically increased over the last 25 years according to the last annual report of the Charity National Headquarter. Whereas Kopřiva and colleagues, shortly after 2000 registered approximately 300 charitable projects, in 2013 the number increased to 1198 (Charita Česká republika 2013), with the largest services as follows: outreach care service (164), personal assistance (62), respite services (47), homes for seniors (38), shelter houses for the homeless (64), lowthreshold facilities for children and youth (58), social activation services for families with children (60) and home care service (81).

7.3. Development of the quality of services provided While at the beginning Charity predominantly adopted the ‘learning by doing’ ­model, contacts with charity organisations in Germany, Austria, Switzerland, the Netherlands and France supported the implementation of new services as well as enhanced professional competence and quality. In 1994 German Caritas helped to found Ústav sociálních studií (Institute of Social Studies) at the University of Hradec Králové, which provided undergraduate study programs in social services management. A graduate program at the Faculty of Humanities of Charles University, Prague, was added to the study options in this field in 2011. A similar educational facility was established in Olomouc, Moravia, in 1996 when CARITAS – Vyšší odborná škola sociální (CARITAS – College of Social Work) started to provide tertiary education in the field of social and humanitarian work.26 Thanks to collaboration with the local theological faculty, college students can study both at the undergraduate (bachelor’s) level and, since 2009, at the graduate (master) level.

Yet, the development of service quality is related not only to the infrastructure of the professional education of social workers. The critical moment was the intro26

See Kopřiva et al. (cf. n.1).

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duction of the Social Services Act of 2006, mentioned above, which defined a wide range of quality standards inspired by the British model which the charitable ser­vices should strive to adhere to. The process of implementing these quality standards is one of the greatest challenges charitable services have had to face. The field of quality development and management is expected to make further progress in the future as the legally defined standards should ensure a common level of quality across the entire range of social service providers. The creation and development of corporate identity and corporate culture as well as the selection of tools used to that end are left to the discretion of each particular organisation. Today, charitable organisations can choose from secular-based (Bendář 2012) as well as charity-tailored tools (Bopp & Neuhauser 2001; Jünemann & Kilz 2009).

7.4. Personnel and career development After the restoration of Charity, its personnel first formed a relatively homoge­ neous group coming from the Roman Catholic Church. With the number of services ­provided by charitable agencies growing, organisations were forced to employ new staff who were professionally qualified but had no connection with the church. This development did not cause any significant tension for a long time. However, the situation changed in early 2006 as the Magisterium of the Catholic Church had repeatedly drawn attention to the specific character of Catholic charity. Partial quantitative research among Charity staff demonstrated that more than half of them lack any meaningful connection to the Catholic Church.27 On the other hand, in comparison with the general Czech population, charitable facilities staff exhibit a prevalence of proclaimed religious faith,28 and the proportion of Christians with church affiliation is also considerably higher among them than in the Czech majority population.29 Thus, the sector of charitable work represents an important potential for evangelisation and a reduction of the resentment against the Catholic Church within the Czech population.

In this way the management of charitable facilities are exposed to a certain degree of pressure in their attempt to ensure consensus over targets, means and the importance of Charity activities. The tool to achieve consensus was supposed to be the ‘Code of Caritas Czech Republic’ (Charita Česká republika 2009) – the first document to specify the central parameters of an ‘identity of Charity’. Its actual im27

28

29

A survey carried out by Opatrný (2010) among the diocesan Charity in Plzeň (N = 153) showed that only 36% of respondents considered themselves practising Catholics.

Mišovič (2011) carried out quantitative research on a sample of 258 social workers of Christianity-oriented charitable organisations. 71% of respondents considered themselves believing in, or at least admitting the existence of, God, while only 29% labelled themselves unbelievers. According to the latest national census only 20% of the Czech population affiliated themselves with any religious group whereas 34% completely rejected religious faith (Czech Statistical Office 2013).

In Opatrný’s study (2010), 62% of respondents affiliated themselves with Christianity.

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plementation, however, has fallen short of expectations. Challenges Charity has to face over the next years include how to deepen corporate identity and how to handle the consequences at the level of individual services.

Personnel development within Charity involves not only professional workers but also volunteers. The strategy of expanding charitable services has, for the past twenty-five years, unilaterally given preference to professional workers. It remains an open question whether this phenomenon can be ascribed to the influence of the professional-oriented model of charity practice in Germany. Nonetheless, it is tempting to make a comparison that shows these two national Charity organisations as having an almost equal proportion of professionals and volunteers (Doležel 2012).

Actual data (Charita Česká Republica 2013) even shows that Czech Catholic Charity employs a prevailing number of professionals (7,273) over volunteers (4,068). The maintenance or enhancement of this personnel structure of Charity professionals seems unfeasible for the future and indefensible in view of its global uniqueness.

7.5. Bridging the gap between Charity and the parishes All the features discussed above come together in the latest trend observed in the restored Charity. It is the construction of bridges between the services of professional charitable agencies and facilities on the one hand and the pastoral environment of parish communities on the other. Whereas in its early days the restored Charity was organically linked to parishes, the Czech Charity – due to its expansion and professionalisation – has retreated from this original position unlike its counterparts in the neighbouring and Western European countries. This alienation had the side effect of distrust or, on the contrary, unreal expectations on both sides. In terms of theology, this phenomenon has been repeatedly described by German theologians and called a ‘pastoral schism’ (e.g. Lechner 2000).

Finally, thanks to an emphasis put on the issue by the Magisterium’s kerygma (Benedict XVI 2005; 2012), the parish community as the fundamental and irreplaceable focus of service to the needy in their natural environment has experienced a renaissance (Doležel 2008). The imperative to overcome the alienation and find a model of mutual synergy for the operation of charitable agencies and parish com­ munities, as previously defined exclusively by practical theology, was confirmed by the authority of canon law in ‘Motu Proprio Intima Ecclesiae Natura’ (­ Benedict XVI 2012, esp. Art. 9. §1). The success of this charitable renaissance is to a large extent the responsibility of the charitable facilities, central offices and their ­managements.

It is surely a process with an enormous potential for change, in all of the aspects discussed above, even in professional Charity services. An explication of this potential, however, would go beyond the limits of this study.

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8. Conclusion From the data, collected and analysed above, on the development of the Czech Charity over the last nine decades, and the information on a corresponding topic in the neighbouring post-Communist countries (Biel 2009; Puschmann 2008; Török et al. 2010), it is possible to draw three essential conclusions. First, charitable engagement is a highly complex phenomenon. It can adapt and take on various forms, the interpretation of which requires the combination of a variety of perspectives. Second, the context of charitable engagement is always a particular society with its specific (political) conditions. This feature helps to understand why the development of the Czech Charity was so different from its counterparts in neighbouring countries within the same geopolitical area after the Second World War. Third, the phenomenon of Charity must be explored both extensively and intensively, especially with respect to the similarities and differences in its practical operation and functioning in an international context. The context of post-Communist countries of Central ­Europe establishes optimum conditions for such research.

References Balík, S. & J. Hanuš (2007) Katolická církev v Československu 1945–1989 (Brno: Centrum pro studium demokracie a kultury).

Bednář, M. (2012) Kvalita v sociálních službách (Olomouc: Univerzita Palackého).

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Kučera, M. & F. Jemelka (2012) Charita v Olomouci 1922–2012: dějiny, osobnosti, současnost (Olomouc: Charita Olomouc).

Ladenbauer, W. (1899) Das sociale Wirken der katholischen Kirche in der Diöcese Budweis (Vienna: Mayer).

Larisch, J. (2012). P. Rudolf Nejezchleba, zakladatel charitního díla na Ostravsku v první polovině 20. století (Ostrava: Diecézní charita ostravsko-opavská).

Lechner, M. (2000) Theologie in der Sozialen Arbeit: Begründung und Konzeption einer Theologie an Fachhochschulen für Soziale Arbeit (München: Don Bosco).

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Mikulec, J. (2000) Barokní náboženská bratrstva v Čechách (Praha: Nakladatelství Lidové noviny).

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European Journal of Mental Health 11 (2016) 97–111 DOI: 10.5708/EJMH.11.2016.1-2.6

Benedek T. Tihanyi, Andrea Sági, Barbara Csala, Nóra Tolnai & Ferenc Köteles*

BODY AWARENESS, MINDFULNESS AND AFFECT Does the Kind of Physical Activity Make a Difference?** (Received: 12 May 2014; accepted: 8 October 2014)

The aim of this cross-sectional study is to explore expected differences in the connection between particular physical activities and positive and negative affect, body awareness or mindfulness.

Additionally, we describe the so-called tingling phenomenon (i.e. skin-related sensations evoked by focusing on a body part) in terms of prevalence, gender differences and psychological concomitants. A total of 1,057 individuals (331 male; mean age: 30.6 ± 10.17 years) practicing yoga, Pilates training, kung fu, aerobic, or ballroom dance completed our questionnaire. Analysing data of all sports together, weekly frequency of practice, as opposed to time elapsed since starting practice, was connected to lower levels of negative affect and somatosensory amplification, and to higher levels of positive affect. Advanced yoga and Pilates participants showed higher body awareness; advanced kung fu participants amplified bodily signals the least, and aerobic was related to the highest positive affect. Among beginners, there were no practically relevant differences in the assessed constructs. These results might help to clarify the common and different psychological properties that are needed for and/or can be developed by different sports.

Keywords: aerobic, body awareness, kung fu, mindfulness, physical activity, positive affect, ­somatosensory amplification, tingling, well-being, yoga Körperbewusstsein, bewusste Präsenz und die Auswirkungen: Zählt es, welche Bewegungsform du wählst? Durch unsere Querschnittstudie wollten wir den Zusammenhang zwischen den verschiedenen körperlichen Aktivitäten und der positiven bzw. negativen Stimmung, dem Körperbewusstsein sowie der bewussten Präsenz erforschen. Ein weiteres Ziel stellte die genauere Beschreibung des sog. Phänomens des Kribbelns (ein durch die auf einen bestimmten Körperteil *

**

C orresponding author: Ferenc Köteles, Institute for Health Promotion and Sport Sciences, Eötvös Loránd University, Bogdánfy Ödön u. 10., H-1117 Budapest, Hungary; koteles.ferenc@ppk.elte.hu.

The ����������������������������������������������������������������������������������������������������� authors want to express thanks to Dániel Somoskői, Zsófia Szekeres, Andrea Szegedi, Boglárka Kollárszky, Zsófia Szabó and Lilla Paksi (for data collection) and to Ádám������������������������������������� ����������������������������������������� B.F. Czinege (for proofreading). Research for this paper was supported by the Hungarian National Scientific Research Fund (OTKA K-109549) and by the Bolyai János Research Scholarship of the Hungarian Academy of Sciences (for F. Köteles).

ISSN 1788-4934 © 2016 Semmelweis University Institute of Mental Health, Budapest

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gerichtete Aufmerksamkeit hervorgerufenes, auf der Haut lokalisiertes Gefühl) dar (Häufigkeit, Geschlechtsunterschiede, psychologische Korrelate). Insgesamt 1057 Personen (331 Männer, Durchschnittsalter: 30,6 ± 10,17 Jahre), die Yoga, Pilates, Kung-Fu, Aerobic oder Gesellschaftstänze ausübten, haben den Fragebogen ausgefüllt. Alle Bewegungsarten insgesamt betrachtet, hatte die wöchentliche Häufigkeit der körperlichen Aktivität inversen Zusammenhang mit der negativen Affektivität und der somatosensorischen Verstärkung und sie zeigte positive Korrelation mit der positiven Affektivität. Die seit dem Beginn des Trainings verstrichene Zeitspanne stand mit keiner der gemessenen Variablen in Zusammenhang. Die Teilnehmer, die Yoga und Pilates fortgeschritten ausüben, zeigten ein höheres Körperbewusstsein, das Niveau der somatosensorischen Verstärkung war bei den Kung-Fu praktizierenden Personen das niedrigste, während Aerobic war mit einer höheren positiven Affektivität verbunden. Unter den Anfängern haben wir keinen wesentlichen Unterschied in Bezug auf die untersuchten Variablen gefunden. Diese Ergebnisse könnten dazu beitragen, die allgemeinen und speziellen psychologischen Eigenschaften zu klären, die bei der Ausübung verschiedener körperlicher Aktivitäten nötig sind oder die dadurch entwickelt werden können.

Schlüsselbegriffe: körperliche Aktivität, Yoga, Kung-Fu, Aerobic, Wohlbefinden, Körperbewusstsein, positive Affektivität, Präsenz, somatosensorische Verstärkung, Kribbeln

1. Introduction The concept that physical activity (PA) plays a fundamental role in maintaining and regaining physical and psychological health appeared in human culture millennia ago. Growing evidence shows that PA has a positive impact on many organ systems and it plays a fundamental role in maintaining and developing physical health – it has even been called a ‘miracle drug’ (Pimlott 2010). Positive impact of PA on mental problems has also been reported. For example, in the case of depression, PA proved to be an efficient treatment (Fox 1999), and its efficacy increased with the severity of the disorder (Meyer & Broocks 2000).

It is also well known that PA improves mental functioning even among healthy people. As for cognitive functioning, PA can help to avoid neurological dysfunctions and cognitive decline in old age (Cotman & Engesser-Cesar 2002), to improve school performance in childhood (Fisher et al. 1996), and to improve attentional functions, intelligence, decision making, and effortful memory in adults (­ McDowell et al. 2003; Trudeau & Shephard 2010). The positive effect of PA on subjective well-being is also reported (Fox 1999). According to a meta-analysis based on more than 100 studies, increase in well-being as a result of regular aerobic exercise was mediated by positive affect (Reed & Buck 2009). The decrease of negative affect was also described (Scully et al. 1998). Another mediating construct between PA and well-being is self-esteem. Fox (2000) identified 36 randomised controlled studies and 44 controlled studies since 1971 and found that approximately 50% indicated pos­ itive changes in self-esteem. Evidence suggests that participation in certain physical activities throughout the adolescent years positively affects self-esteem, body image and physical strength (Jaffee & Manzer 1992). PA affects global self-worth through EJMH 11:1-2, April 2016

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body areas satisfaction, appearance evaluation and athletic competence (Haugen et al. 2011; McAuley et al. 2000). Interestingly, these aspects mainly represent an ­external (i.e. a third-person) point of view of the body.

Beyond exteroceptive information on physical appearance improved by PA, regular exercise can have an impact on body awareness that might also contribute to subjective well-being. Elevated levels of body awareness are often regarded as a negative phenomenon in medical context as it can lead to amplification of perceived symptoms (i.e. somatosensory amplification) and to catastrophisation (Barsky et al. 1988; Wickramasekera 1995). On the other hand, body awareness may be helpful in identifying important bodily sensations, and it gives the opportunity to react to them appropriately (e.g. by resting or by visiting a physician, etc.; Bakal 1999). Moreover, it has been proposed that states of the body heavily influence the contents and processes of the brain and that these so-called ‘somatic markers’ are indispensable for decision making and emotions (Damasio et al. 1996). The advantage of paying attention to bodily signals was also shown in the field of sport. Professional marathoners as opposed to non-elites attempt to read and process somatic information during running (Morgan & Pollock 1977). In summary, outcome of higher body awareness partly depends on the individual’s emotional reaction. While compulsive focus and anxiety (somatosensory amplification) is maladaptive, nonjudgemental recognition might be adaptive.

Although skin-related information is traditionally regarded as part of exteroception, it also contributes to the internal representation (i.e. a first-person point of view) of the body (Mehling et al. 2009). Recent findings suggest that skin-related sensations (tingling, crawling, etc.) may indeed represent an important component of body-related information. Such tingling sensations were usually considered bene­ ficial (e.g. reducing pain, easing traumatic memories or simply being consequences of the therapeutic touch) in some studies (Cox & Hayes 1999; Fang et al. 2013; Levine 1997, 2008; Meloy & Martin 2001). However, negative aspects were also reported (Lazarus & Mayne 1990). A possible explanation of the tingling sensation may be that the majority of sensory information from the skin is usually filtered out in order to free attentional resources to process information from more import­ ant (e.g. visual and auditory) sensory modalities (Nelson 2010, 197–218). When we focus on a body part, however, skin and muscle-related information can reach consciousness, the body area in question ‘pops out’, and the change in perception is accompanied by a new sensation. As our knowledge on this phenomenon is scarce, its precise description (prevalence, gender differences, related psychological constructs, etc.) would be extremely important for the development of a more comprehensive model of body awareness.

Another significant and recently much investigated construct that is also connected to body awareness and can increase well-being is mindfulness (Kabat-Zinn & Hanh 2009). Mindfulness has a role in enhancing positive outcomes in several important life domains, including mental health, physical health, behavioural regulation and interpersonal relationships, and in curtailing negative functioning (Brown EJMH 11:1-2, April 2016

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et al. 2007). Mindfulness showed significant positive correlation with positive affect, positive emotion, joviality, attentiveness and vitality, and negative correlation with anxiety (Keune & Perczel Forintos 2010). Hölzel and colleagues proposed a model for the interaction of the factors required for the state of mindfulness (2011).

They consider mindfulness meditation practice as a process of enhanced self-regulation, consisting of an interplay of attention regulation, body awareness, emotion regulation (in form of reappraisal and extinction) and a change of perspective regarding the self.

In the present study, correlates of regular PA in five sports (ballroom dance, aerobic, kung fu, yoga, and Pilates) were investigated. We deliberately chose sports which explicitly aim to improve body awareness (yoga and Pilates; Daubenmier 2005; Lynch et al. 2009), sports which are expected to improve mindfulness (yoga and kung fu) and sports which do not directly target these changes (ballroom dance, aerobic). First, it was hypothesised that PA, regardless the particular activity, is connected to lower levels of negative affect and somatosensory amplification, and to higher levels of positive affect and body awareness. Second, we expected differences in the assessed characteristics among those practising the five PAs. More precisely, we hypothesised that yoga and Pilates training relates to higher levels of body awareness and to lower levels of somatosensory amplification, and that yoga and kung fu training is linked to higher levels of mindfulness. We were also curious about whether the assessed personality characteristics had an impact on choosing a certain physical activity or not (e.g. whether beginners with a marked proneness to somatic absorption prefer yoga or Pilates to aerobic, etc.). Finally, we aimed to obtain detailed descriptive information on the above-mentioned ‘tingling’ phenomenon.

2. Methods 2.1. Participants Overall, 1,057 individuals (331 male; mean age = 30.6 ± 10.17 years; range: 18–69 years) participated in the study. Trainers and participants under the age of 18 years were excluded. Participants were reached through the centres they exercised in.

Online and paper-based forms of the questionnaires were available. Questionnaires were completed anonymously and voluntarily, participants did not receive any reward for their participation. The study was approved by the Institutional Ethical Board of Eötvös Loránd University.

2.2. Questionnaires The Positive and Negative Affect Schedule (PANAS) (Watson et al. 1988) consists of two independent scales rated on a five-point Likert scale. The negative affect scale EJMH 11:1-2, April 2016

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measures the general dimension of subjective distress and unpleasant engagement that subsumes a variety of aversive mood states (e.g. guilt, fear, nervousness), while the positive affect scale assesses the extent to which a person feels enthusiastic, active and alert. In the current study, the short (5-item) version of the scales was used (Thompson 2007). The Hungarian version of this scale had acceptable internal consistency (Gyollai et al. 2011). In the current study, Cronbach’s alpha coefficients were 0.72 and 0.71, respectively.

The Somatosensory Amplification Scale (SSAS) (Barsky et al. 1988; 1990) is a scale that assesses the tendency to experience a somatic sensation as intense, noxious, and disturbing. The SSAS evaluates sensitivity to mild bodily sensations that are uncomfortable and unpleasant but not pathological. It consists of ten self-rated statements that are estimated on a five-point Likert-scale. The Hungarian version proved to be valid and psychometrically sound (Köteles et al. 2009). Its Cronbach’s alpha coefficient was 0.70 in the present study.

The 19-item Somatic Absorption Scale (SAS) was developed by David ­Watson to measure the dispositional aspects of body awareness, especially the attention focusing on somatosensory processes (posture, heart beating, bodily changes caused by sport or meal, etc.). The developer aimed to create a questionnaire that is independent of negative affectivity/neuroticism, has a single factor structure and assesses the proneness to continuously monitor body processes (D. Watson, personal communication). The Hungarian version of the scale proved to be valid and showed good internal consistency (Cronbach’s alpha = 0.84) in a previous study (Köteles et al.

2012). Its Cronbach’s alpha coefficient was 0.87 in the present study.

The 15-item Mindful Attention and Awareness Scale (MAAS) (Brown & Ryan 2003) measures the extent to which one is able to focus on the present moment in an open and non-judgemental way. Each of the items is stated inversely using a six-point Likert scale (from almost always to almost never) asking the respondents of how often they find themselves acting automatically, inattentively or being pre­occupied.

The Hungarian version had a good internal consistency (Cronbach’s alpha = ­0.78) in an earlier study (Simor et al. 2013). In the present study, the internal ­consistency of the scale was 0.83.

Sport practice. Two variables were used to characterise participants’ phys­ ical activity: duration (time in months since the beginning of the particular sport) and current weekly frequency of practice. Beginners were defined as individuals who had started practising maximum six months before (N = 286), while advanced ­participants had practiced for more than six months (N = 754). This cut-off point was chosen based on previous results that show that after six months significant psychological changes can be registered, such as reduction in anxiety and depression (O’Rourke et al. 1990), rise in self-esteem and well-being (Alfermann & Stoll 2000) and shift from extrinsic to intrinsic motivation (Maltby & Day 2001).

Moreover, approximately 50% of those who join exercise programs drop out during the first three to six months (Marcus et al. 1994).

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Tingling phenomenon. Participants were asked to focus on a freely chosen body area (e.g. hand, ear) with closed eyes and to report whether the perception of that particular area had changed as a result of paying attention to it (yes-no question).

2.3. Data analysis Data analysis was conducted using the SPSS v20 software. As data were appropriate for parametric analysis, five multiple linear regression analyses were carried out to investigate the contribution of duration and frequency of exercising to the assessed variables regardless the type of PA. In each case, independent variables were entered in one step using the ENTER method. In all analyses, participants’ gender and age, duration (time in months since starting practice) and weekly frequency of body exercises were used as independent variables. Additionally, positive and negative affect scores were also used as independent variables in the equation predicting somatic absorption score. In the two analyses with positive and negative affect as dependent variables, somatic absorption score was used as an additional independent variable.

Finally, in the analyses predicting mindfulness and somatosensory amplification scores, positive and negative affect and somatic absorption scores were used as independent variables beyond the four variables mentioned earlier.

Differences among the five selected activities were estimated by separate covariance analyses for the five assessed psychological constructs. In the case of beginners, participants’ age was used as a covariant in all cases. As for advanced participants, age, and duration and frequency of practice were used as covariants.

Differences among sports were further explored using post hoc tests with Bonferroni correction (p < 0.05 in all cases).

Gender differences in the tingling phenomenon were examined by chi-square test; differences in the other assessed variables were checked by Student t-tests. Finally, a binary logistic regression analysis was carried out with the tingling phenomenon as criterion variable. Age, gender and educational qualification were entered as control variables, and scores of the five assessed psychological constructs as predictors.

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3. Results 3.1. Descriptive statistics Descriptive statistics of the measured variables are presented in Table 1.

Table 1 Descriptive statistics of the assessed variables

Positive affect Negative affect Somatic absorption Mindfulness Somatosensory amplification Duration of practice (months) Frequency of practice (per week)

Mean

SD

19.3 9.2 65.0 60.3 27.7 46.0 2.4

2.97 3.10 6.02 9.76 6.02 65.97 1.73

Min.–Max. 5–25 5–22 25–94 15–88 10–45 0–576 0–19

3.2. Positive and negative affect According to the results of the multiple linear regression analysis, practice frequency as opposed to practice duration was significantly related to positive affect even after controlling for participants’ age and gender (Table 2). Positive affect also showed a positive correlation with somatic absorption. Negative affect was inversely related to frequency of practice, but the connection was very weak (Table 2). It is worth noting that both equations explained a very low proportion of the total variance (7.1% and 4.8%, respectively). Thus these results may have no practical importance.

Table 2 Positive and Negative Affect Positive affect R2 = 0.071; p < 0.001 Standardised β coefficients Age Gender Duration of practice Frequency of practice Somatic absorption

0.050 0.077* 0.037 0.114*** 0.210***

Negative affect R2 = 0.048; p < 0.001 Standardised β coefficients –0.166*** 0.089** –0.027 –0.081* –0.018

Results of the multiple linear regression analyses predicting positive and negative affect scores. * p < 0.05; ** p < 0.01; *** p < 0.001.

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In the case of beginners, ANCoVA showed no differences among sports either for positive or for negative affect (F(4) = 2.274; p > 0.05, and F(4) = 1.500; p > 0.05, respectively). Regarding people who had practised for more than six months, significant differences in positive affect (F(4) = 2.460; p < 0.05) were found among sports. In the post hoc analysis, only one significant pairwise difference was found: those who practised aerobic showed higher levels of positive affect than kung fu practitioners (20.1 ± 0.27 vs. 19.0 ± 0.27). As for the controlling variables, only the impact of the weekly frequency of practice was significant (F(1) = 4.898; p < 0.05). For people who had practised for more than six months, the effect of the frequency of practice was significant for negative affect (F(1) = 4.40; p < 0.05) but no significant differences among sports were found (F(4) = 0.931; p > 0.05).

3.3. Body awareness Table 3 Body awareness R2 = 0.052; p < 0.001 Age Gender Duration of practice Frequency of practice Negative affect Positive affect

Standardised β coefficients 0.057 –0.044 0.002 –0.003 0.038 0.224***

Results of the multiple regression analysis predicting somatic absorption score. *** p < 0.001.

According to the results of the multiple linear regression analysis, neither practice frequency nor practice duration was significantly related to body awareness ­(Table 3), and the explained proportion of total variance was very low (5.2%) again.

In the case of beginners, ANCoVA showed significant differences among sport types (F(4) = 2.970; p < 0.05). However, no significant pairwise differences were found in the post hoc analysis. Regarding advanced participants, significant differences were found among the five sports (F(4) = 10.578; p < 0.001). The post hoc an­ aly­sis revealed that yoga practice (70.2 ± 0.96) was connected to significantly higher somatic absorption score than kung fu (65.9 ± 1.12), ballroom dance (63.3 ± 0.85) and aerobic practice (61.7 ± 1.12). Moreover, Pilates practice (68.0 ± 1.06) was linked to higher somatic absorption score than dance and aerobic.

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3.4. Somatosensory amplification According to the results of the multiple linear regression analysis, somatosens­ ory amplification was negatively connected to practice frequency and positively ­related to negative affect and somatic absorption (Table 4).

Table 4 Somatosensory Amplification R2 = 0.299; p < 0.001 Age Gender Duration of practice Frequency of practice Negative affect Positive affect Somatic absorption

Standardised β coefficients –0.069* 0.122*** –0.008 –0.058* 0.242*** –0.086** 0.466***

Results of the multiple regression analysis predicting somatosensory amplification score. * p < 0.05; ** p < 0.01; *** p < 0.001.

In the case of beginners, ANCoVA showed significant differences among sports (F(4) = 3.130; p < 0.05). No significant pairwise differences were found in the post hoc analysis, however. Regarding advanced participants, significant differences were found among the five sports (F(4) = 2.953; p < 0.05). Post hoc analysis revealed that kung fu practice (26.2 ± 0.56) was connected to significantly lower somatosensory amplification than Pilates practice (28.7 ± 0.53). Significant controlling variables were age (F(1) = 11.425; p < 0.01) and practice frequency (F(1) = 7.398; p < 0.01).

3.5. Mindfulness The multiple linear regression analysis revealed significant correlations between mindfulness and somatic absorption, positive affect, and negative affect (reverse relationship) (Table 5). No significant differences among sports were found either among beginners or among advanced participants (F(4) = 1.448; p > 0.05, and F(4) = 1.331; p > 0.05, respectively).

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B. T. TIHANYI, A. SÁGI, B. CSALA, N. TOLNAI & F. KÖTELES Table 5 Mindfulness R2 = 0.302; p < 0.001 Age Gender Duration of practice Frequency of practice Negative affect Positive affect Somatic absorption

Standardised β coefficients 0.156*** –0.057* –0.034 0.023 –0.382*** 0.210*** 0.069*

Results of the multiple regression analysis predicting mindfulness score. * p < 0.05; *** p < 0.001.

3.6. Tingling phenomenon Presence of the tingling phenomenon was reported by 63.2% of the participants. ­Chi-square test showed no significant gender differences (chi-square = 0.439; p = 0.508). According to the results of Student t-tests, the phenomenon was not connected to age, positive and negative affect, and mindfulness, and was positively associated with somatosensory amplification and somatic absorption (see Table 6 for details).

In the latter two cases, Cohen’s d values indicated small and medium effect sizes, respectively. In the binary logistic regression analysis (p < 0.001, Nagelkerke R2 = 0.128) somatic absorption was the only significant predictor variable of the tingling phenomenon (ExpB = 1.054; p < 0.001) Table 6 Results of t-tests comparing characteristics of participants who reported and not reported the tingling phenomenon (N = 1,057)

Age Somatosensory amplification Somatic absorption Positive affect Negative affect Mindfulness p < 0.001.

***

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Tingling not reported

Tingling reported

t-value

Cohen’s d

30.98 ± 10.378

30.44 ± 10.055

0.820

0.053

26.38 ± 5.697

28.48 ± 6.073

–5.549

***

–0.357

60.10 ± 12.408 19.04 ± 3.095 9.11 ± 3.042 60.59 ± 9.490

67.87 ±11.517 19.39 ± 2.892 9.24 ± 3.128 60.16 ± 9.921

–10.255*** –1.870 –0.666 0.688

–0.650 –0.117 –0.042 0.044

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4. Discussion Regardless of the type of exercise, weekly frequency of physical activity (PA) was connected to lower levels of negative affect and somatosensory amplification, and to higher levels of positive affect in a cross-sectional questionnaire study. No connections between frequency of PA and body awareness or mindfulness were found.

Interestingly, time elapsed since starting the particular PA showed no connection to any assessed psychological construct. As for the tingling phenomenon, it was connected to the two constructs that assess some sort of body awareness (i.e. somato­ sensory amplification and somatic absorption) and was independent of mindfulness and positive and negative affect.

In the case of participants who had practised for more than six months, significant differences in positive affect, body awareness, and somatosensory amplification scores were found among the five sports included in the study. Yoga practitioners showed higher levels of body awareness than people practising kung fu, ballroom dance or aerobic. Pilates practice was linked to higher body awareness than ballroom dance or aerobic practice. Kung fu practice was connected to weaker somato­sensory amplification tendency than Pilates practice. Finally, those practising aerobic showed higher levels of positive affect than kung fu practitioners.

As for beginners, no practically relevant differences were found among the five sports. Thus when starting to do sports, participants’ choice was seemingly not affected by any of the psychological constructs examined here, and the differences found among the advanced either refer to the effect of the physical activity they practise or to the influence of the constructs we examined on exercise adherence and drop-out.

Our results are in accordance with previous findings on the positive connection between PA and positive affect, and on the negative connection between PA and negative affect (Reed & Buck 2009; Scully et al. 1998). Our results also confirm that the former connection is stronger (Hsiao & Thayer 1998). As our data was cross-sectional, these relations might be explained in two ways. On one hand, exercising may improve affect; on the other hand, good mood and energy may have a positive impact on practice. Nevertheless, existence of the former connection (i.e. PA as a cause of improved well-being) was supported by longitudinal and intervention studies (Netz et al. 2005). Interestingly, weekly frequency of practice as opposed to the time since starting practice was connected to these constructs in the present study, showing the importance of regular exercise even for advanced practitioners.

Positive affect was also connected to higher levels of body awareness, showing either that body awareness contributes to mental well-being or that optimal emotional state helps to connect properly to bodily signals. Putting all sports together, body awareness was not connected to weekly frequency and duration in the regression analysis. However, among advanced participants, yoga and Pilates practice were connected to higher levels of body awareness than the other three, which supports EJMH 11:1-2, April 2016

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B. T. TIHANYI, A. SĂ GI, B. CSALA, N. TOLNAI & F. KĂ&#x2013;TELES

our hypothesis that these activities actually improve it. The lowest levels of body awareness were found among advanced kung fu practitioners. Kung fu might train to tolerate pain through repressing negative bodily signals and thus keeps body awareness lower. Repression can be a negative effect of sports especially on a professional level as in the case of ballet (McEwen & Young 2011).

Somatosensory amplification was positively related to body awareness and negative affect, which is in accordance with its definition (Barsky et al. 1990). It was negatively related to positive affect and frequency of PA, which suggests that regular exercise can decrease uncomfortable bodily signals and/or the propensity to amplify them. While advanced kung fu practitioners showed less tendency to somatosensory amplification than Pilates practitioners, no such difference was found among beginners. This might mean that kung fu decreased this maladaptive reaction more (e.g. because pain and pain tolerance are part of kung fu training), but it is also probable that those showing higher levels of amplification stopped attending the kung fu classes (because they did not tolerate painful experiences).

Finally, mindfulness was not related to PA either when we treated all sports together or when we treated them separately. The connection of mindfulness to different sports may have been hidden by our methods. Namely, different classes and studios were pooled in each sport. However, a connection between mindfulness and body awareness was found, which relates to the hypothesis that body awareness is a key element of mindfulness (HĂślzel et al. 2011).

The present study had an additional (primarily descriptive) goal: to gain more information on what is called the tingling phenomenon. In our results it was not connected to gender, age, educational qualification, affect and mindfulness. However, it showed a positive connection to the indicators of body awareness, particularly to its non-judgemental, affect-free form (i.e. somatic absorption). Participants who had the tendency to pay attention to the current state of their body (internal feelings, posture, etc.) were also prone to experience tingling sensations in the body parts they focused on. The connection with somatic absorption found in the current study is in accordance with the attention model mentioned in the introduction: participants who generally pay more attention to their body are obviously able to allocate more attentional resources to body parts. Moreover, the recent findings suggest that tingling sensations are originally free of positive or negative emotions, and evaluation (e.g. based on the actual state of the individual or on the meaning attached to them) takes place in a later step of their cognitive processing.

The most important limitation of the present cross-sectional study is that it is not able to reveal the causal direction of the reported connections, that is, the possible effects of PA. Moreover, our sample was not representative; thus the generalisability of the results is limited. A proportion of the participants filled in the questionnaire on the internet. The conditions in these cases were uncontrollable.

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5. Conclusion The present findings extended our knowledge about connections among sports and psychological characteristics. Despite scientific results supporting positive effects of PA, the sedentary behaviour remains high in industrialised nations (Sági et al. 2012).

Deeper clarification of how different sports affect mental health may help to propagate PA and to choose the proper sport which boosts intrinsic motivation and makes PA pleasant and enduring (Maltby & Day 2001). Such results can help practitioners and trainers to exploit the resources of PA more, that is, to recognise psychologic­al factors which are needed for and can be developed by PA, to choose the sport that is most suitable for a person, to decrease dropout and to give valid information in order to make regular PA popular. Identifying such factors might also help us to include PA in mental healthcare and form an integrated mind-body medicine.

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European Journal of Mental Health 11 (2016) 112–127 DOI: 10.5708/EJMH.11.2016.1-2.7

Benedek T. Tihanyi, Petra Böőr, Lene Emanuelsen & Ferenc Köteles*

MEDIATORS BETWEEN YOGA PRACTICE AND PSYCHOLOGICAL WELL-BEING Mindfulness, Body Awareness and Satisfaction with Body Image** (Received: 6 February 2015; accepted: 8 October 2015)

Regular yoga practice was connected to higher levels of psychological well-being in cross-sectional and longitudinal studies. However, the psychological mechanisms of this connection are still unexplained. In the present cross-sectional questionnaire study, hypothesised mediating effects of body awareness, satisfaction with body image, and mindfulness were investigated. 203 healthy adults (183 females, mean age: 36.8 ± 10.03 years) practicing yoga at an advanced level were involved in the study. Participants completed online questionnaires assessing body awareness (BAQ), dissatisfaction with body image (BIQ), mindfulness (MAAS) and well-being (WHO-5).

Body awareness, body image dissatisfaction and mindfulness showed significant correlations with the weekly frequency of yoga practice as well as with psychological well-being. Body awareness, body image and mindfulness mediated the connection between yoga practice and well-being. In the regression analysis, body image dissatisfaction and body awareness remained connected to well-being even after controlling for practice frequency, mindfulness, gender and age. According to these results, body awareness, body image satisfaction and mindfulness are mediators of the connection between yoga practice and well-being.

Keywords: body awareness, body image, body-mind, mindfulness, physical activity, well-being, yoga Vermittler der Verbindung zwischen Yoga und dem geistigen Wohlbefinden: bewusste Präsenz, Körperbewusstsein und Zufriedenheit mit dem Körperbild: Regelmäßiges Yoga ist in zahlreichen Quer- und Längsschnittstudien mit einem höheren psychischen Wohlbefinden verbunden, zugleich sind die psychologischen Hintergrundmechanismen dieser Korrelation nicht bekannt. Bei *

**

orresponding author: Ferenc Köteles, Institute of Health Promotion and Sport Sciences, Eötvös Loránd C University, Bogdánfy Ödön u. 10., H-1117 Budapest, Hungary; koteles.ferenc@ppk.elte.hu.

The authors express thanks to Ádám B.F. Czinege for proofreading. Research for this paper was supported by the Hungarian National Scientific Research Fund (OTKA K-109549).

ISSN 1788-4934 © 2016 Semmelweis University Institute of Mental Health, Budapest

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der vorliegenden Querschnittsumfrage wurde die vermittelnde Wirkung des Körperbewusstseins, der Zufriedenheit mit dem Körperbild bzw. der bewussten Präsenz untersucht. In der Studie haben 203 Yoga auf fortgeschrittenem Niveau praktizierende gesunde Erwachsene (183 Frauen, Alter: 36.8 ± 10.03 Jahre) den Fragebogen online ausgefüllt, der das Körperbewusstsein (BAQ), die Zufriedenheit mit dem Körperbild (BIQ), die bewusste Präsenz (MAAS) und das Wohlbefinden (WHO-5) bewertete. Die Körperwahrnehmung, die Zufriedenheit mit dem Körperbild und die bewusste Präsenz zeigten signifikante Korrelation sowohl mit der wöchentlichen Häufigkeit der Yoga-Übungen als auch mit dem Wohlbefinden. Einzeln betrachtet vermittelten sowohl die Körperwahrnehmung als auch die Zufriedenheit mit dem Körperbild und die bewusste Präsenz eine Verbindung zwischen Yoga und Wohlbefinden. In der Regressionsanalyse blieb der Zusammenhang zwischen Zufriedenheit mit dem Körperbild bzw. Körperbewusstsein und Wohlbefinden auch nach der Kontrolle der bewussten Präsenz, der Häufigkeit der Yogaübungen, des Geschlechts und des Alters signifikant. Die vorliegenden Ergebnisse zeigen, dass Körperbewusstsein, Zufriedenheit mit dem Körperbild sowie bewusste Präsenz als Vermittler zwischen Yoga und Wohlbefinden betrachtet werden können.

Schlüsselbegriffe: Yoga, Wohlbefinden, bewusste Präsenz, Körperbewusstsein, Körperbild, Körper-Geist, Bewegung

1. Introduction A body-mind boom may be observed in the fields of leisure, sport, (psycho)therapy and scientific discourse. One emblematic representative of this trend is yoga ­(Harrington 2008). In this paper, the term ‘yoga’ refers to modern yoga, the newest branch that is most widely practised and researched nowadays, which includes ‘certain types of yoga that evolved mainly through the interaction of Western individuals interested in Indian religions and a number of more or less Westernized Indians over the last 150 years’ (Michelis 2005, 2).

Yoga practice was originally divided into five basic principles (Vishnu-­ devananda 2011): proper exercise, proper breathing, proper relaxation, proper diet, and positive thinking and meditation, emphasised to various extents in the different modern yoga schools. It is important to emphasise that there is a huge diversity in the literature concerning the particular yoga practice under investigation. Fortunately, the mindfulness-based stress reduction program (MBSR), which has recently attracted much scholarly attention, includes hatha yoga, which provides a standardised form of the otherwise diverse collection of different yoga protocols. Hatha yoga was found to be the strongest component of MBSR in improving mental health (Carmody & Baer 2008). The most common effects linked to and expected from yoga practice are strength, flexibility and balance of both body and mind (Impett et al. 2006).1 1

ee also ‘Sacred Balance: Yoga Poses for Strength and Flexibility’, retrieved 19 Aug 2015 from the S ­Yoga-paws website (www.yogapaws.com/yoga-blogs-yoga-paws/bid/60972/Sacred-Balance-Yoga-Posesfor-Strength-and-­Flexibility); Stephanie Watson, ‘Yoga Health Benefits: Flexibility, Strength, Posture, and More’ (­ 14 July 2014), retrieved 19 Aug 2015 from the WebMD website (www.webmd.com/balance/guide/ the-health-­benefits-of-yoga); ‘Teachings’, retrieved 19 Aug 2015 from the International Sivananda Yoga Vedanta Centres website (www.sivananda.org/teachings/).

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The positive psychological effects of yoga on healthy adults’ well-being, defined as an increased rate of calmness and a state of pleasant enthusiasm, and a decreased rate of anxiety and depressive symptoms (Daniels 2000), were reported by a number of empirical studies (Adair et al. 1998; Hadi & Hadi 2007; Hartfiel et al. 2011; Impett et al. 2006; Malathi et al. 2000; Michalsen et al. 2005; Oken et al. 2006; Ross & Thomas 2010; Smith et al. 2007; West et al. 2004; Wood 1993). However, no empirical research investigating the background (i.e. possible mediators) of the association between yoga practice and psychological well-being has been published hitherto. One possible candidate might be body awareness (i.e. ‘perception of bodily states, processes and actions that is presumed to originate from sensory proprioceptive and interoceptive afferents and that an individual has the capacity to be aware of’; ­Mehling et al. 2009, 4), which was found to be connected to psychological well-being in several empirical studies (Daubenmier 2005; Köteles 2014; Tihanyi et al. 2016).

Although elevated levels of body awareness (also called somatic awareness or embodied self-awareness; Bakal 1999; Fogel 2009) are often considered as harmful in medical contexts as they can lead to the amplification of the perceived symptoms and to catastrophisation (Barsky et al. 1988; Wickramasekera 1995), body awareness has been found helpful in identifying important bodily sensations and in giving the opportunity to react to them in an adaptive way (e.g. by resting or other ways of self-care, visiting a physician, etc.; Bakal 1999). Moreover, it was proposed that actual states of the body heavily influence the contents and processes of the brain (Ádám 1998; Cameron 2002; Damasio 2010), and that these so-called ‘somatic markers’ are indispensable for decision making and emotions (Damasio et al. 1996).

In more detail, body-mind psychotherapists agree that body awareness (1) facilitates the inner dialogues which govern behaviour based on need states, (2) strengthens the self-regulation in stress response, (3) helps know and respect more the selfborders and thus enables the interpersonal communication to be more effective, (4) directs the attention on ‘what is’ instead of ‘what should be’, which strengthens the skill of acceptance, (5) enhances the sense of self and self-confidence (Fogel 2009).

The frequency of yoga practice was shown to be connected to body awareness in several studies (Impett et al. 2006; Tihanyi et al. 2016). In an experimental study, three months of yoga training was found to lead to higher body awareness in healthy adults compared to a non-randomised control group (Rani & Rao 1994), while only ten weeks of yoga practice increased body awareness in a randomised controlled study in colorectal patients (Cramer et al. 2014). In summary, as body awareness is con­nected to both well-being and yoga practice, it may play a mediating role between the two.

According to Mehling and colleagues (2009), body awareness is based almost exclusively on interoceptive input, whereas body image also includes exterosensory information. Hence, the latter refers to a more complex representation of the body that also incorporates attitudinal and perceptual experiences. An essential aspect of body image is subjective evaluation – that is, to what extent the individual is satisfied or dissatisfied with their physical appearance. From early childhood on, body image influences one’s thoughts, behaviour, and emotions; it is one of the key elements EJMH 11:1-2, April 2016

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of self-esteem, and it predicted well-being as well (Cash & Hicks 1990; Cash & Pruzinsky 2002; Fox 1999).

Body satisfaction and body awareness were higher among yoga practitioners than among those practicing aerobic or in the control group in a study (Daubenmier 2005), and members of a yoga intervention group reported less body image-related anxiety after 20 units of training than a gym-group in another research (HafnerHolter et al. 2009). However, body dissatisfaction was improved by cognitive dissonance therapy, while yoga was not more efficient than the control group, in another study (Mitchell et al. 2007).

Body awareness is one of the key components of mindfulness (i.e. an intentional, non-elaborative, non-judgemental awareness which focuses on one’s emotions, thoughts and sensations of the here-and-now; Bishop et al. 2004; Mehling et al. 2009; Zgierska et al. 2009) – another important and recently much investigated construct that is also able to increase well-being (Brown & Ryan 2003; KabatZinn & Hanh 2009). Mindfulness meditation practice was proposed to be a process toward enhanced self-regulation, consisting of the interplay of attention regulation, body awareness, emotion regulation (in form of reappraisal and extinction) and a change of perspective regarding the self (Hölzel et al. 2011).

Mindfulness practice was found to lead to positive outcomes in several import­ ant life domains including mental health, physical health, behavioural regulation and interpersonal relationships, and in curtailing negative functioning (Brown et al.

2007). Moreover, mindfulness showed a positive relationship with positive affect, positive emotion, joviality, attentiveness, and vitality (Bowden et al. 2011; Carmody & Baer 2008; Keune & Perczel Forintos 2010; Richards et al. 2010), and a negative correlation with anxiety and stress (Grossman et al. 2004; Praissman 2008). Although body awareness was hypothesised to lead to more self-care, mindfulness but not self-awareness mediated the relationship between the subjective importance of self-care and well-being in one study (Richards et al. 2010).

The MBSR program increased mindfulness (Shapiro et al. 2007), even over a relatively short period of time (six weeks) (Klatt et al. 2008). Advanced hatha yoga practitioners showed higher levels of mindfulness than beginners (Brisbon & Lowery 2011), and in a pilot study of a four-month residential yoga group, mindfulness was found to mediate the group effect on quality of life, compared to matched controls (Gard et al. 2012). In a cross-sectional study, however, no connection was found between mindfulness and frequency of yoga practice, and advanced yoga practitioners showed no higher levels of mindfulness than those practicing aerobic (Tihanyi et al. 2016).

In summary, (1) yoga practice was found to be connected to well-being, body awareness, body image and mindfulness, and (2) body awareness, body image and mindfulness were also connected to well-being. Based on these empirical and theor­ etical considerations, it was hypothesised in the current study that body awareness, body image and mindfulness are mediators of the relationship between yoga practice and psychological well-being (Figure 1).

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1;

yoga

body awareness

well-being

2;

yoga

body image

well-being

3;

yoga

mindfulness

well-being

body awareness 4;

yoga

body image

well-being

mindfulness

Figure 1 Hypotheses of the study

2. Methods 2.1. Participants Overall, 203 advanced yoga practitioners (183 females; mean age = 36.8 ± 10.03 years; range: 19–68 years) participated in the study. Individuals under the age of 18 years and those who had practiced yoga for less than six months were excluded. Participants were reached through either the centres they exercised at or social media.

Questionnaires were completed online, anonymously and voluntarily, and participants did not receive any reward for their participation. The study was approved by the Institutional Ethical Board of Eötvös Loránd University. All participants read and signed an informed consent form before completing the questionnaire.

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2.2. Questionnaires Body Awareness Questionnaire (BAQ) (Shields et al. 1989). The questionnaire consists of eighteen statements that measure beliefs about one’s sensitivity to normal non-emotive bodily processes, and the ability to anticipate bodily reactions. Agreement/disagreement is indicated on a seven-point Likert scale. The BAQ is con­sidered a reliable and valid instrument for measuring self-reported attentiveness to normal bodily processes (Mehling et al. 2009). The Hungarian version showed good validity and reliability in past studies (Emanuelsen et al. 2015; Köteles 2014). In the present study, the internal consistency of the scale was 0.89.

Body Image Ideals Questionnaire (BIQ) was developed by Cash and S ­ zymanski (1995) and is a frequently used measure of body image. The questionnaire deals with various physical characteristics such as height, weight, chest size, facial features, and muscle definition. Twenty-two items tap the discrepancy between how subjects perceive themselves and how they wish they were (personal ideal). The importance of the personal ideal is also reported. Answers are given on a four-point Likert scale.

Higher scores reflect greater discrepancies, dissatisfaction, and greater importance, respectively. Unlike other measures of body image, the BIQ measures discrepancy between the real and the ideal self, and the strength of the discrepancy will vary as a function of the subjective importance of the physical ideals. Reliability and validity is firmly established and the BIQ correlates strongly with other measures of body image such as the Body Areas Satisfaction Scale (BASS), Situational Inventory of Body-Image Dysphoria (SIBID), and the Appearance Schemas Inventory (Cash & Szymanski 1995). Reliability of the Hungarian version was appropriate in a past study (Emanuelsen et al. 2015) and also good in the present study (0.81).

Mindful Attention and Awareness Scale (MAAS) (Brown & Ryan 2003). The ­fifteen-item scale measures the extent to which one is able to focus on the present ­moment in an open and non-judgemental way. Each of the items is stated inversely using a six-point Likert scale (from almost always to almost never) asking the respondents of how often they find themselves acting automatically, inattentively or being preoccupied.

The Hungarian version had a good internal consistency ­(Cronbach’s alpha = 0.78) in earlier studies (Simor et al. 2013; Tihanyi et al. 2016). In the present study, the internal consistency of the scale was 0.86.

Psychological well-being was assessed using the five-item WHO-Five scale (Bech 1990). The respondents appraised their level of energy, calmness, cheerfulness and of being interested on a four-point Likert scale. The validated Hungarian version had a good internal consistency in an earlier study (Susánszky et al. 2006).

In the present study, the internal consistency of the scale was 0.73.

Yoga practice. Current weekly frequency of practice was used to characterise participants’ yoga activity. The cut-off point for advanced yoga practice was chosen based on previous results, showing that after six months significant psychological changes can be registered, such as reduction in anxiety and depression (O’Rourke et al. 1990), rise in self-esteem and well-being (Alfermann & Stoll 2000) and EJMH 11:1-2, April 2016

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shift from extrinsic to intrinsic motivation (Maltby & Day 2001). Moreover, approximately 50% of those who join exercise programs drop out during the first three to six months (Marcus et al. 1994).

2.3. Data analysis Data analysis was conducted using the SPSS v21 software. As the distribution of yoga frequency and well-being did not fulfil the criterion of normality, non-parametric analyses were used. Spearman correlation analyses were carried out to investigate the connections among weekly frequency of exercise, body awareness, body image dissatisfaction, mindfulness and psychological well-being. To investigate the independent contribution of variables to well-being, a multiple binary logistic regression analysis was conducted. First, the sample was split into two at the median of well-being scores (n1 = 123, n2 = 80). Second, the independent variables were entered in four steps using the ENTER method: (Step 1) participants’ gender (males = 0, females = 1) and age, a binary variable referring to being a yoga instructor (0 = no, 1 = yes), and weekly frequency of yoga practice, (Step 2) mindfulness score, (Step 3) body image dissatisfaction score, and finally (Step 4) body awareness score. To check mediating effects, the bootstrapping method developed by Preacher and Hayes (2008) was used, which does not require normal distribution for any variables. The procedure answers the same question as the widely used Sobel test, that is, is there a significant change (decrease) in the regression coefficient between the independent and the dependent variable after including one or more (mediating) variable(s)? In contrast to the Sobel test, it determines confidence intervals instead of significance levels. Four tests were conducted: three investigating the independent meditating effects of the three respective variables, and a fourth analysis where all variables were included simultaneously (Figure 1).

3. Results 3.1. Descriptive statistics Descriptive statistics of the measured variables are presented in Table 1.

3.2. Correlation analysis All assessed variables correlated significantly with each other. Both well-being and frequency of yoga practice were connected to body awareness, mindfulness and body image dissatisfaction (Table 2). The Spearman coefficients are negative in the case of body image dissatisfaction, since this construct reveals the dissatisfaction with body image.

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MEDIATORS BETWEEN YOGA PRACTICE Table 1 Descriptive statistics and normality of the assessed variables

Age Gender Teacher Yoga Frequency Well-Being Mindfulness Body Image Dissatisfaction Body Awareness *

KolmogorovSmirnov Z

Minimum

Maximum

Mean

SD

19 0 0 1 10 24

68 1 1 7 20 87

36.8 0.9 0.3 3.4 15.1 62.7

10.03 0.30 0.44 1.94 2.12 11.27

1.7

1.41

0.75

95.1

15.98

0.99

–2.45 31

6.45 124

1.61* 7.56*** 6.66*** 3.24*** 1.67** 0.96

p < 0.05; ** p < 0.01; *** p < 0.001.

Table 2 Two-tailed Spearman correlations among the assessed variables Yoga Frequency Well-Being Mindfulness Body Image Dissatisfaction Body Awareness **

p < 0.01;

***

0.26*** 0.22** –0.21** 0.24***

Well-Being

Mindfulness

Body Image Dissatisfaction

0.33*** –0.34***

–0.40***

0.39***

0.31***

–0.31***

p < 0.001.

3.3. Mediation analysis According to the results of the first three mediation analyses, an indirect (mediating) effect were found (i.e. the 95% confidence interval was above zero) in the case of body awareness, body image dissatisfaction and mindfulness (for details, see Figure 2 and Table 3). In the fourth analysis, where the hypothesised mediating variables were included simultaneously, the total mediating effect was also significant. However, an inspection of the individual effects of the variables revealed that the 95% confidence intervals for body awareness and body image were above zero (0.0220– 0.1168 and 0.0149–0.1051, respectively), while it was not significant in the case of mindfulness (–0.0038–0.0935).

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1;

body awareness

1.859 ± 0.567**

0.0449 ± 0.009***

yoga frequency

well-being 0.265 ± 0.075

***

2;

-0.141 ± 0.050**

/ 0.183 ± 0.073

*

body image

-0.480 ± 0.100***

yoga frequency

well-being 0.265 ± 0.075

***

3;

-1.272 ± 0.401**

/ 0.197 ± 0.073

**

-0.051 ± 0.013***

mindfulness

yoga frequency

well-being 0.265 ± 0.075

***

4;

1.856 ± 0.567** yoga frequency

/ 0.200 ± 0.074

body awareness

**

-0.032 ± 0.009***

0.265 ± 0.075*** / 0.128 ± 0.071n.s.

-0.141 ± 0.050**

body image

1.272 ± 0.401**

well-being

-0.317 ± 0.104** 0.025 ± 0.013n.s.

mindfulness

Figure 2 Regression coefficients and standard errors between (1) yoga practice and mediator(s), (2) mediator(s) and well-being (with the control of yoga practice), and (3) yoga practice and well-being (direct effect before / after including the mediator(s))

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Table 3 Descriptive statistics (mean, 95% confidence intervals, standard error) of the indirect effect calculated from 1000 bootstrap samples for the four mediation analyses Mediating Variable

Mean of the Indirect Effect

95% CIs

SE

0.0299 0.0679 0.0657 0.1381

0.0399–0.1493 0.0253–0.1305 0.0180–0.1362 0.0707–0.2142

0.0059 0.0264 0.0293 0.0361

A; BAQ B; BIQ C; MAAS D; BAQ & BIQ & MAAS

3.4. Regression analysis The first step of the multiple linear regression analysis revealed a significant connection between frequency of yoga practice and well-being even when the effects of age, gender and being a yoga instructor were controlled for (Table 3). In the second step, mindfulness and weekly frequency of yoga practice were connected to wellbeing. The third step of the analysis revealed a significant connection between body image dissatisfaction and well-being, while the contribution of mindfulness became non-significant. In the last step, practice frequency, body image dissatisfaction and body awareness remained significantly connected to well-being. The final equation explained 17.9% of the total variance of well-being (p < 0.001) (Table 4).

Table 4 Results of the binary logistic regression analysis (Exp(B) coefficients with 95% confidence intervals) predicting well-being score Step 1 Cox & Snell R2 = 0.073; p < 0.01 Age Gender Yoga Instructor Frequency of Yoga Practice Mindfulness Body Image Dissatisfaction Body Awareness *

Step 2 Cox & Snell R2 = 0.111; p < 0.001

Step 3 Cox & Snell R2 = 0.156; p < 0.001

Step 4 Cox & Snell R2 = 0.179; p < 0.001

1.009 [0.980, 1.039] 1.155 [0.418, 3.190] 1.573 [0.777, 3.188]

1.003 [0.973, 1.033] 1.201 [0.428, 3.370] 1.412 [0.686, 2.904]

1.010 [0.979, 1.042] 1.474 [0.505, 4.306] 1.051 [0.490, 2.256]

1.011 [0.979, 1.043] 1.396 [0.485, 4.018] 1.010 [0.466, 2.190]

1.267** [1.076, 1.491]

1.228* [1.039, 1.451]

1.231* [1.036, 1.463]

1.199* [1.006, 1.429]

1.043** [1.013, 1.074]

1.027 [0.996, 1.059]

1.021 [0.990, 1.054]

0.648** [0.492, 0.854] 0.678** [0.512, 0.897] 1.027* [1.004, 1.051]

p < 0.05; ** p < 0.01.

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4. Discussion In this cross-sectional questionnaire study, body awareness, body image dissatisfaction and mindfulness were connected to both the frequency of yoga practice and psychological well-being in a sample of healthy adults practising yoga at an advanced level. Moreover, body awareness, body image dissatisfaction and mindfulness mediated the connection between yoga practice and well-being. In the regression analysis, body image dissatisfaction, body awareness and weekly frequency of yoga practice remained connected to well-being even after controlling for mindfulness, gender and age.

Our results are in accordance with previous findings on the positive connection between the frequency of yoga practice and well-being (Hartfiel et al. 2011; Malathi et al. 2000; Ross & Thomas 2010). As our data was cross-sectional, these relations might be explained in two ways. On the one hand, practicing yoga may improve well-being, on the other hand, good mood and energy may have a positive impact on practice. Nevertheless, existence of the former connection in other sports (i.e. exercise as a cause of improved well-being) was supported by longitudinal and intervention studies (Netz et al. 2005).

Body awareness, body image dissatisfaction and mindfulness were connected to yoga practice, which is also supported by former results (Brisbon & Lowery 2011; Daubenmier 2005; Impett et al. 2006; Tihanyi et al. 2016). Our results are also in accordance with previous findings showing a connection between body awareness, body image dissatisfaction, and mindfulness and well-being ­(Carmody & Baer 2008; Cash & Hicks 1990; Daubenmier 2005; Köteles 2014; Tihanyi et al. 2016).

We found significant mediating effects of body awareness, body image dissatisfaction and mindfulness between yoga practice and well-being, which is a novel ­finding to our knowledge. One possible interpretation of this mediating effect is that (1) frequent practice of yoga increases body awareness and mindfulness, and de­creases dissatisfaction with body image; and (2) higher consciousness towards the body’s signs, higher satisfaction with the body and higher present-oriented attention all lead to higher well-being. On the other hand, the opposite direction of causation is also a possible explanation of these findings, that is, (1) higher well-being increases the probability of turning to bodily perception and accepting it, of being satisfied with the body and of staying in a non-judgemental awareness, (2) and these factors might lead to more frequent yoga practice. Since only advanced yoga practitioners were involved in the study, these mediating effects could also be interpreted as a reflection of a ‘yoga personality’, that is, those who are characterised by high levels of body awareness, body image satisfaction and mindfulness tend to practice yoga more frequently and experience higher well-being, with no causal link between the latter two.

Body image satisfaction had the strongest independent connection to well-being, and body awareness also showed a significant connection after controlling for age, gender, frequency of yoga practice, and mindfulness. Body image might play an EJMH 11:1-2, April 2016

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important role in enhancing well-being in our sample of yoga practitioners in at least two parallel ways: (1) through the change of cognitive perception, evaluation and acceptance of the body (Daubenmier 2005), and (2) through the physical change of the body itself (e.g. body weight, muscle strength) (Raub 2002; Tran et al. 2001).

Further factors can be hypothesised to mediate the link between the frequency of yoga practice and well-being. Paying attention to the bodily signals may actually be just the first step towards well-being; the tendency to let the bodily sensations influence behaviour and enhance self-caring, that is, body responsiveness, may also be required (Daubenmier 2005). The term ‘body intelligence’ was also used for the synthesis of body awareness, body knowledge and body responsiveness, a construct to be later examined in yoga research (Anderson 2006; Gavin & Moore 2010).

The stress-reductive and physiological effects of yoga could also lead to higher wellbeing, independently of body awareness, body image and mindfulness (Michalsen et al. 2005; West et al. 2004). The supporting personal connection to a yoga group and an instructor may also enhance well-being, while practising yoga at home may strengthen the subjective impression of control and self-esteem – two factors later to be examined in similar studies.

The most important limitation of the present cross-sectional study is that it could not reveal the causal direction of the reported connections, that is, the pos­sible interaction between practicing yoga, psychological well-being and the suggested mediators. Moreover, our sample was not representative, thus the generalisability of the results is limited. Participants completed the questionnaire online, therefore the conditions of answering were not controlled, and data from different classes, studios and yoga schools were pooled.

To our knowledge, this study was the first to show the mediating effect of body awareness, body image dissatisfaction and mindfulness between frequency of yoga practice and well-being. These results can encourage further studies to explore the causal link between yoga and well-being, and can give an example of how to examine and describe the positive mental effects of other body-centred methods. Exploring the mediators between modern yoga and its mental benefits can help practitioners and teachers make use of this technique, develop this newest branch of yoga, which has both Eastern and Western roots, and adopt it to different cultural and personal needs.

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European Journal of Mental Health 11 (2016) 128–143 DOI: 10.5708/EJMH.11.2016.1-2.8

Kimmo Kuosmanen, Suvi Rovio, Miia Kivipelto, Jaakko Tuomilehto, Aulikki Nissinen & Jenni Kulmala*

DETERMINANTS OF SELF-RATED HEALTH AND SELF-RATED PHYSICAL FITNESS IN MIDDLE AND OLD AGE** (Received: 27 August 2014; accepted: 30 September 2015)

Self-rated health (SRH) correlates with psychological factors, mortality and functional capacity.

Self-rated physical fitness (SRF) has been examined less, and the relationship between SRH and SRF is unclear. The aim of this study was to explore the determinants, differences and similar­ ities of these concepts in middle and old age. In total, 2,000 persons at the mean age of 50.6 years were examined at baseline, and 1,449 were re-examined when they were aged between 65–79 years. On both occasions, the participants underwent a comprehensive clinical examination and health status/habit assessment. We found a strong correlation between SRH and SRF. In midlife, low income, hopelessness, active use of healthcare services, physical inactivity, angina pectoris, arthropathy and elevated blood pressure were associated with both poor SRH and SRF. In old age, high income, alcohol abstinence, physical inactivity, hopelessness, difficulties in activities of daily living, angina pectoris, asthma, rheumatoid arthritis and musculoskeletal disease of the back, and (in men) urinary tract infection were associated with poor SRH and SRF. Income, hopelessness, physical inactivity and angina pectoris correlated with both instruments in both age groups.

A wider range of variables was associated with SRH than with SRF. The determinants of SRH and SRF were relatively similar in the younger and older age groups. However, SRH appeared to be a more multi-dimensional instrument than SRF. SRH and SRF are considered reliable indicators of mental and physical health status, and should be accorded more importance when evaluating health among middle-aged and older people.

Keywords: cross-sectional study, self-rated fitness (SRF), self-rated health (SRH), self-perception *

**

orresponding author: Jenni Kulmala, School of Health Care and Social Work, Seinäjoki University of ApC plied Sciences, P.O.Box 412, SF-60101 Seinäjoki, Finland; jenni.kulmala@seamk.fi.

T he study was supported by EVO 5772720 from Kuopio University Hospital, grant IIRG-04-1345 from Alzheimer Association, Academy of Finland grants 103334, 206951 and 250385, the Gamla Tjänarinnor Foundation, the SADF (Insamligsstiftelsen för Alzheimer- och Demensforskning), Juho Vainio Foundation, Yrjö Jahnsson Foundation and Finnish Cultural Foundation. J. Kulmala was supported by grant 250385 from the Academy of Finland.

ISSN 1788-4934 © 2016 Semmelweis University Institute of Mental Health, Budapest

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Die Bestimmungsfaktoren des subjektiven Gesundheitszustandes und der subjektiven Fitness in mittlerem und höherem Lebensalter: Der subjektive Gesundheitszustand (self-ratedhealth, SRH) korreliert mit psychologischen Faktoren, der Sterblichkeit und auch der funktionellen Belastbarkeit. Die subjektive physische Fitness (self-ratedphysicalfittness, SRF) wurde weniger erforscht, und auch das Verhältnis der beiden Merkmale ist unklar. Unsere Forschung zielt darauf ab, die Bestimmungsfaktoren, die Ähnlichkeiten und die Unterschiede der beiden Begriffe bei Menschen von mittlerem und höherem Alter zu erforschen. Insgesamt wurden 2000 Personen (Durchschnittsalter 50,6 Jahre) bei der ersten Datenerhebung befragt, dann wurden 1449 Personen im Alter von 65–79 Jahren wieder untersucht. Die Teilnehmer wurden in beiden Fällen umfassenden klinischen Untersuchungen unterzogen, ihre Gesundheit und Gewohnheiten wurden bewertet.

Wir haben eine starke Korrelation zwischen SRH und SRF gefunden. Bei Personen in mittlerem Alter standen niedriges Einkommen, Hoffnungslosigkeit, aktive Nutzung der Gesundheitsdienstleistungen, körperliche Inaktivität, Schmerzen in der Brust, Gelenkbeschwerden und hoher Blutdruck sowohl mit SRH als auch mit SRF im Zusammenhang. Bei älteren Menschen standen hohes Einkommen, Alkoholabstinenz, Bewegungsmangel, Hoffnungslosigkeit, Schwierigkeiten im Alltag, Brustschmerzen, Asthma, rheumatoide Arthritis und Erkrankungen des Bewegungsapparates bzw. (bei Männern) das Vorliegen einer Infektion der Harnwege im Zusammenhang mit dem niedrigen SRH und SRF. Einkommen, Hoffnungslosigkeit, Bewegungsmangel und Schmerzen in der Brust korrelierten mit beiden Merkmalen in beiden Altersgruppen. Insgesamt korrelierten mit SRH mehr Merkmale als mit SRF. Die Bestimmungsfaktoren von SRH und SRF waren bei der jüngeren und älteren Altersgruppe ähnlich, es scheint jedoch, dass SRH mehr Dimensionen darstellt als SRF. SRH und SRF können als gültige Indikatoren der körperlichen und geistigen Gesundheit betrachtet werden, und bei der Bewertung des Gesundheitszustandes von Menschen von mittlerem und höherem Alter sollte ihnen größere Bedeutung beigemessen werden.

Schlüsselbegriffe: Querschnittsstudie, subjektiver Gesundheitszustand, subjektive körperliche Fitness, Selbstwahrnehmung

1. Introduction1 The concept of self-rated health (SRH) has been studied previously and found to be a good predictor of all-cause mortality (DeSalvo et al. 2006) and functional status (Lee 2000). SRH has been shown to be influenced by physical health and physician-diagnosed diseases (Kivinen et al. 1998), and to correspond closely with perceived need and utilisation of healthcare services (DeSalvo et al. 2005). SRH has also been found to correlate with various clinical and psychosocial symptoms and medical conditions such as hypertension, stroke, diabetes mellitus (Froom et al. 2004; Jylhä et al. 2006); depression, cancer (Kivinen et al. 1998; Molarius & Janson 2002); locomotor disorders (Kanagae et al. 2006), and with some sociodemographic and lifestyle-related factors such as education and socio-economic status (Laaksonen et al. 2005), dissatisfaction with life (Borglin et al. 2005), body 1

eclaration of conflicting interests: none declared. The study was approved by the local ethics committee, and D written informed consent was obtained from all participants. We thank Prof. Em. Eeva-Liisa Helkala for her contributions on an earlier draft of this paper.

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mass index, physical activity (Kanagae et al. 2006), smoking (Oka et al. 1999) and alcohol drinking (Stranges et al. 2006). Also some biomarkers such as circulating cytokines (Lekander at el. 2004); blood haemoglobin level, white cell count (Jylh辰 et al. 2006); ratio of total to HDL cholesterol and genetic factors (Goldman et al. 2004) have been found to be associated with SRH. Self-rated physical fitness (SRF) has been investigated less than SRH, and it has been almost entirely ignored in studies conducted among older people. Previous studies have mainly focused on the possible effects of physical activity and objective fitness on SRF (Drummond 1996; Ferrer et al. 1999; Lamb & Morris 1993).

SRF has been found to be associated with perceived cardiovascular endurance 足(Delignieres et al. 1994), level and type of physical activity (Drummond 1996; Lamb & Morris 1993), objective fitness measures (Ferrer et al. 1999) and also emotional well-being (Oka et al. 1999). It also predicts adverse health outcomes, such as cognitive decline (Kulmala et al. 2014). In addition, previous studies have suggested that self-reported functional disability correlates with performance-based functional limitations (Brink et al. 2003).

The results concerning the effect of age on SRH remain unclear. It has been suggested that older people, especially the oldest old, take their own age group as the reference point when evaluating their own health status and consequently tend to perceive their health in more positive terms (i.e. give overestimates rather than 足underestimates of their health status compared to objective measurements) 足(Pinquart 2001). Similarly, the results concerning the effect of gender on SRH has remained controversial in previous studies, although it has been suggested that women tend to report poorer health than men (Laaksonen et al. 2005).

Health comprises not only physical but also psychological and social components, and it is therefore important to take self-rated measurements into consideration when evaluating health status. SRH and SRF are both self-evaluations of health, yet the relationship between these two concepts has not previously been studied. It is possible that these concepts are independently associated with psychological wellbeing, physical health, functional capacity and the ability to take care of oneself. The aim of this study was to explore the relationship between SRH and SRF and the factors associated with each of these concepts at midlife and in old age.

2. Methods 2.1. Subjects The individuals participating in the Cardiovascular Risk Factors, Aging and Dementia (CAIDE) study were the survivors of four separate, independent, population-based random samples first examined within the North Karelia Project and the FINMONICA study. The study design has been described in detail elsewhere EJMH 11:1-2, April 2016

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­(Vartiainen et al. 1994). The subjects were first studied at midlife either in 1972, 1977, 1982 or 1987. Participation rates in the midlife surveys ranged from 82% to 90%. On average 21 years later, a random sample of 2,000 persons aged 65–79 years by the end of the year 1997 and living in the area of Kuopio or Joensuu were invited to a re-examination, and 1,449 (72.6%) persons agreed to participate (Figure 1).

At baseline, the gender distribution of the participants was 1,250 (62.5%) women and 750 (37.5%) men, and at re-examination it was 900 (62.1%) women and 549 (37.9%) men. The study was approved by the local ethics committee, and written informed consent was obtained from all participants.

STUDY POPULATION IN MIDDLE AGE (N = 2,000) Random sample examined in 1972

Random sample examined in 1977

Random sample examined in 1982

Random sample examined in 1987

A random sample of 2,000 survivors were invited for a re-examination in 1998

STUDY POPULATION IN OLD AGE (N = 1,449) 72.6% of the invited participated

Figure 1 Procedure for selection of the study population

2.2. Survey methods The survey methods used at midlife were carefully standardised and complied with international recommendations. They also followed the World Health Organ­ ization MONICA protocol (WHO 1988) in 1982 and 1987 and were comparable with the methods used in 1972 and 1977. The methods used in the re-examination (old age) followed those used in the previous surveys in all aspects. The surveys EJMH 11:1-2, April 2016

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included a self-administered questionnaire on health behaviour, health status and medical history.

SRH and SRF were assessed with a questionnaire. SRH was measured with the question: What is your opinion about your present health status? The response options were 1) good, 2) fairly good, 3) moderate, 4) fairly poor, and 5) very poor. Validity of SRH has been demonstrated in many previous studies.

SRH has exceptional predictive validity especially with respect to mortality and other adverse health events, and the validity of SRH has been shown to increase over time, for example, due to increased educational level and better cognitive ability (Schnittker & Bacak 2014). Further, the study by Lundberg and Manderbacka (1996) reported the good overall reliability of SRH, but the reliability of SRH seems to be worse for disadvantaged sociodemographic groups (Zajacova & Dowd 2011).

SRF was measured with the question: What is your opinion about your present physical fitness? The response options were the same as for SRH: 1) good, 2) fairly good, 3) moderate, 4) fairly poor, and 5) very poor. SRF correlates strongly with objectively measured physical fitness and also similarly predicts adverse health events (Kulmala et al. 2014; Ortega et al. 2013).

The answers to the SRH and SRF questions were dichotomised as in previous population-based studies (Heidrich et al. 2002; Jylhä et al. 2006): the three highest categories (good, fairly good, moderate) were combined (= good SRH/SRF), and the two lowest (fairly poor and very poor) were combined (= poor SRH/SRF).

The questionnaire was used to assess factors possibly related to SRH and SRF. Marital status was dichotomised into: 1) living with someone and 2) living alone.

Education was measured in years and the main occupation was categorised into: 1) farming and forestry, 2) industry, 3) office work and services, 4) housewives, and 5) others. Yearly household income was divided into three groups: high, medium and low. An indicator of the ability to perform daily activities (ADL) was calculated using six questions assessing participants’ ability to manage the following activities: bathing, dressing, climbing stairs, walking 500 meters without a rest, short distance running (100 meters) and long distance running (over 500 meters).

The answers were categorised as follows: 1) not at all (1 point); 2) yes, but with difficulties (2 points); and 3) yes, without difficulties (3 points). The sum score was used as the indicator of ADL (higher score indicating better performance).

Hopelessness was assessed using the following statement: ‘I feel hopeless for the future, and I do not believe that things can change for the better’. Participants were asked to choose one of the following response options: 0) absolutely agree, 1) partly agree, 2) do not know, 3) partly disagree, or 4) absolutely disagree. The responses were re-categorised into the following three groups: 1) agree (response options 0 and 1), 2) do not know (response option 3), and 3) disagree (response options 3 and 4). Self-reported history of cerebro- and cardiovascular events and other chronic diseases (yes/no) was elicited. Following recommendations in the literature (Haskell et al. 2007; Pate et al. 1995), leisure time physical activity EJMH 11:1-2, April 2016

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was categorised into: 1) sedentary (= physical activity a few times a year or less), 2) low (= physical activity 2–4 times a month), 3) moderate (= physical activity 2–4 times a week), and 4) active (= physical activity daily). Current alcohol consumption (not at all; less than once a month; at least once a month) was assessed.

Participants were also categorised into non-smokers, ex-smokers, and current smokers according to their smoking habits at the time of the survey.

The participants also underwent a clinical examination. Blood pressure was measured, and body mass index (BMI, weight divided by height in meters squared) was calculated. A venous blood sample was taken to determine serum cholesterol concentrations. Dementia was assessed at the re-examination with a three-step diagnostic procedure, and the final diagnoses were assessed according to NINCDS-ADRDA (McKhann et al. 1984) and NINCDS-AIREN (Roman et al. 1993) criteria.

2.3. Statistical methods Descriptive statistics are reported as frequencies and percentage distributions, and statistical differences between men and women were tested with chi-square tests. Lo­ gistic regression analyses were used to examine the association between SRH/SRF and socio-demographic, psychological, clinical and lifestyle variables. First, all vari­ ables (Table 1) were introduced simultaneously into separate models for SRH and SRF. All variables that were non-significantly associated with the outcomes were excluded from the model one at a time, starting with the most non-significant. Additionally, all models were adjusted for age, sex, and education. Possible interactions between the factors were analysed by introducing an interaction term into the fully ­adjusted ­model.

To compare the similarities between the concepts of SRH and SRF, the predicted values for belonging to the poor SRH and SRF group were calculated using logistic regression models. The Spearman correlation coefficients were calculated using the predicted values. Statistical analyses were conducted with SPSS for Windows.

3. Results At baseline, the mean age of participants was 50.6 (SD = 6.0) years, and mean length of education 8.3 (SD = 3.5) years. Altogether, 12.5% of the participants reported poor SRH, and there were no differences between men and women (11.9% vs. 12.9%, p = 0.51). Overall, 13.0% of the middle-aged persons (12.4% of men and 13.3% of women, p = 0.61) reported poor SRF status. In middle age, 8.6% reported both poor SRH and poor SRF (7.9% of men and 9.0% of women, p = 0.85).

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K. KUOSMANEN ET.AL Table 1 Variables analysed in the study Variables Socioeconomic and psychological variable Municipality Marital status Education Household income Main lifetime occupation Hopelessness Biological and physical variables Age Gender ADL index Accidents Diseases Dementia Cardiac infarction Cerebral haemorrhage/infarction High blood pressure Angina pectoris Cancer Asthma Lung diseases Gallstones/cholecystitis Rheumatoid arthritis Other arthropathy Musculoskeletal disease of the back Urinary tract infection/nephritis Cerebrovascular disease Diabetes Lifestyle variables Physical activity Systolic blood pressure Diastolic blood pressure Cholesterol levels Body mass index Alcohol drinking Smoking Use of health services (doctor)

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At the re-examination (1998), the mean age of participants was 71.3 (SD = 4.0) years, and their mean ADL index was 14.8 (SD = 2.4). Altogether, 13.9% (16.9% of men and 11.9% of women, p = 0.01) reported poor SRH, while 14.3% of the participants (16.8% of men and 12.6% of women, p = 0.03) rated their SRF as poor. Only 10.3% of the subjects considered themselves as having both poor SRH and poor SRF (13.1% of men and 8.5% of women, p = 0.05). The percentages of participants in each SRH/SRF subgroup in middle and old age are presented in Figure 2.

0 1 13 13 55

59

26 27 2

SRF

4

1 1 12 13 50

30

53

34

4 4

SRH 0

10

20

30

40

50

60

70

Old age (mean age of 71.3 ± 4.9) Middle age (mean age of 50.3 ± 6.0)

Figure 2 Self-rated health (SRH) and self-rated physical fitness (SRF) in middle and old age (percentages of distributions)

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Tables 2 and 3 present the variables that were significantly associated with SRH and/or SRF in middle and old age. Neither age nor education was found to be significantly associated with either SRH or SRF. Men had about two times higher odds for poor SRH and SRF than women, although this association was found only in old age.

Higher household income was associated with poor SRH and SRF in old age, while in midlife, high income reduced the odds for poor SRH and SRF. Income, leisure time physical activity, hopelessness and history of angina pectoris were associated with both concepts in both age groups.

In midlife, a history of angina pectoris and arthropathy, elevated blood pressure and active use of healthcare services were associated with increased odds for poor SRH and SRF. Living with a partner, and cerebrovascular disease, pulmonary emphysema, asthma or spondylosis were associated only with poor SRH. Moderate leisure time physical activity (2–4 times per week) reduced the odds for poor SRH and SRF. High level of serum HDL cholesterol decreased the odds for poor SRH, while being a non-smoker decreased the odds for poor SRF. In old age, hopelessness, history of angina pectoris, asthma, rheumatoid arth­ ritis and a musculoskeletal disease of the back increased the odds for both poor SRH and SRF. Additionally, a high ADL index score, a moderate to high level of leisure time physical activity (at least 2 times per week) and alcohol drinking were found to be associated with decreased odds for poor SRH and SRF. Diagnosis of dementia and history of cancer and cerebrovascular disease were associated only with poor SRH, whereas a history of diabetes mellitus was associated only with poor SRF. The only significant interaction was found between gender and a urinary tract infection or nephritis. Men with a urinary tract infection or nephritis had higher odds for poor SRH and SRF compared to women.

The effect of almost all the factors studied was relatively similar for SRH and SRF. However, the effects of rheumatoid arthritis and the interaction between gender and urinary tract infection or nephritis on the odds for SRH were approximately two times higher than their effect on SRF. The Spearman correlation coefficients, using the predicted values for membership of the poor SRH and SRF group, showed that in old age R2 between SRH and SRF was 0.925 (p < 0.001) among all participants, 0.920 (p < 0.001) among men and 0.932 (p < 0.001) among women. After dividing the predicted values for poor SRH into three groups, (≤ 0.3, > 0.3 but < 0.7, and ≥ 0.7), most participants (86.9%) were in the lowest group. The correlation between SRH and SRF was found to be strongest in the lowest group (R2 = 0.893; p < 0.001), moderate in the middle group (R2 = 0.468; p < 0.001) and strong again in the highest group (R2 = 0.641; p < 0.001).

In midlife, the overall correlation between the concepts was found to be somewhat lower (R2 = 0.850; p < 0.001).

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A decrease in SRH from midlife until the late life examination was reported by 407 (28.6%) persons, while 270 (19.0%) reported an increase, and 746 (52.4%) reported no change. The corresponding numbers for SRF were 337 (24.1%), 337 (24.1%) and 723 (51.8%), respectively. Unfortunately the unavailability of intermedi­ ate time-points did not allow us to further investigate the health/fitness trajectories or other age group differences during the twenty-year follow-up.

Table 2 Determinants of poor self-rated health (SRH) and poor self-rated fitness (SRF) in middle age.

Variables Income Low Medium High Marital status Living alone Living with someone Hopelessness Angina pectoris Arthropathy Cerebrovascular disease Asthma Spondylosis Pulmonary emphysema Elevated blood pressure High HDL cholesterol Use of healthcare services Smoking (non-smokers) Physical activity Sedentary Low activity Moderate activity Active

Poor SRH OR (95% CI)

Poor SRF OR (95% CI)

1.00 0.49 (0.29–0.80) 0.15 (0.08–0.30)

1.00 NS 0.44 (0.27–0.71)

1.00 2.15 (1.27–3.63) 3.12 (1.86–5.22) 4.35 (2.22–8.51) 2.96 (1.78–4.91) 5.05 (1.48–17.20) 5.63 (2.05–15.50) 2.14 (1.39–3.30) 2.74 (1.39–5.39) 1.83 (1.19–2.79) 0.64 (0.45–0.91) 1.18 (1.11–1.25) NS

1.00 NS 3.37 (2.02–5.63) 3.54 (1.84–6.80) 2.48 (1.53–4.01) NS NS NS NS 2.12 (1.43–3.13) NS 1.17 (1.11–1.24) 0.44 (0.27–0.72)

1.00 NS 0.40 (0.25–0.63) NS

1.00 NS 0.47 (0.32–0.71) NS

Additional adjustment for age, gender and education.

NS = Statistically non-significant association.

*

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Table 3 Determinants of poor self-rated health (SRH) and poor self-rated fitness (SRF) in old age Variables

Poor SRH OR (95% CI)

Poor SRF OR (95% CI)

Gender Women Men High income Hopelessness High ADL-index Dementia Angina pectoris Cancer Asthma Rheumatoid arthritis Musculoskeletal disease of the back Cerebrovascular disease Diabetes Physical activity Sedentary Low activity Moderate activity Active Alcohol drinking Not at all Less than once a month At least once a month Gender combined with urinary tract infection or nephritis Women with infection Men with infection

1.00 2.11 (1.28–3.48) 1.20 (1.01–1.41) 3.05 (2.06–4.50) 0.68 (0.62–0.75) 4.15 (1.62–10.6) 1.90 (1.20–3.00) 3.30 (1.35–8.08) 2.52 (1.44–4.41) 6.51 (3.23–13.10)

1.00 1.70 (1.06–2.74) 1.31 (1.12–1.53) 3.06 (2.08–4.52) 0.66 (0.60–0.73) NS 2.00 (1.29–3.08) NS 2.23 (1.30–3.81) 2.73 (1.32–5.65)

1.58 (1.02–2.45)

1.59 (1.04–2.42)

2.90 (1.55–5.43) NS

NS 2.02 (1.03–3.98)

1.00 NS 0.36 (0.19–0.66) 0.33 (0.18–0.63)

1.00 NS 0.28 (0.15–0.49) 0.25 (0.14–0.46)

1.00 0.44 (0.26–0.77) 0.48 (0.28–0.83)

1.00 NS 0.51 (0.29–0.88)

1.00 14.4 (4.10–50.60)

1.00 7.80 (2.33–26.10)

Additional adjustment for age, gender and education.

NS = Statistically non-significant association.

*

4. Discussion We found that SRH and SRF are multidimensional concepts influenced by several chronic diseases and lifestyle, socioeconomic and psychosocial factors. Somewhat different factors were associated with each concept, indicating that there might be some differences between the bases of the two concepts. It seems that SRH is a EJMH 11:1-2, April 2016

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broader concept influenced by more factors. The determinants of SRH and SRF seem to be relatively similar at younger and older ages.

Leisure time physical activity and the ability to perform daily activities were associated with both SRH and SRF. This indicates that both concepts have a physical aspect. Therefore, both of them can be considered as reflections of physical health and functional capacity. A moderate to high level of leisure time physical activity as well as being a non-smoker and moderate alcohol drinking were associated with better ratings of SRH and SRF, suggesting that healthy lifestyle may protect against poor self-ratings of health and physical fitness. Moderate alcohol use has been linked to several health benefits, especially for the cardiovascular system (Huang et al. 2014), which may explain the association we found. However, it should be noted that our measure of alcohol consumption was very crude and we were therefore not able to investigate the association between excessive drinking and SRH/SRF, which might have resulted in inverse findings.

In previous studies physical activity (Kanagae et al. 2006) and moderate alcohol drinking (Stranges et al. 2006) were found to be beneficial, while smoking (Ho et al. 2003) was indicated to be hazardous for SRH. It seems that unfavourable lifestyle factors play an important role in perceptions of poor SRH and SRF. In addition to the physical aspects, hopelessness was strongly associated with poor SRH and SRF in both mid- and late life. A sense of hopelessness reflects a negative view of the future and hopelessness is considered as a determinant of depression and vice versa (Han et al. 2013). Therefore both SRH and SRF seem to be strongly associated not only with physical health but also with mental and psychological wellbeing.

We found some differences between the two concepts in the younger and older age groups. In midlife both SRH and SRF were found to be influenced more by lifestyle and cardiovascular risk factors such as blood pressure, cholesterol, use of healthcare services, marital status and income, while in old age these factors had been overtaken by more severe diseases and medical/clinical conditions such as cancer, dementia and a lower ADL index. These findings have clinical relevance, since it seems that poor SRH or SRF reflects more severe stages of underlying diseases and increased risk for developing a disease. In old age, especially, poor SRH or SRF may reflect the presence of non-diagnosed chronic conditions. In midlife, poor SRH and SRF correlated particularly strongly with well-established risk factors for cardiovascular and other chronic diseases. Therefore a single question on perceived health or fitness may act as a screening tool for identifying persons in midlife who might benefit from preventive interventions.

We found that higher household income was associated with poor SRH and SRF in old age, whereas it was associated with better SRH and SRF at midlife.

The effect of income was significant at both ages, but the point estimate from the analysis at the older age was fairly low, suggesting that the effect of income might not have high clinical relevance later in life. Further, our results concerning the effect of education conflicted with those of previous studies in which a EJMH 11:1-2, April 2016

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higher level of education was associated with better SRH (Laaksonen et al.

2005). In this study, we could not confirm this association, since no association between education and SRH or SRF was found. The lack of an effect of education on SRH and SRF, and the homogeneity in income of the older participants, support the assumption that physical factors most likely make a larger contribution than socio-economic factors to SRH and SRF in midlife and that this is even more pronounced in old age.

In the present study, a higher percentage of men rated their health and fitness as poor compared to women. Previously, the independent effect of gender on SRH was shown conflicting results although SRH was consistently found to better predict mortality among men than women (Heidrich et al. 2002; Laaksonen et al. 2005).

It is possible that there are significant differences in the variables associated with SRH and SRF among men and women, and that this may explain the inconsistency found in the results for gender. Men’s SRH has been proposed to reflect mainly severe and life-threatening diseases, whereas the range of factors affecting women’s SRH are thought to be broader.

The strong correlation between the predicted values of SRH and SRF support the hypothesis that these concepts measure overall health perceptions and are also relatively similar in quality. The only previous study to focus on the possible association between self-perceived health and self-perceived fitness reported a positive correlation between the two concepts (Lamb 1992). It is likely that when a person’s ratings of his/her health or fitness are at the extremes of the continuum (good or poor), the two measures agree, whereas in-between ratings show greater conceptual mismatch. This correlation pattern also seemed to be very similar for both men and women. In midlife, SRH and SRF seem to differ somewhat more than they do in later life. SRH is influenced by a wider range of symptoms and diseases which also affect physical well-being, for example, stroke, pulmonary emphysema, bronchitis, asthma and spondylosis. However, these strong physical components were not associated with SRF at midlife. This indicates that SRH and SRF have at least a partially different basis. It is possible that SRH is more u­ seful than SRF, especially in midlife, when aiming to evaluate physical health as it may be more sensitive in capturing the persons with non-diagnosed diseases. On the other hand, poor physical fitness in midlife was strongly associated with unfavourable lifestyle habits, including smoking. Further, in old age, the n­ egative associ­ ation between poor SRF and physical activity was more pronounced than the association between SRH and physical activity. The results indicate that SRH could be more beneficial when aiming to detect physical illnesses, while SRF could be more useful tool to evaluate the need for lifestyle interventions. Future studies in different populations and different age groups are needed to gain a better understanding of the relationship between SRH and SRF and also about the factors affecting them independently. Future studies could also provide new insights into the predictive value of both self-rated measures.

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5. Conclusion The study has a few limitations that need to be addressed. Although the response rates in mid- and late life examinations were very high, it is possible that persons with poorer health or fitness dropped out of the study and therefore persons with good SRH and SRF may be overrepresented in the study sample. The non-participants of this study were older and more often women. They were also likely to have poorer health and fitness and also an unhealthier lifestyle than the participants, which might have affected the results. However, if non-participation was related to worse outlook concerning the factors related to SRH and SRF, that is more likely to produce underestimation than overestimation of the associations. Additionally, a self-administered questionnaire was used to elicit information about the participants’ health status and lifestyle factors. Even if self-reports do not necessarily provide wholly accurate information about the factors of interest, they can be used to categorise participants, as was done in this study. However, the reliability of responses related to SRH has been found to be good when compared with objective health assessments (Kivinen et al.

1998; Pinquart 2001).

SRH and SRF appear to be influenced by rather similar factors, suggesting that these two concepts might overlap and partially reflect the same phenomena. Both concepts are influenced by chronic diseases, lifestyle and psychosocial factors, and socioeconomic status, but some differences also exist between the concepts. A single question asking about SRH or SRF seems to be a good way to obtain important information about a person’s overall health and functional status and may be used as a screening tool when aiming to identify persons in need of preventive interventions.

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DeSalvo, K.B., N. Bloser, K. Reynolds, J. He & P. Muntner (2006) ‘Mortality Prediction with a Single General Self-Rated Health Question: A Meta-Analysis’, Journal of General Internal Medicine 21, 267–75.

Drummond, J.L. (1996) ‘Type of Physical Activity, Variables Describing Participation in Phys­ ical Activity, and Self-Perceived Fitness’, Perceptual and Motor Skills 83, 472–74.

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Ferrer, M., R. Lamarca, F. Orfila & J. Alonso (1999) ‘Comparison of Performance-Based and Self-Rated Functional Capacity in Spanish Elderly’, American Journal of Epidemiology 149, 228–35.

Froom, P., S. Melamed, I. Triber, N.Z. Ratson & D. Hermoni (2004) ‘Predicting Self-Reported Health: The CORDIS Study’, Preventive Medicine 39, 419–23.

Goldman, N., D.A. Glei & M.C. Chang (2004) ‘The Role of Clinical Risk Factors in Understanding Self-Rated Health’, Annals of Epidemiology 14, 49–57.

Han, Y., J. Yuan, Z. Luo, J. Zhao, J. Wu, R. Liu & V. Lopez (2013). ‘Determinants of Hopelessness and Depression among Chinese Hospitalized Esophageal Cancer Patients and Their Family Caregivers’, Psychooncology 22, 2529–36.

Haskell, W.L., I.M. Lee, R.R. Pate, K.E. Powell, S.N. Blair, B.A. Franklin & A. Bauman (2007) ‘Physical Activity and Public Health: Updated Recommendation for Adults from the American College of Sports Medicine and the American Heart Association’, Medicine and Science in Sports and Exercise 39, 1423–34.

Heidrich, J., A.D. Liese, H. Lowel & U. Keil (2002) ‘Self-Rated Health and its Relation to All-Cause and Cardiovascular Mortality in Southern Germany: Results from the MONICA Augsburg Cohort Study 1984–1995’, Annals of Epidemiology 12, 338–45.

Ho, S.Y., T.H. Lam, R. Fielding & E.D. Janus (2003) ‘Smoking and Perceived Health in Hong Kong Chinese’, Social Science & Medicine 57, 1761–70.

Huang, C., J. Zhan, Y.J. Liu, D.J. Li, S.Q. Wang, Q.Q. He (2014) ‘Association between Alcohol Consumption and Risk of Cardiovascular Disease and All-Cause Mortality in Patients with Hypertension: A Meta-Analysis of Prospective Cohort Studies’, Mayo Clinic Proceedings 89, 1201–10.

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Kanagae, M., Y. Abe, S. Honda, N. Takamura, Y. Kusano, T. Takemoto & K. Aoyagi (2006) ‘Determinants of Self-Rated Health among Community-Dwelling Women Aged 40 Years and Over in Japan’, The Tohoku Journal of Experimental Medicine 210, 11–19.

Kivinen, P.,P. Halonen, M. Eronen & A. Nissinen (1998) ‘Self-Rated Health, Physician-­Rated Health and Associated Factors among Elderly Men: The Finnish Cohorts of the Seven Countries Study’, Age and Ageing 27, 41–47.

Kulmala, J., A. Solomon, I. Kåreholt, T. Ngandu, T. Rantanen, H. Soininen, J. ­Tuomilehto & M. Kivipelto (2014) ‘Association between Mid- to Late Life Physical Fitness and ­Dementia: Evidence from the CAIDE Study’, Journal of Internal Medicine 276, 296–307.

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EJMH 11:1-2, April 2016

European Journal of Mental Health 11 (2016) 144–150 DOI: 10.5708/EJMH.11.2016.1-2.9

András Láng*

RELATIONSHIP BETWEEN RECALLED PARENTAL CARE AND RELIGIOUS COPING The Mediating Effect of Attachment to God (Received: 22 May 2014; accepted: 10 October 2014)

Attachment to God is related to both parental bonding and religious coping, but the relation of the two latter variables has gained little attention until now. In a study among 95 Roman Catholics (49 women), the mediating role of attachment to God between perceived parental care and religious coping was tested. Results showed that levels of avoidant attachment to God and positive religious coping were independent of perceived parental care. Multiple linear regressions revealed that anxious attachment to God fully mediated the relationship between parental care and negative religious coping. Possible explanations for these selective relationships are discussed.

Keywords: attachment to God; religious coping; parental bonding; mediation Das Verhältnis zwischen der heraufbeschworenen elterlichen Fürsorge und dem religiösen Coping: Die vermittelnde Wirkung der Bindung an Gott: Die Bindung an Gott hängt mit der elterlichen Fürsorge und dem religiösen Coping zusammen, das Verhältnis dieser zwei letzteren Variablen wurde jedoch nur wenig untersucht. In der vorliegenden Studie wurde die eventuelle vermittelnde Wirkung zwischen wahrgenommener elterlicher Fürsorge und religiösem Coping getestet. Im Sample sind 95 (49 weiblich) römisch-katholische Personen erfasst. Die Ergebnisse zeigen, dass die unsicher-vermeidende Bindung an Gott und die positive religiöse Bindung von der wahrgenommenen elterlichen Fürsorge unabhängig sind. Die Analysen mehrfacher linearer Regressionen beweisen, dass die ängstliche Bindung an Gott das Verhältnis zwischen elterlicher Fürsorge und negativem religiösem Coping in vollem Maß vermittelte. Plausible Erklärungen für diese selektive Wirkung wurden überlegt.

Schlüsselbegriffe: Bindung an Gott, religiöses Coping, elterliche Fürsorge, vermittelndes Modell

*

András Láng, Institute of Psychology, University of Pécs, Ifjúság útja 6., H-7624 Pécs, Hungary; andraslang@ hotmail.com.

ISSN 1788-4934 © 2016 Semmelweis University Institute of Mental Health, Budapest

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1. Introduction The developmental background of general coping strategies has received much attention (Rutter 1981; Skinner & Zimmer-Gembeck 2007). In several studies (Kliewer et al. 1996; Matheson et al. 2005), early experiences – especially relational experiences – were found to have a great impact on the development of appropriate coping strategies. Surprisingly, this burgeoning of research on developmental antecedents is not characteristic of the field of religious coping. On the one hand, little is known about the relationship between general parental care and religious coping. Granqvist (2005) found no significant correlations between insecure attachment history and collaborative, self-directing, and deferring religious coping.

Bradley and her colleagues (2005) reported weak positive correlation between severity of childhood trauma and negative religious coping. On the other hand, studies point to the importance of socialisation effects in the development and utilisation of religious coping, although these developmental antecedents are usually more specific than general parental care. For example, Cullman (2006) reported that both actual and perceived parental and peer religious coping was significantly related to the religious coping of the individual.

An attachment theory approach to religiosity and to the relationship with God (Granqvist et al. 2010; Kirkpatrick 2005; Reinert et al. 2009) might be promis­ ing in linking parental care to religious coping. One of the important aspects of this theory is mental representations – internal working models of God and self – under­lying attachment to God (Beck & McDonald 2004). On the one hand, these representations are rooted in early relationships with caregivers. According to the findings of several studies (Beck & McDonald 2004; Birgegard & Granqvist 2004), more secure (i.e., less anxious and less avoidant) attachment to God is related to better perceived quality of parental care giving. On the other hand, these representations of God – corresponding to avoidant attachment to God – and representations of self in relation to God – corresponding to anxious attachment to God – are formative in regard to the quality and extent of religious coping. Insecure (i.e., more anxious and more avoidant) attachment to God covers a less loving, less supporting, and more controlling image of God (Rowatt & ­Kirkpatrick 2002), which in turn is connected with the more frequent use of negative and less frequent use of positive religious coping (Bjork & Kim 2009). Belavich and Pargament (2002) reported that secure attachment to God is related to positive forms of spiritual coping, while anxious attachment to God is related to negative forms of religious coping. In a more recent study, Davis and his colleagues (2008) reported correlations between avoidant attachment to God and positive religious coping (negative correlation) and negative religious coping (positive correlation). Anxious attachment to God had a weak positive correlation with negative religious coping. Kelley and Chan (2012) found a positive correlation between secure attachment and positive religious coping.

Based on the previously presented body of research, we tested the relationships between perceived parental care, attachment to God, and religious coping.

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Furthermore, the mediating effect of attachment to God between parental care and religious coping was tested.

2. Method In a cross-sectional study, 95 young adults who identified themselves as Roman Catholics participated and completed self-report questionnaires. The sample consisted of 49 females and 46 males with an average age of 31.1 ± 6.74 years. Most of the participants (77.9%) had a high level of education (12+ years of formal education).

Participants were recruited through the leaders of Catholic small groups. No reward was offered for participation.

The Hungarian translation1 of the Brief Religious Coping Scale (Brief RCOPE) was used to measure religious coping (Pargament et al. 2011; Pargament et al. 1998). Brief RCOPE consists of 14 items with two independent subscales that measure positive and negative religious coping. To measure attachment to God, we used the Hungarian translation of the Attachment to God Inventory (AGI; Beck & McDonald 2004). AGI is a 28-item self-report instrument that measures two dimensions of attachment to God: 1. avoidance (of intimacy with God), and 2. anxiety (of separation from God). To measure parental care, the 12 items of the Care subscale from the Hungarian version of Parental Bonding Instrument (H-PBI) was used (Tóth & Gervai 1999; Parker et al. 1979). Participants rated the items on a 4-point Likert scale both for their mothers and fathers. Higher scores on the Care subscale refer to memories of an emotionally warmer, more caring parent.

Statistical analysis was done by SPSS 19.0 for Windows. Pearson’s and Spearman’s correlation was used to test relationships between non-categorical and categorical variables respectively. To test mediation, we used multiple linear regression (Baron & Kenny 1986).

3. Results According to Spearman’s correlation coefficients, neither gender nor level of education had a significant effect on Brief RCOPE subscales, AGI dimensions, and maternal care. Women (ρ = 0.22; p < 0.05) and less educated individuals (ρ = –0.21; ­p < 0.05) reported a higher level of perceived paternal care. Age had no effect on at­tachment to God, religious coping, and maternal care. Perceived paternal care decreased with age (r = –0.24, p < 0.05).

1

Acknowledgements: The author would like to thank Professor Richard Beck and Professor Kenneth I. ­ argament for giving their permission to translate the instruments Attachment to God Inventory (Professor P Beck) and Brief Religious Coping Scale (Professor Pargament) into Hungarian. Many thanks for their work and time with checking the back-translations.

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RELATIONSHIP BETWEEN RECALLED PARENTAL CARE Table 1 Pearson’s correlation coefficients between religiosity measures variables and perceived parental care POS_ RCOPE

NEG_ RCOPE

AGI_AV

AGI_ANX

PA_CARE

MA_CARE

POS_RCOPE

α = 0.80

–

–

–

–

–

NEG_ RCOPE

0.13

α = 0.70

–

–

–

–

AGI_AV

–0.72**

–0.13

α = 0.82

–

–

–

AGI_ANX

–0.02

0.51**

0.07

α = 0.89

–

–

PA_CARE

0.05

–0.28**

–0.05

–0.26*

α = 0.93

–

MA_CARE

0.12

–0.33**

0.02

–0.40**

47**

α = 0.92

Note: * p < 0.05; ** p < 0.01; POS_RCOPE: positive religious coping; NEG_RCOPE: negative religious coping; AGI_AV: avoidant attachment to God; AGI_ANX: anxious attachment to God; PA_CARE: perceived paternal care; MA_CARE: perceived maternal care; α: C ­ ronbach’s alpha coefficient

Table 2 The mediating effect of anxious attachment to God between perceived parental care and negative religious coping tested with multiple regressions R2 = 0.28

β

p

R2 = .28

β

p

PA_CARE

–0.15

= 0.10

MA_CARE

–0.15

= 0.11

AGI_ANX

0.47

< 0.001

AGI_ANX

0.45

< 0.001

Note: Dependent variable in both models: negative religious coping; AGI_ANX: anxious attachment to God; PA_ CARE: perceived paternal care; MA_CARE: perceived maternal care

Pearson’s correlations (Table 1) revealed significant relationships between par­ ental care and anxious attachment to God, between parental care and negative religious coping, and between anxious attachment to God and negative religious coping in the expected directions. Avoidant attachment to God and positive religious coping were also strongly and negatively correlated, but parental care showed no significant correlation with either avoidant attachment to God or positive religious coping.

Relationships among parental care, anxious attachment to God, and negative religious coping made these variables suitable to test the mediating effect of anxious EJMH 11:1-2, April 2016

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attachment to God (Baron & Kenny 1986). Multiple linear regressions were used to decide whether mediation existed, and whether this was partial or full mediation.

Results in Table 2 show that anxious attachment to God fully mediated the effects of both maternal and paternal care on negative religious coping. Thus, less parental care leads to more frequent use of negative coping via leading to more anxious attachment to God. 4. Discussion The positive correlation between negative religious coping and anxious attachment to God supported results from previous studies (Belavich & Pargament 2002; Davis et al. 2008). Highly anxious attachment to God represents an increased preoccupation with the relationship with God and constant fear of abandonment (Beck & McDonald 2004). Therefore, individuals who exhibit more anxious attachment to God are prone to interpret negative life events in the light of separ­ ation from God and God abandoning them than individuals with low scores on the anxiety dimension of AGI. The negative correlation found between positive religious coping and avoidant attachment to God in this study was in line with expectations and previous results (Belavich & Pargament 2002; Davis et al. 2008; Kelley & Chan 2012). Low avoidance of God is associated with an image of God who is loving and caring, and renders support in times of need. This supportive image of God enables the individual to turn to God in the case of adverse life events when help is needed.

Parental care was correlated with anxious but not avoidant attachment to God. This selective relationship might be due to the nature of attachment representations.

Avoidant attachment in general reflects representations of significant others, and is more relationship-specific, while anxious attachment represents representations of the self, which is more stable across relationships (Moreira 2011). So, on the one hand, perceptions of God and parents seem to be independent, while on the other hand, perception and evaluation of the self remains stable across relationships.

Our results that maternal and paternal care correlated with negative but not posi­tive religious coping replicated the results of Bradley and her colleagues (2005) in an average environment. Whereas they found that severity of childhood trauma correlates with negative religious coping, we found that lack of parental care in a normative sample is associated with higher frequency of negative religious coping. Furthermore, multiple linear regressions showed that this negative relationship between parental care and negative religious coping was fully mediated by anxious attachment to God. Rejection by parents might lead to the formation of a representation that the self is not loveable, not even by God. The proneness of these individuals to interpret negative life events as if God had abandoned them stems from this negative image of the self. Their assumption of an abandoning God leads to the more frequent use of negative religious coping, which also emphasises the world as om­ EJMH 11:1-2, April 2016

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inous and God as absent (Pargament et al. 1998), because we are not worthy of his attention, not even in times of distress.

Further studies with advanced theological approach should investigate whether the selective relationships described in this study with Roman Catholic participants existed in individuals from other Christian denominations or other religious affiliations as well. Future research should also reveal what factors of socialisation (e.g. religious education, experiences with religious groups and authorities) play a role in forming avoidant attachment to God and positive religious coping.

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Parker, G., H. Tupling & L.B. Brown (1979) ‘A Parental Bonding Instrument’, British Journal of Medical Psychology 52, 1–10.

Reinert, D.F., C.E. Edwards & R.R. Hendrix (2009) ‘Attachment Theory and Religiosity: A Summary of Empirical Research With Implications for Counseling Christian Clients’, Counseling and Values 53, 112–25.

Rowatt, W.C. & L.A. Kirkpatrick (2002) ‘Two Dimensions of Attachment to God and their Relation to Affect, Religiosity, and Personality Constructs’, Journal for the Scientific Study of Religion 41, 637–51.

Rutter, M. (1981) ‘Stress, Coping, and Development: Some Issues and Some Questions’, Journal of Child Psychology and Psychiatry 22, 323–56.

Skinner, E.A. & M.J. Zimmer-Gembeck (2007) ‘The Development of Coping’, Annual Review of Psychology 58, 119–44.

Tóth, I. & J. Gervai (1999) ‘Szülői Bánásmód Kérdőív (H-PBI): A Parental Bonding Instrument (PBI) magyar változata’, Magyar Pszichológiai Szemle 54, 567–89.

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European Journal of Mental Health 11 (2016) 153–156 DOI: 10.5708/EJMH.11.2016.1-2.Rev.1

Regina Polak

PIONIERGEIST UND ENGAGEMENT Udo Tworuschka Burkard, F.-P., R. Pokoyski, Z. Štimac, Hrsg., (2014) Praktische Religions­ wissenschaft: Theoretische und methodische Ansätze und Beispiele: Festschrift zum 65. Geburtstag von Udo Tworuschka, (Münster: LIT) 144 S., 23,5 cm, ISBN 978-3-643-12140-0, € 24,90.

Wer ihn noch nicht kennt, wird neugierig: auf Udo Tworuschka, den Doyen der deutschen „Praktischen Religionswissenschaft“. Dies gelingt den Herausgebern der vorliegenden Festschrift in hervorragender Weise, auch bei jemandem „Fachfremden“ wie mir.

1949 in Seesen am Harz geboren forschte und lehrte Tworuschka von 1982– 1993 in der Lehrerausbildung an der Erziehungswissenschaftlichen Fakultät der Universität Köln; 1993–2011 hatte er an der Theologischen Fakultät der FriedrichSchiller-Universität Jena den Lehrstuhl für Religionswissenschaft inne. Berühmt wurde er vor allem als Wegbereiter der Schulbuchforschung: Er widmete sich gemeinsam mit dem Islamwissenschaftler Abdoldjavad Falaturi der Analyse der Beschreibung von Religion in Schulbüchern, ein Projekt, das international ausgeweitet wurde. Wissenschaft und Praxisrelevanz müssen kein Gegensatz sein, ganz im Gegenteil: Dafür steht Tworuschka mit seinem bisherigen Gesamtwerk, das sich durch Pioniergeist und Engagement auszeichnet und auch für andere wissenschaftliche Disziplinen eine Fülle an Anregungen bietet. Einige davon greifen die zehn Beiträge der Festschrift auf.

Den Herausgebern gelingt es durch Auswahl der Autorinnen und Autoren sowie der Themen sehr gut, Vielfalt, Breite und Tiefe des Werkes des 2014 65 Jahre alt gewordenen Jubilars darzustellen – auch wenn so mancher Beitrag, wie in Festschriften leider immer wieder üblich, etwas wenig expliziten Bezug auf Tworuschka nimmt und ein fehlendes Autorenverzeichnis eigene Recherchen nötig macht. Solcherart etwas mühsam auf die Spur eines originellen und innovativen Grenzgängers gebracht, kann man auch anhand der Beiträge, die dessen Ideen weiterführen, erkennen, dass Tworuschka guten Grundes in mehrfacher Hinsicht als Pionier gilt: Pionier der Schulbuchforschung, des interreligiösen Lernens und der Praktischen Religionswissenschaft.

Damit nun zum Inhalt: Aus der Fülle wähle ich exemplarisch vier aus, die für mich als Praktische Theologin von besonderer Inspiration sind. Gleich zu Beginn gibt die Religionswissenschaftlerin Zrinka Štimac einen kompakten Einblick in die zeitgenössische Relevanz des Werkes von Udo Tworuschka. Diese liegt zum einen ISSN 1788-4934 © 2016 Semmelweis University Institute of Mental Health, Budapest

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im Bereich der Bildung, für die der umstrittene Ansatz der Religionsphänomenologie fruchtbar gemacht werden kann. Religionswissenschaft ist für ihn „Wahrnehmungswissenschaft“. Gerade weil Tworuschkas Ansatz die Kategorie des Heiligen als irreduzible Größe ernst nimmt und sich dem Phänomen Religion hermeneutisch nähert, können religionsästhetische Themen ebenso in den Blick kommen wie die individuellen Erfahrungen von Menschen wahrgenommen werden. Im Horizont der sozioreligiösen Situation der Gegenwart und der damit verbundenen (religions)politischen Herausforderungen liegt eine weitere Relevanz sodann in der kontextuellen Wahrnehmung von Religion als gesellschaftlicher Größe mit heterogenen Wirkungen. Štimac hebt schließlich eine weitere pezialität Tworuschkas hervor: Sein Interesse liegt und lag daran, zu erforschen, wie S religiöse Traditionen „die elementaren Vollzüge und Bereiche des menschlichen Lebens, wie z.B. Lehren und Lernen, Lebensphasen, Leben in der Familie, Sexualität, Gesundheit, Essen und Trinken, Kleidung, Arbeit und Freizeit, Wohnverhältnisse, Gestik, Bewegungsweisen, die Einstellung zu Zeit und Raum, zu den Gefühlen, Bedürfnissen und Wahrnehmungen prägen“.

(8)

Denn Religionen bergen Werte, Grundhaltungen und Weisheiten, also Orientierungswissen, das auch über die Religion hinaus wirkt. Tworuschka sucht dabei immer auch nach „pazifierenden, konflikthemmenden und humanisierenden Impulsen aus den diversen religiösen Traditionen“ (8). Dies fördert nicht nur den interreligiösen Dialog, sondern macht diesen auch fruchtbar für das Gemeinwohl der Gesellschaft. Tworuschka sieht von daher die Aufgabe der Religionswissenschaft wesentlich auch als „mediatorische“ (8). Religionswissenschaft ist „Transferwissenschaft“: Der Transfer religionswissenschaftlichen Wissens in die Praxis und religiöser Wirkmechanismen aus dem privaten Raum in die Gesellschaft, beides zentrale wissenschaftspolitische Anliegen Tworuschkas, führen daher nicht nur zu zahlreichen Publikationen, sondern auch zu einem intensiven Engagement in Organisationen, die sich der interreligiösen Arbeit widmen. Religionswissenschaft ist für den Jubilar Teil eines „Kommunikations- und Reflexionsprozesses“, „um auf den wachsenden Problemdruck, an dem die Religionen (mit-)beteiligt sind zu reagieren“ (9). Allein dieses Wissenschaftsverständnis macht Tworuschka zu einer kritischen Herausforderung für alle Wissenschaften.

Eine solche wissenschaftstheoretische Herausforderung ist auch der Beitrag des Religionswissenschaftlers Richard Friedli: „Angewandte Religionswissenschaft im Teststand: Ein Beitrag teilnehmender Aktionsforschung“. Dieser versteht Religionswissenschaft als „teilnehmende Aktionsforschung“ (21). Religion ist ein funktionales Teilsystem, das immer auch mit den gesellschaftlichen, wirtschaftlichen und politischen Systemen vernetzt ist. Von daher bedarf das Fach nicht nur der selbstverständlichen Übernahme philologischer, historischer und kulturwissenschaftlicher Forschungsergebnisse, sondern auch der Erweiterung des Blickes auf aktuelle Gesellschaftsentwicklungen und soziopolitische Herausforderungen. Sozial- und Kommunikationskompetenz, Risikobereitschaft und öffentliche Verankerung gehören notwendig in den „Werkzeugkasten der praktischen Religionswissenschaft“ (22).

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Nur auf dieser Basis können Entscheidungsträgern in Politik, Schule, Wirtschaft, Polizei, Familie, Medien- und Gesundheitswesen jene Informationen über den Religionskontext zur Verfügung gestellt werden „die unter den Bedingungen einer multikulturellen und interreligiösen Gesellschaft berücksichtigt werden müssen“ (22).

Friedli nennt exemplarisch drei Projekte, in denen er sich engagiert: a) Migration und die damit verbundenen Phänomene der Transkulturation, die sich auch in Symptomen wie „fundamentalistischer Gettobildung“, „fanatischer Dämonisierung“ oder „dogmatischer Verhärtung“ zeigt; b) Entwicklungszusammenarbeit, bei der „nördliche“ Entwicklungszusammenarbeit oft von säkularisierten Fachpersonen organisiert wird, deren Praxis für die „südlichen“, noch religiös geprägten Adressaten existenziell aggressiv und zerstörerisch wirken kann; c) Friedensforschung, weil sowohl innerhalb der Peace Studies als auch in den entsprechenden friedenspolitischen Organisationen der Faktor Religion noch wenig aktiv und griffig in die internationale Debatte sowie interdisziplinäre Lösungssuche eingebracht wird. Als konkretes Ergebnis einer solch „engagierten Religionswissenschaft“ (Klaus Hock) beschreibt Friedli das MAS-Programm Conflict Transformation and Peace an der World Peace Academy, akkreditiert durch die Universität Basel. Das Zusammenleben der Studierenden aus aller Welt wird dabei zum Peace – Laboratorium: Menschen mit verschiedenen Koch- und Essensgewohnheiten atheistischen und religiösen Mentalitäten, verschiedenen Genderverständnissen oder mit okzidentaler bzw. kolonialer Vergangenheit lernen miteinander leben.

Hervorheben möchte ich auch den Beitrag der evangelischen Religionspädagogin Eva Hoffmann-Stakelis: „Interreligiöse Multiplayer?! Forschungsergebnisse zum interreligiösen Lernen im Elementarbereich.“ Sie widmet sich aus einer qualitativ-empirischen Perspektive der Religiosität von Kindergartenkindern – einer Gruppe, deren Wahrnehmungen und Erfahrungen in der Wissenschaft in aller Regel eine marginalisierte Rolle spielen. Nach einem Einblick in einschlägige religionspädagogische Studien zur Thematik, die vor allem die Bedeutung von Differenzerfahrung und Strategien des Umgangs damit reflektieren, veranschaulicht sie anhand von Gesprächssequenzen aus Diskussionen mit Kindergartenkindern unterschiedlicher Religionszugehörigkeit deren Gedanken zum Thema „Tod und ein mögliches Leben danach“. Exemplarisch arbeitet sie heraus, wie interreligiöse Kommunikation- und Lernprozesse zwischen Kindergartenkindern ablaufen können. Schon bei Kindergartenkindern können Fähigkeiten vorfindbar sein, die für interreligiöses Lernen unerlässlich sind: „die Bereitschaft, sich auf Fremdes einzulassen, sich mit diesem auseinanderzusetzen, über eigene Vorstellungen nachdenken und sie manchmal angesichts anderer Überlegungen partiell zurückzunehmen oder argumentativ zu stützen“ (60). Freilich bedarf es religionspädagogischer Begleitung, diese Fähigkeiten wahrzunehmen und zu fördern.

Der Beitrag des Religionswissenschaftlers Hamid Reza Yousefi: „Logik und Hermeneutik der interkulturellen Religionswissenschaft“ stellt ein ambitioniertes und höchst zeitaktuelles Projekt vor: Die theoretische und methodische Konzeption einer interkulturellen Religionswissenschaft, die die Förderung des Friedens zum EJMH 11:1-2, April 2016

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Ziel hat. Ganz in der Tradition Tworuschkas möchte dieser Ansatz Wissenschaft im Kontext zeitgenössischer Herausforderungen betreiben. Theoretisch vom religionsphänomenologischen Zugang ausgehend, der das Heilige als Wirklichkeit ernst nimmt, ohne es innerhalb einer Religion zu fixieren, berücksichtigt die interkulturelle Religionswissenschaft methodisch die religiös-spirituelle Dimension als eigenständige Realität, die aber weder ethnisch noch konfessionell gebunden ist. Indem historische, systematische und vergleichende Methoden miteinander verbunden werden, kann intern wie zwischen den Religionen ein polyfoner Dialog entstehen, der auf eine „echte Toleranzkultur“ abzielt. Religionswissenschaft in dieser Spur anerkennt Zentren, lehnt aber Zentrismus und alle Formen von Exklusivität ab. Sie strebt nicht nach Konsens, wohl aber nach Kompromissen.

Viele weitere Themen werden in der Festschrift noch diskutiert: die religionswissenschaftliche Schulbuchforschung (Zrinka Štimac, Wolfram Reiss); die Rolle der Religionswissenschaft in der Pflegebranche (Ronald Pokoyski) und in der interkulturellen Bildungsarbeit (Michael A. Schmiedel); das Thema der „Gelebten Religion“ (Wolfgang Gantke) sowie das breite Feld „Neuer Religiosität“ (Michael Klöcker). Diese Mischung aus grundlagenorientierten und angewandten Themen wird nicht nur dem Gefeierten gerecht, sie ist – auch angesichts unterschiedlicher wissenschaftlicher Qualität der einzelnen Beiträge – anregend für jede Forschungspraxis, die sich dem Transfer zwischen Theorie und Praxis verpflichtet weiß. Ich habe jedenfalls bei der Lektüre einen Kollegen entdeckt, dessen Werk mich motiviert, auch in meinem Fach, der Praktischen Theologie, weiterhin grenzüberschreitend und gesellschaftspolitisch engagiert zu forschen und zu lehren.

Das Buch verlasse ich mit einer Fülle von Literaturhinweisen, Forschungsideen und dem Eindruck, dass es in einer ökonomisierten, teilweise immer selbstreferenzieller werdenden Wissenschaft Menschen gibt, für die Wissenschaft kein autistischer Selbstzweck ist, sondern die ihre Agenda in Forschung und Lehre von den Fragen der Zeit her entwickeln, zugleich grundlegende hermeneutische und philosophische Fragen stellen und dabei disziplinäre und gesellschaftliche, kulturelle und religiöse Grenzen überschreiten.

EJMH 11:1-2, April 2016

European Journal of Mental Health 10 (2016) 157–160 DOI: 10.5708/EJMH.11.2016.1-2.Rev.2

Anett Mária Tróbert

A LIFE IN THE SERVICE OF MENTAL HEALTH Ittzés, G., ed. (2013) Cura mentis – salus populi: Mentálhigiéné a társadalom szolgálatában: Ünnepi kötet Tomcsányi Teodóra 70. születésnapjára: Festschrift für Tomcsányi Teodóra zum 70. Geburtstag (Budapest: Semmelweis Egyetem EKK Mentálhigiéné Intézet) 572 pp., 23 cm, ISBN 978-963-9129-95-5, 3980 Ft. To celebrate Professor Teodóra Tomcsányi’s seventieth birthday in 2013, the Institute of Mental Health published a Hungarian–German bilingual volume in the interdisciplinary library series under the title of Cura mentis – salus populi with a subtitle that can be translated as ‘mental health in the service of society’. In his foreword the editor, Gábor Ittzés, outlines the individual chapters in the context of Professor Tomcsányi’s work. The structure of the book reflects the diversity of her oeuvre, in which a firm grounding in theory, practice-oriented professional work, the transfer of theoretical and empirical knowledge through various forms of training, and a commitment to research form an integral whole and appear as a service to mental health on a social scale.

The studies represent great diversity in terms of themes and genres. That is the result of a conscious decision on the part of the editor to reflect the multifaceted nature of the dedicatee’s career over a lifetime. The main structural units are devoted to scholarship, practice, teaching and research. Taken together, their subordinate sections, each containing three to four papers, provide an overview of the main stages of Tomcsányi’ professional career and give an impression of the richness of her oeuvre. In this review I will present the volume under four keywords, borrowed from concepts that run through the studies. These concepts are central not only to the book but also to the dedicatee’s work and include dialogue, integration, value and personality.

As I first leafed through the book, I had the feeling of finding myself in the midst of an open dialogue in which values of Tomcsányi’s oeuvre appear, both explicitly and implicitly. One such value is dialogue itself. The theoretical studies themselves emerge from a dialogue. Questioning our views, placing them in a broader context, accepting the viewpoints and different views of others, and openness to development are all preconditions for dialogue. With their critique of Israëls’ attack on Freud, Patrick Luyten and Jozef Corveleyn (31–52) point to openness and self-criticism as some of the essential elements of a scholarly attitude. Susanne Heine (53–68) also adopts this approach in his examination of Freud’s hostility to religion. Grete Leutz (69–78) describes the ways, different but not mutually exclusive, in which the same therapeutic tool was used in practice by Freud and Moreno. She presents this as an example of the further development and transformation of theories, which is also ISSN 1788-4934 © 2016 Semmelweis University Institute of Mental Health, Budapest

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an important part of dialogue. In Ferenc Patsch’s reflection on the philosophy of religion (116–29), dialogue and cooperation appear as possible conditions for a new, relational approach to truth. Besides stressing the points of contact between different trends in psychotherapy, Dóra Perczel Forintos (165–72) shows how the schools enrich each other.

In addition to papers on psychology in part four (research), we come across encounters between psychology and sociology in the context of religiousness, interreligious dialogue and family studies. Since dialogue is a fundamental reality in the independent discipline of mental health, but one that has to face many difficulties, the book should have offered a presentation of the current challenges of scholarly dialogue, counterbalanced with available good examples. That, however, is missing from the book.

On Teodóra Tomcsányi’s view the connection between theory and practice is not linear. It is a spiral continuously integrating the elements of training and research. In renewal and development it is just as important to return to the sources as it is to be open to new theories and experience. The dynamic unity of theory and practice can be seen in the papers on psychotherapy. Krisztina Csáky-Pallavicini and Piroska Milák (189–202), for example, provide insight into an extended application of the psychodrama method in a new framework. But it is not only in terms of theory and practice that the volume emphasises integration. It is also the basis of an approach to mental health reflected in several studies. In an earlier article Teodóra Tomcsányi defined mental health as a concept with psychosocial, sociocultural and political-economic aspects that can be interpreted as an internal equilibrium process (2003, 20). Mental health requires the power of integration not merely because of its complexity but also because of the ambivalence of its internal and internalising contents. As Endre J. Nagy puts it in the volume, ‘it is the dynamic unity of opposites that gives the personality its strength or a healthy personality’ (98, my trans.).1 Since the training of mental health professionals requires an interdisciplinary dialogue, educational programs in the field provide a forum for integrating different branches of learning. This is well illustrated in the contributions of Hanneke Meulink-Korf (385–400), Andreas Wittrahm (401–16), Karl Heinz Ladenhauf (153–62) and in the joint study by Gábor Török and Máté Joób (417–29).

The role of values in mental health is indisputable. In addition to the envir­ onment, itself a complex reality, and personality factors, elements that are beyond the perceivable environment also play an important role in shaping and maintaining mental health. In his study Endre J. Nagy (81–101) points out that mental health itself is a value choice, raising numerous challenges in the postmodern age. The role of elements beyond the perceivable environment, such as spirituality, is also confirmed by research not only in mental health but also in physical well-being. In their article, Ferenc Túry and his colleagues (133–41) explore the deep connections 1

riginal text: ‘maguknak az ellentéteknek a dinamikus egységes adja a személyiség erejét vagy az egészséges O személyiséget’.

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between food, life and spirituality. Timea Tésenyi’s paper on spiritual counselling in hospitals (277–93) shows how important spirituality is in modern healing. It is a dynamically developing component with deep roots. Károly Varga (102–15) examines the connection between religion and mental health through the lens of spirituality and consciousness. As science becomes open to the values of spirituality and religion, persons who represent the churches and spirituality must enter into dialogue with science. An example of this can be found in the article by Dávid Németh (294– 321) on the fruitful dialogue based on the values of logotherapy and pastoral care. If we interpret spirituality and religion as a dimension needed for people to unfold their potential, it follows that education must allow space for religious values. In this light Martin Jäggle (142–52) describes a German training model conceived in the context of religious diversity. Norbert Mette (337–59) examines the challenges of religious pedagogy in childhood. His findings and questions integrate the perspectives of the related disciplines and encourage further reflection.

Empirical research is an activity that both preserves and creates value. It explores phenomena that determine the quality of life and is one of the cornerstones of prevention and the promotion of mental health. This is clearly illustrated by the ­studies in part four on research. Eszter Hámori (445–60) shows that interviews can have a therapeutic effect for the interviewee because they contribute to self-reflection and the articulation of problems. The family is the most important place for the transmission and protection of values in all stages of life. Research by Katalin HorváthSzabó and Beáta Dávid (534–50) throws light on the importance of family support among adolescents. Péter Török and András Ittzés (514–33) draw attention to the possibilities of interfaith dialogue for the preservation of values from the perspective of family welfare. They have reviewed data collected over several decades. The study

by Gábor Ittzés and colleagues (495–513) describes how the salvation item of the widely used Rokeach Value Survey can serve as an indicator of religiosity. In view of the significance of the topic of spirituality and religion, and the pioneering work done in this direction by the dedicatee, one would have liked to see more space given in the book to the sociology of religion in Hungary.

The practice of empirical research teaches that, however important efforts to achieve objectivity are, the personal cannot be excluded from the scientific enquiry.

For those in the helping professions the personal is a tool, and the connection with ourselves, self-knowledge and self-reflection are essential for professional work.

This is why self-knowledge and psychodrama work are among the pillars of the pastoral care and mental health training programs established by Teodóra Tomcsányi.

The studies in the section devoted to psychodrama present examples of the internal development that can be achieved through such work.

The volume reflects what I myself have learnt from Professor Tomcsányi: to blaze new trails you must know where you have come from and where you are going. Be bold in connecting dreams and reality, creating consciously. This jubilee publication is a collection that invites dialogue. Despite the diversity of its themes, it is a holistic, integrative work. It opens new perspectives for professional work in EJMH 11:1-2, April 2016

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mental health from its personal nature to its impact on society. It is worth returning again and again to this rich volume that encourages further reflection.

References Tomcsányi, T. (2003) ‘A mentálhigiéné jelenségvilága’ in T. Tomcsányi, F. Grezsa & I. Jelenits, eds., Tanakodó (Budapest: Semmelweis Egyetem TF, Párbeszéd (Dialógus) Alapítvány & HÍD Alapítvány) 16–45.

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European Journal of Mental Health 11 (2016) 161–163 DOI: 10.5708/EJMH.11.2016.1-2.Rev.3

Agnieszka Krzysztof-Świderska

PRIESTS IN THE EYES OF YOUNG PEOPLE Is This Issue in Mental Health Professionals’ Interest?

Baniak, J. (2013) The Image of the Priest in the Awareness of Polish Youth: A Socio­ logical Study (Münster: LIT) 168 pp., 23,5 cm, ISBN 978-3-643-90380-8, €29.90.

The international community of scientists has very few occasions indeed to get acquainted with the results of longitudinal, sociological or other studies. It is not an easy task to design and perform a longitudinal research, irrespective of the field and subject of interest. The research described and discussed in the dissertation en­ titled The Image of the Priest in the Awareness of Polish Youth: A Sociological Study requires unshakeable consistence in putting into effect the theoretical and meth­ odologic­al concepts, and perseverance in the effort to conduct the research study practically (Trochim 2006). From a strictly scientific point of view, it is a valuable work, worth showing to the wider audience. Fellow scientists can benefit from reading it, regardless of their field of specialisation within humanities. Scientific circles need this kind of methodological and practical knowledge because they need more occasions to follow the dynamics of cultural and developmental changes of their subjects. As usual, language is the problem – English-speaking natives do not use such complicated sentence structures. But is it really a serious failure? Most of the readers are professionals from the field of mental healthcare, or scientists who find no difficulty in reading more complicated content. It is a scientific dissertation, not a popular publication. Anyone who has had some contact with scientific publications in humanities is doubtless aware that sociological studies are no ‘bedside books’.

It is still a very rare and precious chance to look at political, social, and cultural changes in people’s awareness in the transition period which affected a large part of Europe. What is especially interesting is learning how young people, the so-called ‘future of mankind’ see the world nowadays. Last but not least, the issue of priesthood seems to be an intellectually appealing matter at all times. Despite the general attractiveness of the subject, one core question accompanied my reading of the dissertation and the preparation of this review: why could the image of a Catholic priest in Kalisz (a Polish city of 104 000 inhabitants) prevalent among young people be interesting for mental health professionals abroad in the times of ecumenism and progressive secularisation? Apart from the problem of cultural bias, which I will discuss later, what are the merits of this book from the point of view of psychiatrists, psychologists, psychotherapists and social workers in the whole of Europe?

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authorities. The number of psychotherapists and social workers interested in working with young people and their families, for whom the problem of authority is very acute, is constantly increasing. It should be remembered that authority is a multi­dimensional issue, which could be seen from many points of view, including sociological and psychological aspects of this by no means culturally determined phenomenon (Gelder 2007). And from the point of view of cross-cultural psychology, one can ask whether authority really has the same meaning in all European countries. Maybe what is problematic from the point of view of European readers is the very translation of the term ‘authority’ from Polish to English. In many English-speaking countries, first of all, the UK, the word ‘authority’ is understood in the aspect of formal institutions and their actual, real possibility to influence. A parish priest is still formally a kind of civil ser­ vant. A couple of months ago I talked to Professor Benjamin Beit-Hallahmi from Haifa about religiousness in the times of extreme individualism. He observed that religion has currently lost its political and actual power in most Western countries. It is not such a serious matter to be rebellious against institutional priesthood as it was before. In his opinion, Poland is different in that aspect: because of its difficult history (partitions of Poland, communism), authority and power mean something entirely different here.

Nowadays, religious authorities and actual power represented by the government seem to be closer than for many years before. At the same time, people in Poland are used to some double standards (Sztompka 1993). Priesthood, even deprived of real power, is still more institutional than in most modern European countries, and arouses feelings typical for institutions as such – the tendency to create double standards here is particularly strong. In all likelihood, a similar psychological situation occurs in South America which is home to the largest Roman Catholic community in the world, and from where more and more immigrants – potentially also clients (Pellegrino 2004) – arrive.

The study offers answers to many different questions. What kind of authority does a Catholic priest have in a modern society? How is the social role of a priest actually perceived in a modern society? How are young people influenced by their parents’ views on a priest as a figure of authority – what is the place of a Catholic priest or another spiritual and life guide in the family system of most Catholic families? Is it somehow similar to a systemic psychotherapist? How, therefore, do Polish youth, as the representatives of youth in general, perceive priests as potential figures of religious and moral authority? What it means to be a figure of authority and what kind of authority young people need today is a very urgent issue for their mental condition.

In this context, the whole book, especially the chapters concerning the social role and authority of priests as it has been seen by the Polish youth from 1983 until 2008, is extremely interesting for mental health professionals. Despite its cultural bias, and although it is specific for a certain type of settlement (a fairly small town in south-eastern Poland), which is obviously a challenge, readers can follow a cultural change in young people’s needs and perception of Church authorities over 25 years (Aponte et al. 1995). They cannot derive direct conclusions, but they can try to under­stand the dynamics of these cultural and social changes. Especially if we take into account the fact that it is not only trendy styles of attachment or object relations EJMH 11:1-2, April 2016

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or personality as a whole that determine cross-cultural transition in particular individuals, but also broadly understood religiousness (Zakrzewska-Wirkus 2013).

The issue which is raised in a separate chapter and which undoubtedly deserves special attention is the phenomenon of the Polish pope, John Paul II as a personal model for Polish youth. A few years ago he was so popular that Polish media even coined the term ‘JP2 generation’ to refer to people born in the 1980s. Even if this term was used mostly as a catchy slogan, the impact of his magnetic personality on the expectations and vision of an ideal parish priest and academic minister is undoubtedly powerful throughout all the described period. Probably not only in Poland.

Although this was probably not the author’s primary intention, we can also learn a lot about the reality, social functions, theological basis, and psychological conditions of this very special profession: being a Catholic priest. Most people, even mental health professionals, have poor knowledge of all the pressures, internal and external, that affect the clergy. It is useful knowledge in our field: the occupation of a priest is still one of the considered ways of life for young people, and priests can also suffer from mental problems and become patients. However, it is more frequently the case that we need additional knowledge about young people’s experience with priests as a moral authority and a ‘guide to life’. Due to these circumstances, the problem of mandatory celibacy in the opinion of young people deserves additional attention and a separate chapter.

The book is about awareness, and it provides us with knowledge of the cultural background and its changes, which is very useful in interpreting the mindset of young people and necessary to helping them. We should not try to understand and interpret individuals only in the light of our knowledge of unconscious mechanisms without taking into account cultural and generational factors. Expanding our know­ ledge and awareness of social changes as mental health professionals, we could limit our own projections and broaden our awareness of our clients more effectively.

References Aponte, J.E, R.Y. Rivers & J. Wohl, eds. (1995) Psychological Interventions and Cultural Diversity (Boston: Allyn & Bacon).

Gelder, C. van (2007) ‘Defining the Issues Related to Power and Authority in Religious Leadership’, Journal of Religious Leadership 6:2 (Fall) 1–13, retrieved 11 July 2014 from http:// arl-jrl.org/Volumes/VanGelder07.pdf.

Pellegrino, A. (2004) Migration from Latin America to Europe: Trends and Policy Challenges (Geneva: IOM International Organization for Migration).

Sztompka, P. (1993) ‘Civilizational Incompetence: The Trap of Post-Communist Societies’, Zeitschrift für Soziologie 22, 85–95.

Trochim, W.M.K. (2006) ‘Time in Research’, retrieved 11 July 2014 from www.socialresearchmethods.net/kb/timedim.php.

Zakrzewska-Wirkus, K. (2013) Determinanty procesu Kulturowej zmiany: osobowość, styl przywiązania i religijność (PhD diss., Jagellonian University, Kraków).

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European Journal of Mental Health 11 (2016) 164–168 DOI: 10.5708/EJMH.11.2016.1-2.Rev.4

Mónika Földvári

RELIGIOUS DIMENSIONS OF EUROPE Pollack, D., O. Müller & G. Pickel, eds. (2012) The Social Significance of Religion in the Enlarged Europe: Secularization, Individualization and Plur­ alization (Farnha & Burlington: Ashgate) 264 pp., 23.5 cm, ISBN 978-1409426-219, £58,50.

The basic question of the book, the social significance of religion, has always been a central issue in the sociology of religion. Because the answer to this question depends on how we define and study religion, a wide range of views have been developed in this field. If we want to understand social changes in modern Europe, we have to take religion into account. There is, however, little agreement on the fundamental tendencies of religion and their consequences. Disagreements originate partly from theoretical considerations and partly from empirical research. The chapters of the book edited by Detlef Pollack, Olaf Müller and Gert Pickel are interesting in terms of both.

The empirical study of religion has some deficits. One of them is that data analysis is often only superficially connected to theoretical considerations. In this volume, seeing the necessity of a comparative analysis through recourse to theoretic concepts of religious change, the authors take into consideration three main theories of the relationship between religion and modernity: the secularisation theory, the individualisation theory and the economic market theory.

To put it simply, secularisation theory suggests that the process of modernisation goes hand in hand with the decline of the social significance of religion. As a critique of the secularisation theory, the individualisation theory states that religion is not necessarily losing its significance in general in the modernisation process.

De-churchification does not mean a general loss of the significance of religion but a shift to the private sphere: religion becomes increasingly invisible. Finally, according to the economic market model the religious pluralisation in modern societies has a positive effect on the vitality of religious communities.

A further shortcoming of the empirical study of religion is that comparative international studies on a wide empirical basis are rare, and the majority of them focus only on traditional, church-related religiosity. The authors of this volume wish to take a step towards a wider and more precise systematic analysis of religion in modern Europe.

The chapters written by well-known experts of the sociology of religion present the analysis of the religious situation in nine countries, using mainly but not exclusively representative data from the C&R 2006 survey (Church and Religion in an Enlarged Europe). The volume examines countries from different regions of Europe ISSN 1788-4934 © 2016 Semmelweis University Institute of Mental Health, Budapest

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and with different religious traditions: from Western Europe Finland with a Protest­ ant, Ireland with a Catholic background and Germany as a mixed denominational country; from the post-Communist countries Estonia with a Protestant, Croatia and Poland with a Catholic, Hungary with a mixed, and Russia with an Orthodox religious tradition. Eastern Europe, with its particular historical and ideological background as distinguished from that of Western Europe, provides an opportunity to study the three theories of modernity and the social role of religion.

The aim of the survey was to study the social significance of religion primarily at the individual level by analysing data, in addition to the C&R, also from the EVS (European Values Study), the ISSP (International Social Survey Programme) and other international surveys. Nevertheless, other social levels were also taken into consideration. On the mezzo (organisational) level the connection between modern­ ity and organisational-structural changes within the churches, while on the macro (societal) level the relations between the churches and the state, media and similar structures were explored. The examination of mezzo and macro levels became possible through an analysis of church and national statistics and documents.

The researchers, relying on the tradition of Charles Glock, distinguished three dimensions of religiosity: religious identification (belonging to and the feeling of being connected with a religious community, church or denomination), religious praxis (rites and cultic performances) and religious experience and faith. These dimensions are analysed not only in the case of Christianity but in the case of non-Christian and extra-ecclesiastical forms of religiosity as well. Belief in astrology, spiritualism, magic and occultism, belief in amulets, stones or crystals as well as the belief in the spiritual dimension of life are the indicators of extra-ecclesiastical religiosity. One more question had fundamental importance for the purposes of the research: the role and place of religion in the private life of respondents. The data of the C&R survey contains information not only about respondents’ religiosity and frequency of church attendance but also about their assessment of the significance of religion for everyday life and society.

Individual studies in the book, analysing changes of the social significance of religion in a particular country, are quite interesting in themselves, but perhaps the most remarkable part of the volume is the last chapter on the international results, a systematic comparative analysis of the nine countries by the editors (229–56). The main questions of this chapter are these. What can we say about the changing role of religion in Europe? To what extent can secularisation theory explain religious change? As I mentioned above, we can distinguish three levels of religious change: societal, organisational and individual. They can be related to and interact with each other. In the course of analysing the religious situation in the nine countries, these levels are considered separately.

Secularisation on the level of society means that as a result of functional differentiation religion has lost its overarching importance. It no longer constitutes the overall framework of the interpretation of the world. Functional differentiation between religion and other parts of society was grasped by questions about the acceptEJMH 11:1-2, April 2016

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ance of religious influence in the fields of politics, science and education. As the results show, the separation of religion and politics and the separation of religion and science are widely accepted in Europe, not only in the countries examined but, according to the ISSP survey (1998 and 2008), in other countries as well. However, the results are quite different in the case of the educational system. The strict separation of church and schools is supported only to a limited extent. That might be conceived as evidence that in Europe the Christian cultural heritage is (still) widely accepted and valued. In case of all indicators, the Catholic countries showed a more openminded attitude towards the presence of religion in schools than the Protestant ones.

On the organisational level the authors examined the financial and personal resources of religious institutions and organisations. The data were not fully adequate but showed that in Europe organisational developments do not go hand in hand with the churchesâ&#x20AC;&#x2122; ability to integrate, to increase church membership and to carry out their mission successfully. One of the approaches in the sociology of religion that deals with the organisational level, the economic market-theory is therefore not supported by the data.

At the individual level three statements seem particularly important: 1. Denominational cultural heritage has a great impact on religious membership, on religious affiliation, on the importance of religion in life, on religious selfdescriptions and on belief in God. In historically Catholic countries religiosity is more traditional and institutionally influenced and religious vitality is stronger, religion is more important, and faith in God is more personal than in historically Protestant and mixed countries. Protestant countries report the lowest level of religious vitality, and a high level of religious individualisation.

2. It seems that in the process of modernisation a more diffuse image of God is gaining ground. During the last few years the number of respondents who believe in a higher being has grown, while the number of people who believe in a personal God has decreased.

3. Different forms of alternative religiosity do not substitute traditional religion.

On the contrary, the highest proportion of alternative religiosity was found in countries with strong Christian religiosity (Ireland, Portugal). Though the importance of alternative forms (such as belief in magic, spiritualism, astrology, amulets, crystals) has increased, the number of adherents remains low. Christian symbols (cross, rosary) are far more popular than alternative forms.

What are the main factors â&#x20AC;&#x201C; according to the authors â&#x20AC;&#x201C; that exert a great influence on religiosity in Europe? GDP per capita, one of the measures of modernisation, has a strong effect on the religious field only in Western Europe. There, increasing economic prosperity contributes to the loss of church attendance, church membership and belief in God. By contrast, other factors such as the political suppression of religion by state socialism have a stronger effect in Eastern Europe. Cultural-confessional heritage also seems to be a relevant factor. Catholics have a closer relationship to their church than Protestants, and the proportion of Catholics within the population is in significant relation with the level of religiosity. Moreover, the historical EJMH 11:1-2, April 2016

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connection between church and national consciousness (as in Croatia, Poland and Ireland), the political qualification of religion, even the religious interpretation of political events also have a considerable effect on religiosity.

What is the most appropriate theory that can explain religious change in the light of the comparative analysis? As regards the economic-market model, empiric­ al data contradict the assumptions of this theory. The degree of religious pluralism and the degree of separation between church and state do not have such effect on religiosity as was assumed by the economic-market theory. On the contrary, religious pluralisation in Europe has a negative effect on traditional churches, because pluralisation weakens social confirmation. In terms of the degree of separation, the correlation between state regulation and religiosity is not significant.

The individualisation thesis is more useful, but is has some limitations. According to the data the level of alternative forms of religion and spirituality is rather low, and these forms do not serve as an alternative to ecclesiastical religiosity. Rather, the two go hand in hand to some extent. But alternative religiosity and spirituality, which have no comparable impact on peoples’ lives to that of traditional religiosity, have nonetheless increased, especially among the younger generations. This change in the dominant forms of religion is at the same time a loss of the influence of religion on people’s lives. In this way religious individualisation is integrated into the secularisation processes.

Secularisation theory is highly relevant in Europe if we do not assume that secularisation is a comprehensive, linear and irreversible process. We have to take into account that on the different levels of society the process can have different specificities, and it is also important that secularisation can be overwritten by other factors such as path dependencies (e.g. cultural heritage and political features).

Overall, the strength of the book is the detailed examination of churches and ecclesiastical religiosity in modern society. Each study of the volume gives a carefully drawn picture of the historical background of the churches and denominations, the connection between church and state, the organisational and financial specificities of the religious institutions, and the church related forms of religiosity on the level of the individual in the particular country. The volume gives a comprehensive analysis of the changing significance of the churches on the different levels of society.

The analysis of non-Christian and extra-ecclesiastical forms of religiosity is not so well grounded, especially on the individual level. The indicators cover only a ­narrow field of beliefs such as different superstitions (belief in amulets, stones or crystals, etc.) and beliefs in non-Christian spiritual trends (e.g. astrology, ­spiritualism, magic and occultism) and ignore religious practices and several elements of religious consciousness (other, not so extreme beliefs; religious values; explanations of life, death and suffering; views and feelings about one’s connection to other ­people and to the world, etc.).1 Even the question about the spiritual dimension of life is not the 1

ome authors tried to examine extra-ecclesiastical forms by analysing religious practices (G. Rosta for S Hungary, 187–206) and other beliefs (D. Hall for Poland, 121–42) as well, but these are isolated approaches.

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best way to grasp extra-ecclesiastical religiosity, as the expression ‘spirituality’ can have several meanings. It can be connected closer than any other forms to traditional religiosity (as in the case of Poland). Moreover, religious individualisation that takes place not only outside but also inside the churches cannot be measured by the incidence of extra-ecclesiastical forms of religiosity alone. That is why the conclusions about the individualisation thesis do not seem to be well established.

This deficiency of the volume comes partly from the difficulties of researching religion in modern societies. The problem of grabbing the extra-ecclesiastical forms of religion is one of the most burning questions of the sociology of religion.

Although the examination of institutional religion is indispensable if we want to assess religious change, one of the central tasks of the sociology of religion today is to elaborate a more general conception and measuring tools of religion that are ad­equate for contemporary religion, which has become increasingly free of institutional control. The concept of spirituality seems to be a promising solution, but it should be theoretically and methodologically well founded. As the psychology of religion has a remarkable tradition in researching spirituality, the application of its theories and results could point the way forward for sociological research.

EJMH 11:1-2, April 2016

European Journal of Mental Health 11 (2016) 169–172 DOI: 10.5708/EJMH.11.2016.1-2.Rev.5

Csaba Török

EMPATHISCHE WEGSUCHE IN DER WELT DER INTERRELIGIÖSEN BEGEGNUNGEN Strettberger, H. & M. Bernlochner, Hrsg. (2013) Interreligiöse Empathie lernen: Impulse für den trialogisch orientierten Religionsunterricht (Münster: LIT) 200 S., 21 cm, ISBN 978-3-643-11984-1, € 19,90.

Em-pathie: ein oft verwendeter, doch manchmal unreflektierter Neologismus des 19. Jahrhunderts, der im Anfang als Ergänzung und in Analogie zum alten Terminus Sym-pathie erfunden wurde, und ein wichtiges Element der (ästhetischen) Erkenntnis, des Prozesses seelischen Erkennens beschreiben wollte. Es ist nicht zu bewundern, dass schon die frühere Psychologie dieses Wort in Beschlag nahm, um damit ein inneres, einfühlendes Verstehen zu deuten. Die phänomenologische Wende in der Philosophie (mit E. Husserl und seinen Schülern) öffnete die Türe auf breitere Felder der Wortverwendung – eine der „Husserlianern” war Edith Stein, die ihre Doktorarbeit unter dem Titel Zum Problem der Einfühlung an der Universität von Freiburg i.

Br. 1916 eingereicht und verteidigt hat. Dieser Zweig des philosophischen Denkens hat schon sehr früh angezeigt, dass das Thema des Sich-in-die-Situation-des-Anderen-Einfühlens, bzw. -Einsetzens mächtige und tief gehende religiöse Konnotationen und Konsequenzen hat. Selbst Husserl betrachtete das religiöse Phänomenon als eines der zentralen Themen seines Denkens, geschweige denn von solchen weiteren prominenten Philosophen, wie Max Scheler oder Adolf Reinach – und die oben erwähnte Edith Stein, die (teils durch die Fragen der Phänomenologie und die Beispiele in ihrem intellektuellen Freundeskreis an der Universität motiviert) 1922 sich taufen ließ, und 1933 ihre Aufnahme in den Karmeliter-Orden erbat. Alle diese Denker zeigen, dass Empathie viel mehr ist, als ein sich hinablassendes oder -neigendes Mitgefühl, ein leeres emotionales Verhalten, eine gewisse passive Wahrnehmung der Realität des Anderen. Hier geht es nicht nur um eine Fähigkeit und Gabe, sondern um eine Befähigung und Aufgabe: Man ist nicht nur instinktiv (und seiner gegebenen Natur entsprechend) empathisch, sondern wird zur Empathie angeleitet, begleitet, ja, es wird einem Empathie gelehrt.

Die Religionen haben vieles in diesem Zusammenhang zu sagen: solche alte Traditionen, wie der Buddhismus, heben die Wichtigkeit des Mit-allen-Lebendenmit-Fühlens und -mit-Leidens hervor. Die christliche Spiritualität spricht oft und gerne über das sentire cum Christo, das Mit-Christus-Fühlen, oder noch pointierter: cum Christo pati, das Mit-Christus-Leiden. Es ist ein Grund und Urquelle des gläubigen Empfindens, Verstehens, Daseins, Kern des teilnehmenden Gebets, Meditation, Betrachtung. Wege des Glaubens und der Gotteserfahrungen führen sehr oft über das Reich der Empathie. Im Horizont der jüdisch-christlichen Schrift könnten ISSN 1788-4934 © 2016 Semmelweis University Institute of Mental Health, Budapest

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wir sagen: Der sym-pathische Gott bewegt den Menschen zu einem em-pathischen Glauben, der sich in einem em-pathischen Verhalten gegenüber den anderen Menschen ausdrückt. Es ist nicht zu bewundern, dass dieses empathische Gegenüber ein Leitmotiv christlicher Spiritualität wurde, so im Falle der großen Heiligen der Nächstenliebe (Hl. Franz von Assisi, Hl. Elisabeth von Thüringen), wie im Leben der großen geistlichen Meister und Mystiker (Hl. Ignatius von Loyola, Hl. Theresa von Ávila, Hl. Johannes vom Kreuz). Die gleiche Edith Stein, die ihre akademische Karriere mit einer Doktorarbeit über die Einfühlung begann, hat (schon als Schwester Theresa Benedicta vom Kreuz) ihr Werk mit dem opus magnum von Kreuzeswissenschaft: Studie über Joannes a Cruce gekrönt – ein Buch, das den Weg des inneren Erkennens und Erfahrens betrachtet, und das das höchste Gut des Menschen in der inneren Vereinigung mit Gott sieht, die nichts anderes ist, als „von Gott selbst hineingezogen werden in das eigene Innerste und sich Ihm hingeben”, also ein wesentlich em-pathisches Moment der Existenz.

Damit haben wir zwei wichtige Punkte hervorgehoben, die die Grundlage unseres Buches bilden: erstens, dass Empathie nicht nur Gegebenes, sondern auch Erlerntes ist; zweitens, dass Religion und Empathie zusammengehören (die Empathie kennzeichnet den Weg des Glaubens, und die Religion fordert die Vertiefung und Ausbreitung der Fähigkeit zur Empathie). Daher gab es schon immer (auch wenn auf unreflektierter und unausgesprochener Weise) eine gewisse Pädagogik zur Empathie in den Religionen (darüber finden wir wichtige Nachweise im Buch von Walter Kard. Kasper (2015) über Die Barmherzigkeit, das mit einer religionsgeschichtlichen und -philosophischen Analyse des Phänomenons von Mitgefühl, Mitleiden und Empathie beginnt). Doch die heutzutage immer mehr im Vordergrund stehende Frage nach inter-religiöser Empathie blieb weiterhin meist unbedacht, die großen Theoretiker scheinen sich hauptsächlich nur für abstrakte glaubensinhaltliche Probleme zu interessieren. Das entspricht aber unserer tagtäglichen Erfahrung nicht mehr – es begegnen sich nicht nur religiöse Institutionen, sondern gläubige Menschen, denen nicht nur ein friedliches Neben- und manchmal Miteinander-Leben wichtig ist, sondern auch ein em-pathisches Zusammentreffen und -sein. Das wird gleich am Anfang unseres Buches bestätigt, wo wir über „interreligiöse Lernerfahrungen im Alltag einer jüdischen, muslimischen und christlichen Schülerin” (9–12) lesen dürfen. Hier wird klargestellt, dass das religiös em-pathische Begegnen von Menschen, die gläubig sind, d. h. bei denen „alles eigentlich unter Religion fällt” (Schülerin ­Aishe), zu einem wirklichen Lernprozess wird, nicht nur über den Inhalt der Religion des Anderen, sondern von sich selbst, von der eigenen Religion, wie die Schülerin Rut sagt: „Genauso wie man selber in die Religion ’reinwächst, kann man auch mit Freunden in die Religion ’reinwachsen”.

Diese Aussage ist ein zentraler Punkt für das Verstehen der Intention dieses Buches, das nicht nur „exemplarisch Erfahrungswerte aus Begegnungsfeldern und Konnivenzbereichen von Kindern und Jugendlichen mit unterschiedlicher Religionszugehörigkeit” artikulieren, sondern auch „empathische Lernwege” aufzeigen möchte, um so „ein gegenseitiges Verstehen und Hochschätzen [zu] ermöglichen”.

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Dazu werden Wissenschaftler und Fachexperten verschiedener religiöser und akademischer Herkunft zur Hilfe gerufen, deren Beiträge in drei thematisch getrennten Kapiteln eingeordnet sind. Das erste Kapitel (Interreligiosität und Empathie) kann als „theoretischer Teil“ beschrieben werden, wo die beiden Schlüsselbegriffe, Interreligiosität und Empathie, analysiert und kontextualisiert werden. Besonders nützlich ist der Aufsatz von Klaus von Stosch über die „Empathie als Grundkategorie einer Komparativen Theologie“, da er das oft diskutierte comparative Theology mit Hellsichtigkeit und Gründlichkeit vorstellt, und darüber hinaus einen Weg aufzeigt, wie Empathie akademisch im Kontext von Religion und Glaube ergreifbar sein könnte. Theo Sundermeier (‘Empathie und Dialog’) und Manfred Riegger (‘Empathie und Wahrnehmung’) fassen zielstrebig und sachlich die weiten Horizonte des Problemfeldes der Empathie. Der dieses Kapitel schließende Beitrag von Peter Schreiner zeigt wichtige und praxisorientierte Gesichtspunkte ‘Zur Diskussion um interreligiöse Kompetenz’ auf (Untertitel: ‘Anmerkungen zu aktuellen Konzeptionen und Projekten’).

Das zweite Kapitel (‘Konkretisierungen einer empathischen Wahrnehmungund Begegnungsdidaktik’) wirft das dritte wichtige Konzept, den Begriff von „Trialogität“ auf, der sich auf die dreifache Begegnung von Judentum, Christentum und Islam bezieht, um so die zweiseitige Perspektive des Dialogs auf einen dreiseitigen „Trialog“ zu eröffnen. Das macht den Lesern nochmals bewusst, dass die Realität unseres alltäglichen Lebens nicht mehr mit dem einfachen Schema des Ich–Du, oder besser gesagt mit dem Wir–die Anderen zu beschreiben ist, da selbst „die Anderen“ vielfach und untereinander dialogisierend sind. Diese Situation wird manchmal in den Schulen und an den Universitäten noch intensiver spürbar, als in den Gebieten des Erwachsenendaseins, der Arbeit, des „Zuhause“, wo man sich leichter distanzieren, sogar isolieren kann. In diese trialogische Schulwelt gewährt die Studie von Clauß Peter Sajak einen Einblick (‘Interreligiöse Kompetenz entwickeln: Perspektiven für ein trialogisches Lernen’), die mit der Beschreibung eines Schulwettbewerbs (‘Trialog der Kulturen’) beginnt, und gleich am Anfang aufzeigt, dass die Interkulturalität im Erfahrungsfeld der Studenten auch eine Interreligiosität bedeutet (wie es an den Projekten des Wettbewerbs zu messen ist). So kommt er zu dem Schluss, dass das trialogische Lernen als Kompetenzentwicklung anzusehen ist (und Empathie zählt zu den wichtigsten Kompetenzen in diesem Kontext). Als eine symbolische Figur dieser Trialogität kann Abraham, der Vater der drei großen monotheistischen Religionen gelten. Der Beitrag von Havva Engin (‘Wie viel bzw. welche religiöse Grundbildung benötigen heterogene Einwanderungsgesellschaften? Eine Annäherung aus der inter- bzw. transkulturellen Perspektive’) geht von den statistischen Angaben (und den mit denen verbundenen menschlichen Erfahrungen) Deutschlands aus, und aufgrund der gegebenen Heterogenität für die interreligiöse Handlungskompetenz der Lehrkräfte und eine alle Studierenden ansprechende Diskussion über (religiöse) Wertefragen und Moralvorstellungen eintritt. Gwen Bryde (‘Über die Verletzung religiöser Gefühle und über das Gefühl der Verletzbarkeit als Chance’) macht eine

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sensible Frage zum Thema ihres Schreibens, und zeigt darin nicht nur die Gefahr, sondern auch die (pädagogische) Chance auf.

Das dritte und letzte Kapitel des Buches befasst sich mit den ‘Perspektiven für einen trialogisch orientierten Religionsunterricht’. Da geht es um tiefe und gründliche Pädagogik und um die pädagogische Praxis, die in unseren Schulen zu erwünschen wäre. Brydes Thematik wird von Joachim Willems weitergeführt (‘Die Bearbeitung interreligiöser Überschneidungssituationen als Aufgabe eines interreligiös orientierten Religionsunterrichts’), das Thema des ersten Kapitels auch mit dem Beitrag von Herbert Stettberger entfaltet (‘Interreligiöse Empathie – miteinander voneinander lernen’). Karlo Meyer reicht eine helfende Hand den (Religions) lehrern mit seinen ‘Methodischen Überlegungen zur Einfühlung in fremde religiöse Traditionen – Chancen, Probleme und angemessene Wege’. Seine Folgerung – die Schwierigkeiten, sogar Unmöglichkeiten des Sich-in-die-religiöse-Erfahrung-desAnderen-Einfühlens nicht verschweigend – legt konstruktive Wege dar, die praktisch didaktisch-methodische Möglichkeiten sind. Daniel Krochmalnik (‘Trialog der Religionspädagogen’) weist auf einen wichtigen Punkt hin: hier soll es nicht nur um die Studenten, sondern auch um die Lehrkräfte, ihre Empathie, ihre trialogische Grundeinstellung gehen.

Das Buch von Herbert Stettberger und Max Bernlocher bietet keine theologische Tiefanalyse der Interreligiosität oder detaillierte philosophische bzw. psychologische Beschreibung der Empathie dar – das war auch kein Ziel dieses Projektes.

Fragen werden uns gestellt, Erfahrungen dargestellt, teils auswertet, teils sollen sie zur weiteren Diskussion motivieren. Das ist aber in dieser Hinsicht das Wichtigste: einen trialogischen Weg zu beschreiten, uns der Bedeutsamkeit aber auch der Schwere dieses Weges bewusst zu machen, und dessen Konsequenzen für die Praxis zu ziehen. In einer Welt, wo der Religionsunterricht einerseits immer stärker konfessionell charakterisiert, andererseits immer neu in den Mittelpunkt der Kritiken gestellt wird, ist dieser Band von hoher Bedeutung. Er gibt keine fertigen, geschlossenen Antworten, er stellt keine ausschließliche Methode vor, aber er beleuchtet und zeigt die Sackgassen und neuen aussichtsvollen Routen auf, und dadurch leistet er einen wertvollen Beitrag im Feld der Religionspädagogik.

Referenzen Kasper, W. (2015) Die Barmherzigkeit: Grundbegriff des Evangeliums – Schlüssel christlichen Lebens (Freiburg: Herder).

Stein, E. (1916) Zum Problem der Einfühlung (PhD Diss., Universität von Freiburg i.Br., Freiburg i.Br.).

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European Journal of Mental Health 11 (2016) 173–179 DOI: 10.5708/EJMH.11.2016.1-2.Rev.6

Médea Kis

AN ENCOUNTER OF TWO WORLDS The Intercultural Aspects of Helping Relationships Merle, K., ed. (2013) Kulturwelten: Zum Problem des Fremdverstehens in der Seelsorge (Münster: LIT) 344 pp., 23.5 x 16 cm, ISBN 978-3-643-11629-1, € 34.90.

1. Introduction The book edited by the German theologian Kristin Merle highlights the complicated structure of interpersonal understanding. The editor of the book, who represents the empirical renewal of pastoral theology and also authored part of the volume, carefully chose her co-authors, each from a different applied field. The book revolves around the subject of interculturality, and the authors make it clear that the meeting of two people really means an encounter between two different worlds.

In the 1970s a new question arose (Carter 1991): what is the role of cultural values in a certain group concerning the success of a helping relationship between two people? Four factors were found significant when studying the impact on interpersonal relationships: the values represented by the client, the values the counsellor was driven by, their assumptions about the problem, and the institutional possibil­ ities and limitations of the helping relationship. That means that counsellors living in a culturally closed, ‘encapsulated’ environment can only understand their client if they have a clear self-understanding and know well their own social and cultural background, the source of their experiences and the reasons why they belong to a group with certain values. It is important that they are aware of the patterns and stereo­types that determine their view.

More than ten years ago Schneider-Harpprecht (2002) raised the question about the adequate way of helping someone from a different culture, religion, or with special living conditions. According to him, special intercultural competence is needed to achieve that goal. Without such intercultural competence, we cannot even fully understand the person living next to us. In order to achieve this empathic attitude, we need to handle consciously the other person’s unfamiliar, different personality, characteristics and situation. The volume offers contributions written in that conceptual framework and illustrated by case studies, stemming from the Christian tradition, of person-centred pastoral counselling.

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2. The intercultural relationship of counsellor and client Interculturalism means the colourfulness and difference in views and behaviour occurring during the contact of two people representing different cultures (Niedermüller 1999). A person coming from a foreign environment can have difficulties in her work, in her private sphere, in her ecclesiastical and educational life, during her stay in a hospital, or concerning the environment in which she lives. Given that in such cases the risk of isolation and exclusion is really high, the main aim of the studies in the book is to encourage the adequate communication of those who help them.

Authentic experiences shared by authors urge us to improve the theory and practice of poimenics. Jesus turned to those who asked for help, seeing their belief, past and circumstances, and his love resulted in a change of their conditions. In ­order to give assistance effectively, we need to consider the social background of the strangers as much as we can, keeping in mind the guidance of the Old and New Testament (Ex 22:20, 23:6.9; Heb 12:22), according to which foreigners are also ‘fellow citizens with the saints and of the household of God’ (Eph 2:19).

3. The structure and content of the book Will the counsellor be able to see the multiple perspectives in the conversation as an opportunity, or will she see it as an obstacle to perfect understanding? According to the preface of the book, the hermeneutical issue of understanding strangers raised by Gadamer (1960) is a constant challenge for pastoral counselling.

The book is divided into three main units. The first section (15–112) draws up a coordinate system of spirituality and the philosophy of culture. In each study the authors compare two different areas of research, and the reader realises that knowing one of them necessarily makes the other unknown. However, as Merle points out in the first chapter (15–34), a place, person or time being unknown is not its characteristic, it is just a factor showing the relationship between the two participants, and this factor is characterised by the presence of both closeness and distance. The trust or distrust felt towards the stranger determines whether one feels the other distant, inscrutable, mysterious, frightful or dangerous. When one reacts to strangers with a particular behaviour, they can keep a distance, show exclusion or hostility, and they name the barriers between them language, lifestyle or views. The degree to which the other feels alien determines how well we can accept and get to know the other as an individual. If the cultural traditions and values are different, understanding each other can be difficult at every level. This way, understanding another person is just a construction in our minds that can get close to reality but can never fully reach it. Communication is the only way to get closer to understanding each other, even if the true nature of the stranger is never revealed.

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Wilhelm Gräb’s paper (35–54) deals with the difficulty of interpreting the concepts of religion, belief and spirituality. Due to the fading meaningfulness of church language, rites and symbols, the forms of expressing beliefs become individual for everyone. But society cannot give up on the instruments of religion. Spirituality helps the individual to place herself in a broader context. In order to understand the other, it is essential to reconsider the religious, spiritual and sociological concepts – warns Regine Herbrik in the next essay (55–73).

Gerd Sebald (75–86) highlights that during the conversation of two people who are strangers to each other, the personal space and environment determines individual interpretations. To find meaning, the other person’s words, tone, mimics and gestures serve as a basis, but later on, the interpreter can only rely on her own schemes and explanations. In life, people permanently exchange their objective and subjective experiences and interpretations. It makes interpersonal communication more effective in understanding the stranger if these interpretation patterns are somewhat similar. The immediate environment, the family, a group or a relationship determines the reactions, the background and the sensitivity of an individual.

The sphere of ‘us’ surrounds and influences the sphere of ‘me’. Jörg Metelmann (87–112) analyses this phenomenon in the study closing this section. In connection with a television film, Toter Mann (‘Dead Man’) dealing with a revenge fantasy, he shows the standardised patterns of emotions like revenge, punishment and repar­ ation from the point of view of the victim. With the help of this example, he points out how emotions generated by the media verify and make people aware of their emotions and reactions, morals and values.

The second main section (115–271) deals with certain special areas of pastoral counselling. It not only discusses the temporary environments of hospital, school, prison, circus, airport and holiday resort, but also explains the special context of personal stories created by online communication, trauma and grief. The authors reflect on their own dedicated work, in the role of both participant and observer, and try to find their own explanation to the experiences of the client.

Tabitha Walther’s exemplary study (115–32) explains that being in a hospital is a typical situation of feeling alienated because people experience alienation on all levels. However, the counsellor’s goal of reducing the suffering is not unattainable.

Through the guidance of universal symbols, we can reach the universal source of cultures and beliefs that connect all of us humans together.

Thomas H. Böhm (133–50) explains the connecting force of virtual networks.

Online communication offers new forms of counselling relationships in which we need to re-evaluate the scale of closeness/directness and distance/anonimity. Even the smallest efforts may result in responses, and we can reach those who are far from actual supporting communities. Through virtual space, we can also reach those who are dissatisfied with reality and real conditions (Lk 14:23).

‘I had achieved little that I had wanted, and everything that I had achieved

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I had ceased to want’1 says the nameless heroine of Marlen Haushofer’s novel, The Wall (1990, 50). Maike Schult (151–70) uses this character to show the state of mind when one feels the trauma of the barriers of their personal world. When self-explanations do not work and values are questioned, it is especially import­ ant to place the strange, traumatic experience into a biographic context. Pieces of literature and stories of the Bible can show some alternative for sufferers in their own personal life.

Henrik Simojoki (171–86) explores the problem of hybrid identity in a school environment. He wants to find interculturally competent experts to help the children and teenagers who belong to several worlds but cannot find their place in any of them. The integration of migrants is essential to make them familiar with, and accept, those feelings that they experience as foreign in themselves. They need to find a coherent identity despite the fact that they were forced to leave their home or change their religion.

In contrast to these, the careers of comedians, showmen and street musicians ­depend on this state of being mediators – as Bernard Eisel explains in his eth­nography (187–204). The sociocultural background of travelling circuses is really unique. What is special about them is that they accept being a stranger and not having a permanent home. It is a consciously maintained minority culture with its own language, familial structure, special rules and regulations. The microcosm of these people is a great example of the increasingly common phenomenon that a group’s values and views totally differ from those of the counsellors who want to help them.

Airport chaplain Kerstin Söderblom puts an emphasis on the need to respect and accept differences (205–24). The terminal, she suggests, serves as a temporary area (intermediate space) where events that already happened and events that will happen co-exist. Assisting passengers often requires the skill of travelling between worlds, cultures, and religions, which competence can only evolve if we know our own background and past, and if we have broad knowledge professionally and in terms of religion.

Martin Krauß (225–42) reports from a prison, which is an extremely important place for pastoral counselling. The space is limited there, and we need to distinguish between the person and his actions, the actual sin and the feeling of animosity, the punishment and a chance to start again. The feeling of alienation by society’s outcasts is both objective and subjective. The journey to understand them, according to the author, is similar to a pilgrimage: it requires persistence, continuity and a sense of purpose. It is essential to respect the stranger. The spirit of the counsellor cannot be hidden from the prisoners. It necessarily shows itself in the results he achieves, whether the internal barriers of his clients collapse or are strengthened.

Cäcilie Blume’s contributioon (243–58) explores another special aspect of feeling alienated. Funerals are supporting opportunities when church life and personal 1

riginal text: ‘Ich hatte wenig erreicht von allem, was ich gewollt hatte, und alles, was ich erreicht hatte, hatte O ich nicht mehr gewollt’ (154).

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life intersect. In the traditional liturgical framework of a church funeral, the favourite music of the deceased can appear as something out of place if it is a folk song or a pop song. But even if the personal choice of the relatives seems strange or of a different taste, the unfamiliar feeling caused by the music can still be overcome. The pastor or the congregation who know their own musical ‘mother tongue’ should see no threat if a situation with strong personal involvement asks for a different, rather special musical relief.

Klaus Nagorni’s study (259–71) focuses on experiences beyond everyday life: the joy of being on the road, leaving the world of limited opportunities, finding a new reality and the happiness of transformation. The tourist who dares to leave behind their familiar environment for a while is inspired to get to know and accept the stranger inside them.

The third main section (275–335) offers summarising studies of theology, cultural anthropology and psychology in order to understand the feeling of being a stranger. As Otmar Fuchs, a follower of prophetic counselling, points out, we can only leave our regular life at a point when the extraordinary makes its way into normality (275–98). We can only see reality when we try something totally different.

Birgit Weyel (299–312) believes that psychological counselling is always intercultural. It is clear that the background and experiences of the counsellor and the client are totally different, and the personal life story determines how one sees the world.

Psychological counselling means the reciprocal exchange and sharing of personal meanings. The person who requires help should always be treated during the conversation as an equal partner who is competent to make decisions about his or her own life even in times of crisis. In the concluding chapter of the book, Helmut Weiß (313–36) emphasises that a counselling relationship always means reflecting on different perspectives. There are different forces of language and content, body and emotions, historical and personal experience, partners and relationships. Dynamics of different cultures and religions appear in every meeting. A competent counsellor traces these motions and makes them conscious during the dialogue, relying on the resources that the client shares with them.

4. The validity and relevance of intercultural approach Interculturality has been an important aspect of religious life since Biblical times. It is the responsibility of every Christian believer. It can be found in different forms of communication when believers pray, sing or dance together, in the collective rituals of serving God, in setting the special frames of catechesis, and in helping those in need. Intercultural attitude always needs and brings a broader and more differentiated worldview and behaviour.

This book puts basic socio-psychological terms such as polarisation, exclusion, generalisation, preconception and stereotypes in a new, different light. Interculturally oriented professionals are aware of their own values and assumptions, EJMH 11:1-2, April 2016

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therefore they do not question the significance of values which others find import­ ant. They can deal with the problems of refusal and suppression, and by stepping out of their own comfort zone, they dare to use the techniques and methods which are effective between different denominations, religions and cultures. Intercultural competence means, both in the case of an individual and of a community, that participants are able to enhance the similarities and make them the basis of the dialogue while they can also respect and accept their differences. In the practice of psychology it means that not only the client’s problem but also the setting, the ‘Sitz im Leben’ of the meeting has a multicultural context. System-oriented intercultural psychology focuses on changed situations in life and tries to find value-oriented behavioural alternatives. It examines barriers, roles and influential positions from several angles. In order to find our connections again, we can hold on to simple sentences, symbols and rites. If we understand the important events of personal life, that gives birth to new, healing narratives.

However, when we deal with the differences of cultural background that determine communication, we should not forget about the basic principles of a helping relationship as articulated by Carl Rogers in 1954 (Patterson 2004). Respect towards the patient, the assumption that they know their own problem best and that they are capable of progress, and also the counsellor’s authenticity and skill for empathic understanding are the key factors in psychotherapy because these work with every type of client.

5. Who would we recommend the book to?

For practising counsellors, this book gives an opportunity to reconsider their views and attitudes that might have become routine. For those who are still learning, it can help in finding the way to face their own inner obstacles, schemes and generalisations. The goal is not to unite world religions or even denominations but to preserve and maintain Christian patience and the skill to communicate (Schweitzer 2012). The message of this book can help in the field of social service, in pastoral counselling and in cultural service. Intercultural thinking invisibly trickles into the reader’s mind.

References Carter, R.T. (1991) ‘Cultural Values: A Review of Empirical Research and Implications for Counseling’, Journal of Counseling and Development 70, 164–73.

Gadamer, H.-G. (1960) Wahrheit und Methode: Grundzüge einer philosophischen Hermeneutik (Tübingen: Mohr).

Haushofer, M. (1990) The Wall, trans. Shaun Whiteside (Pittsburgh: Cleis).

Niedermüller, P. (1999) ‘A kultúraközi kommunikációról’ in I. Béres & Ö. Horányi, eds., Társadalmi kommunikáció (Budapest: Osiris) 96–113.

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Patterson, C.H. (2004) ‘Do We Need Multicultural Counseling Competencies?’ Journal of Mental Health Counseling 26, 67–73.

Schneider-Harpprecht, C. (2002) ‘Was ist Interkulturelle Seelsorge? Eine praktisch-theologi­ sche Annäherung’ in K. Federschmidt, E. Hauschildt, Ch. Schneider-Harpprecht, K. Temme & H. Weiss, eds., Handbuch Interkulturelle Seelsorge (Neukirchen-Vluyn: Neukirchener) 38–62.

Schweitzer, F. (2012) ‘Interreligiöse Kompetenz als Voraussetzung evangelischen Bildungshandelns und als Herausforderung der Praktischen Theologie’ in H. Rupp & S. Hermann, eds., Bildung und interreligiöses Lernen: Jahrbuch für kirchliche Bildungsarbeit 2012 (Stuttgart: Calwer) 29–38.

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European Journal of Mental Health 11 (2016) 180–181 DOI: 10.5708/EJMH.11.2016.1-2.Rev.7

Norbert Mette

BIOETHIK UND KLINIKSEELSORGE VOR DER HERAUSFORDERUNG DES PLURALISMUS Haker, H., G. Wanderer, & K. Bentele, Hrsg. (2014) Religiöser Pluralismus in der Klinikseelsorge: Theoretische Grundlagen, interreligiöse Perspektiven, Praxisreflexionen (Berlin: LIT) 21 cm, 434 S., ISBN 978-3-643-11961-2, € 39,90.

Dieser Sammelband, hervorgegangen aus einer internationalen Tagung, die 2010 in Frankfurt am Main im Rahmen des Projekts „Medizinethik in der Klinikseelsorge“ durchgeführt worden ist, ist zwei miteinander zusammenhängenden thematischen Schwerpunkten gewidmet, deren Behandlung in vier Teile untergliedert ist: Beim ersten Schwerpunkt geht es um ethische Fragestellungen, die sich speziell im medizinischen Bereich stellen, beim zweiten um die Krankenhausseelsorge. Die Perspektive aus Religion – bzw. genauer: aus verschiedenen Religionen – heraus verbindet die beiden Schwerpunkte. Zusätzlich werden in gediegener Weise Theorie und Praxis aufeinander bezogen. Anlass zu den Erörterungen gibt die Tatsache, dass die religiöse Pluralität als ein Kennzeichen der (post)modernen Gesellschaft Auswirkungen auch in der Medizin als Wissenschaft sowie in der medizinischen Praxis zeitigt. Auf der einen Seite halten die enormen Erkenntnisgewinne in den Lebenswissenschaften, vorab der Biologie, und die daraus erwachsenden Möglichkeiten der Behandlung von Krankheiten bzw. deren Prävention vermehrt zu einer ethischen Reflexion darüber an, was von dem, was von der Forschung her gesehen möglich ist, verantwortbar zur praktischen Anwendung gebracht werden kann. In ihrem instruktiven Einleitungsbeitrag erörtert die Theologische Ethikerin Hille Harker die Problematik, die sich daraus ergibt, dass einerseits die sich säkular verstehende Bio- und Medizinethik auf für sie grundlegenden Annahmen normativer Art – insbesondere bezüglich des Menschenbildes – aufruhen, die alles andere als weltanschauungsfrei sind, sodass eine im weiteren Sinn verstandene religiöse Dimension bei der Urteilsbildung und Entscheidungsfindung sehr wohl eine Rolle spielt. Andererseits lässt es die vorfindliche Pluralität in diesem Bereich nicht länger zu, sich auf eine bestimmte Religion als die maßgebliche zu beziehen. Dass die Einbeziehung der religiösen Dimension auch bei der Behandlung Kranker Beachtung verdient, wird seit einiger Zeit innerhalb der Medizin verstärkt bewusst. Das hat der in der Vergangenheit oft in den Krankenhäusern eher am Rand stehenden Krankenhausseelsorge zu einer größeren Anerkennung und Wirksamkeit verholfen. Traditionell wird sie – jedenfalls im deutschsprachigen Raum – von den beiden christlichen Großkirchen verantwortet.

Vermehrt wird es jedoch dringlich, bei der seelsorglichen Begleitung (spiritual care) auch jenen Kranken gerecht zu werden, die einer anderen Religion angehören oder

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sich als nicht religiös verstehen. Damit ist das inhaltliche Spektrum umrissen, das in den verschiedenen Beiträgen dieses Sammelbandes erörtert wird.

Im ersten Teil geht es um theoretische Grundlagen im Verhältnis von Bioethik und Religion. Neben dem erwähnten Grundsatzbeitrag von Hille Haker über „Religiöser Pluralismus in der Bioethik“ und den sich daran anschließenden Artikel von Julia Inthorn über „Kulturelle und religiöse Unterschiede als Thema der Medizinethik“ kommen eigens muslimische (Abdulaziz Sachedina), buddhistische (­ Damien Keown), jüdische (Lilian Marx-Stölting) und hinduistische Perspektiven (Dagmar Wujastyk) zur Sprache.

Die drei Beiträge des zweiten Teils handeln über „Interreligiöse Konzeptionen der Klinikseelsorge“: eine Erörterung zum Verhältnis von Krankheit, Sterben und Religion (Bernhard Dörr); multireligiöse Krankenhausseelsorge in praktisch-theologischer Perspektive (Tabitha Walther); Entwicklung kultureller Kompetenz in der Klinikseelsorge (Cheryl Giles).

Im dritten Teil werden ausgewählte „Interreligiöse ethische Fragestellungen“ erörtert: die Frage, ob der Exorzismus ethisch zu rechtfertigen ist (Barbara WolfBraun); der Umgang mit muslimischen Patientinnen und Patienten im Krankenhaus (Carla Amina Baghajati); die Gemeinsamkeit und Differenz von evangelischer und katholischer Seelsorgepraxis und -ethik im Krankenhaus (Reinhard Gilster).

Im vierten Teil sind insgesamt neun „Berichte und Praxisreflexionen“ zu verschiedenen Aspekten der Krankenhausseelsorge zusammengestellt. Sie ermöglichen einen vielfältigen Einblick in Modelle interreligiöser Praxis und die damit bisher gemachten Erfahrungen samt den Fragen, die sich dabei einstellen. Ein Schwerpunkt richtet sich auf die Frage der Ausbildung zur Seelsorge mit kranken Menschen.

Für alle, denen eine zukunftsträchtige Krankenhausseelsorge, die der Tatsache der religiösen Pluralität gebührend Rechnung trägt, ein Anliegen ist und die darüber hinaus sich über das ethische Problemfeld, das sich in diesem Kontext auftut, Gedanken machen möchten, stellt dieser Sammelband eine ergiebige Fundquelle zur Verfügung.

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European Journal of Mental Health 11 (2016) 182–187 DOI: 10.5708/EJMH.11.2016.1-2.Rev.8

Olaf Müller

ZWISCHEN ANSPRUCH UND WIRKLICHKEIT: WERTEFORSCHUNG (IN ÖSTERREICH), QUO VADIS? Polak, R., Hrsg. (2011) Zukunft. Werte. Europa: Die europäische Wertestudie 1990–2010: Österreich im Vergleich (Wien, Köln &Weimar: Böhlau) 341 S., 24 cm, ISBN 978-3-205-78732-7, € 35.

(Unter)titel und Klappentext des von Regina Polak herausgegebenen Sammelbandes versprechen einen Überblick über die Wertelandschaft in Österreich im europäischen Vergleich auf der Basis der Daten der Europäischen Wertestudie (EVS). Der Leser darf mithin eine Bestandsaufnahme der vorgefundenen Wertmuster hinsichtlich verschiedener Bereiche des Lebens und der Gesellschaft samt deren Entwicklung innerhalb der letzten zwanzig Beobachtungsjahre (1990–2010) erwarten – und wird, was viele Beiträge für sich genommen betrifft, durchaus nicht enttäuscht. Der Band enthält eine Reihe von interessanten und informativen Beiträgen und überrascht zudem mit einigen originellen Einzelbefunden. Das ist an sich nicht wenig – als Gesamtkonzept überzeugt das Buch dennoch nicht.

Aber der Reihe nach: Das Buch ist oberhalb der Ebene der einzelnen Beiträge in verschiedene Teilbereiche aufgegliedert. Der Einleitung folgt zunächst der Teil „Grundlagen“, dann ein „empirischer Überblick“, schließlich ein „Vertiefung“ genannter Teil. Den Abschluss bilden die „Perspektiven“. Die Einleitung (R. Polak) widmet sich u. a. der Erläuterung des Hintergrundes, des Ziels und der Fragestellungen der Studie. Letztere beinhalten nicht nur die Analyse des Standes, der Entwicklung und der Bestimmungsgründe der „Werteinstellungen“ der ÖsterreicherInnen im europäischen Vergleich, sondern schließen auch Fragen nach möglichen zukünftigen Szenarien und Handlungsperspektiven ein (13). Die ersten beiden Beiträge innerhalb des Grundlagenteils reflektieren Begrifflichkeiten, Möglichkeiten und Grenzen der Werteforschung aus der Perspektive unterschiedlicher Disziplinen, wobei nicht nur theoretisch-konzeptionelle, sondern auch normative und ethische Fragen zur Sprache kommen (R. Polak: ‘Grundlagenfragen und Situierung des Diskurses’; C. ­Mandry: ‘Werte und Religion im Europäischen Wertediskurs’). Die dritte Abhandlung innerhalb dieses Teils (W. Arts & L. Halman: ‘Value Research and Transformation in Europe’) bietet einen Abriss der sozialwissenschaftlichen Werteforschung im Rahmen des EVS und verbindet diesen mit einer ersten empirisch fundierten Darstellung des Standes und der Entwicklung der Wertvorstellungen in Europa. Der Bereich ‘Empirischer Überblick’ enthält Beiträge zu den Themen Familie und Partnerschaft (E. Kropf & E. Lehner), Leistungsethik und Arbeit (C. Scheid & K. Renner), Demokratie, Politik und Migration (S. Rosenberger & G. Seeber) sowie Religiosität

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(R. Polak & C. Schachinger). Die „Vertiefungen“ widmen sich den Fragen ‘(Groß) Städte in der Wertelandschaft’ (J. Dangschat), ‘Familienkulturelle Modelle zu Geschlechterrollen und Kinderbetreuung’ (B. Pfau-Effinger) sowie ‘Migrationshintergrund als Differenzkategorie’ (B. Perchinig & T. Troger).

Im Rahmen einer Rezension eines Sammelbandes können nicht alle Einzelbeiträge umfassend diskutiert werden. Hervorgehoben werden soll an dieser Stelle der Beitrag von Arts und Halman, der in systematischer und gut nachvollziehbarer Weise die theoretisch-konzeptionellen Grundlagen des EVS inklusive diverser Perspektivverschiebungen zwischen den einzelnen Wellen aufzeigt und anhand einer Replikation der ursprünglich von Hagenaars und seinen Kollegen (2003) entwickelten allgemeinen europäischen „Wertekarte“ (basic values map) einen aktuellen Einblick in die europäischen Wertemuster gewährt. Dem Vorhaben des Sammelbandes Rechnung tragend, steht Österreich dabei besonders im Fokus. Was das entsprechende Werteprofil seiner Bevölkerung betrifft, so siedelt sich Österreich im europäischen Vergleich mehr oder weniger „in der Mitte“ an. Dies traf schon in Bezug auf die „klassischen“ Inglehartschen Unterscheidungen zwischen religiös-traditionalen und rational-säkularen Orientierungen (religious-traditional vs. rational-secular) sowie Überlebens- und Selbstentfaltungswerten (survival vs. self-expression) zu (95; vgl. auch Inglehart & Welzel 2005) und gilt im Wesentlichen auch für die neuere Version von Hagenaars und seinen Kollegen, die zwischen den Faktoren „Autonomie – sozialer Liberalismus“ (autonomy – social liberalism; steht u. a. für die Wertschätzung von persönlicher Autonomie, die Emanzipation der Frau, Toleranz gegenüber anderen ethnischen Gruppierungen, sexuelle Selbstbestimmung, Befürwortung demokratischer Prinzipien und hohes Umweltbewusstsein) und „normativ-religiös“ (normative-religious; charakterisiert etwa durch überdurchschnittliche Religiosität, Betonung der Institutionen Ehe und Familie, Ablehnung von Abtreibung, Befürworten von Autoritäten, Vertrauen in Institutionen, Ablehnung von illegalen Aktionen und hedonistischem Verhalten) unterscheiden. In Bezug auf die beiden letztgenannten Dimensionen ähnelten die ÖsterreicherInnen um die Jahrtausendwende in ihren moderaten Positionen den Befragten in Belgien, Frankreich, Deutschland, Großbritannien, Slowenien und Kroatien und waren auch zuletzt, so die Schlussfolgerung für das Befragungsjahr 2008, weniger normativ-religiös orientiert als die Menschen in Südeuropa und in den meisten osteuropäischen Ländern, aber strikter als die Befragten in den nordeuropäischen Staaten (95).

Dass Österreich in Bezug auf die Wertorientierungen seiner Bevölkerung in vielerlei Hinsicht „unauffällig“ im europäischen Durchschnitt liegt, zeigt sich teilweise auch im Beitrag von Rosenberger und Seeber. Anders als bei der auf allgemeinere Werte abzielenden basic values map fand sich Österreich mit Blick auf die Werte und Einstellungen gegenüber der Politik und der Demokratie zuletzt (2008) aber hier interessanterweise vorrangig in Nachbarschaft zu Ländern wie Finnland, Italien und Griechenland wieder (was sich, insbesondere hinsichtlich der weniger stabilen Einstellungen etwa zur Performanz des politischen Systems, vor dem Hintergrund der Auswirkungen der jüngsten Finanz- und Wirtschaftskrise in den einzelnen LänEJMH 11:1-2, April 2016

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dern inzwischen geändert haben mag). Als österreichisches Spezifikum machen die Autoren ein durchgängig hohes politisches Interesse aus, was sie aber auch darauf zurückführen, dass just zu allen drei Befragungszeitpunkten des EVS Nationalratswahlkämpfe stattgefunden haben, die die entsprechenden Werte möglicherweise kurzfristig nach oben getrieben haben (174). Für diese These spricht, dass dieses hohe Interesse nicht mit einer entsprechenden Bereitschaft zur politischen Partizipation korrespondiert (173ff.). Eine zweite Beobachtung lässt dann doch aufhorchen: Auch wenn sich Österreich damit dem europäischen Niveau nur „verspätet“ anzunähern scheint und die Tendenz auch vor dem Hintergrund der nach wie vor überwältigenden allgemeinen Zustimmung zum Prinzip der Demokratie (1999: 96 %; 2008: 92 %) keinen akuten Anlass zur Besorgnis um die Systemstabilität liefert, erweisen sich der überdurchschnittlich starke Rückgang der Zufriedenheit mit der Demokratie (1999: 77 %; 2008: 53 %; im Vergleich Westeuropa insgesamt: 1999: 58 %; 2008: 49 %) und der überdurchschnittlich hohe Anstieg in Bezug auf den Wunsch nach einem starken Führer zwischen 1999 und 2008 als weitere Besonderheiten. Inwieweit dies tatsächlich nur eine Angleichung an den europäischen „Normalzustand“ nach langen Zeiten der „Hyperstabilität“ darstellt (187), muss abgewartet werden. Besorgniserregend ist in jedem Fall der gleichzeitige starke Anstieg von vorurteilsbeladenen Einstellungen gegenüber Migranten allgemein und Muslimen im Besonderen, die Österreich mittlerweile in Westeuropa den unrühmlichen Spitzenplatz in dieser Kategorie eingebracht haben (182–83).

Die Frage, inwieweit das um sich greifende Unbehagen gegenüber dem zunehmenden ethnischen und religiösen Pluralismus (und besonders gegenüber dem Islam) auch auf ein Gefühl des Verlustes der „eigenen“ kulturellen und religiösen Grundlagen zurückzuführen ist, ist bisher noch kaum systematisch untersucht worden, erscheint angesichts der auch im Beitrag von Polak konstatierten „Erosion kirchlich-gebundener Religiosität“ (195) aber durchaus berechtigt. In Bezug auf die Interpretation des Wandels des religiösen Feldes schüttet Polak dann aber wohltuenderweise das Kind nicht gleich mit dem Bade aus und räumt gleichzeitig mit einem Mythos der zeitgenössischen (west)europäischen Religionsforschung auf: Dem Hinweis, dass Religiosität heute nach wie vor weitgehend konfessionell geprägt ist und von einer „umfassenden Entkoppelung und einem großen ‚neureligiösen‘ Feld . . . derzeit noch keine Rede sein“ kann (207), kann man nur zustimmen. Die Behauptung allerdings, dass sich die Religiosität in Europa im Langzeitvergleich länderspezifisch zwar unterscheidet, aber in den vergangenen beiden Dekaden im Großen und Ganzen eher stabil dargestellt hat (196ff.), erscheint angesichts der empirischen Befunde dann wiederum etwas zu pauschal und in Bezug auf Westeuropa auch zu „optimistisch“. Erstaunlicherweise bezieht Polak hier sogar den Kirchgang mit ein, der doch (neben der Konfessionszugehörigkeit) als einer der zentralen Indikatoren für die kirchlich gebundene Religiosität gilt, deren Erosion sie gleichzeitig feststellt.

Und ein genauerer Blick zeigt dann auch, dass in diesem Bereich teilweise dramatische Abbruchprozesse stattgefunden haben. Dies gilt für Westeuropa als Ganzes, für Österreich aber noch einmal in besonderem Maße. Schon bei den Daten, die Polak EJMH 11:1-2, April 2016

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präsentiert, verringert sich der Mittelwert des von ihr verwendeten Kirchgangindikators in sieben von neun westeuropäischen Gesellschaften, für die Daten im Zeitverlauf vorliegen (vgl. 200, Graphik 19). Noch deutlicher würde sich die Tendenz herauskristallisieren, wenn man weitere Länder bzw. Gebiete wie Spanien, Irland, Großbritannien, Island oder Nordirland einbezöge. Was Österreich betrifft, so hat sich der Anteil der (moderat) regelmäßigen Kirchgänger, die mindestens einmal im Monat den Gottesdienst besuchen, zwischen 1990 und 2008 von 44 auf 29 % verringert; der Anteil derjenigen, die zu diesem Zwecke überhaupt nicht mehr in die Kirche gehen, ist im gleichen Zeitraum von 17 auf 32 % gewachsen. Höhere bzw. ähnlich hohe Verluste hatten in diesen Jahren nur die Kirchen in Spanien, Irland und Nordirland zu verzeichnen (eigene Berechnungen auf der Basis des EVS 2008).

Diese wenigen exemplarischen Ausführungen sollten zumindest angedeutet haben, dass sich in dem Buch eine Fülle an interessanten Belegen und Aussagen findet, die zum weiteren Nachdenken und Diskutieren einladen. Dennoch funktioniert das Buch, wie am Anfang bereits erwähnt, als „Gesamtkunstwerk“ nicht. Schon in der Einleitung (R. Polak) beschleicht den Leser diesbezüglich ein ungutes Gefühl. Um das Problem zu verdeutlichen, lohnt sich ein längeres Zitat. So heißt es wörtlich: m die Stärke der Interdisziplinarität zu fördern, wurde den AutorInnen die Wahl der theoU retischen wie methodischen Annäherung an die übergreifenden Fragestellungen weitgehend freigestellt. Dies führt zu gewissen Widersprüchen und Differenzen zwischen den einzelnen Beiträgen. . . . Die themenspezifisch konkretisierten Fragestellungen, die fachlichen Zugänge, Interessenslagen und Einschätzungen der ExpertInnen für die einzelnen Themenbereiche erwiesen sich nach einer ersten gemeinsamen Ergebnisanalyse als sehr heterogen.

(13–14)

Ob diese Anmerkungen nun als besonderer Ausdruck wissenschaftlicher Redlichkeit und Selbstkritik oder aber als Versuch, hier eine Schwäche als Stärke zu verkaufen, gelesen werden müssen, mag jeder selbst entscheiden. Auf jeden Fall kontrastiert diese Einschätzung, die m. E. das zentrale Problem des Bandes treffend auf den Punkt bringt, auf merkwürdige Weise mit den weit ausgreifenden und anspruchsvollen Forderungen, die in den beiden Grundlagenbeiträgen von Polak und Mandry an die Werteforschung herangetragen werden. Hier werden Maßstäbe angelegt, die aus der jeweiligen philosophischen, ethisch-normativen, geschichtswissenschaftlichen oder theologischen Perspektive durchaus ihre Berechtigung haben mögen; in ihrer Massivität überfrachten diese Anforderungen die „konkrete“, empirische Werteforschung aber derart, dass sie nur daran scheitern kann. Zwar deutet Polak mit ihrem Plädoyer für einen „transformationstheoretischen“ Zugang zur Interpretation des Wertwandels (39ff.) einen alternativen Zugang an; dieses Konzept bleibt jedoch zumindest im Rahmen der Ausführungen in diesem Band ziemlich vage (die Autorin bezeichnet es selbst als „noch nicht . . . ausgegoren“; 46) und lässt sich zudem in praktisch keinem der empirischen Beiträge (den Beitrag der Herausgeberin zum Thema Religiosität eingeschlossen) wiedererkennen.

Die Freiheit, die den Autoren offenbar in jeglicher Hinsicht zugestanden wurde, führte darüber hinaus dazu, dass im Rahmen dieses Bandes auch Themen behandelt werden, die sich auf der Basis der EVS-Daten nur sehr eingeschränkt bzw. überhaupt EJMH 11:1-2, April 2016

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nicht bearbeiten lassen. Dies betrifft etwa den (vom Ansatz her zweifellos sehr interessanten und innovativen) Beitrag von Dangschat, der sich der Frage zuwendet, ob sich die (Groß)stadt, wo Modernisierungsprozesse früher und intensiver stattfinden, auch als Ort erweist, wo der Wertewandel am deutlichsten sichtbar wird (226). Aus Sicht seiner gewählten Fragestellung zwingend, aber mit wenig Gespür für die diesbezüglichen Grenzen allgemeiner Bevölkerungsumfragen fordert er dazu vom EVS eine „Repräsentativität auf niedrigerer Ebene“ ein, die er bereits zu Beginn seines Beitrages als nicht gegeben konstatiert (227ff.) – was ihn nicht daran hindert, die Daten trotzdem zu verwenden. Dass dabei mitunter die merkwürdigsten Ergebnisse herauskommen, verwundert wenig. Wenn dann praktisch alle Resultate, die den theoretischen Erwartungen zuwiderlaufen, mit frappierender Selbstverständlichkeit auf Unzulänglichkeit der Daten bzw. der Erhebungsmethode zurückgeführt werden („denn warum sonst sollten die WienerInnen so deutlich weniger Wert auf Erziehungsorientierungen legen als Menschen in den anderen Großstädten?“; 243, Fn. 45), bleibt der Erkenntniswert des Beitrages allerdings gering. Mit seiner Meinung vom EVS (und von der quantitativen Sozialforschung insgesamt?) hält Dangschat dann auch gar nicht hinterm Berg; spätestens auf Seite 248 bricht der im Laufe der Arbeit an diesem Beitrag offenbar angestaute Ärger aus ihm heraus, wenn von „teilweise in hanebüchener Weise“ abgefragten Wertekategorien, „offensichtliche[n] Fehlern im Fragebogen“, „Schlampereien in der Feldforschung“, der „mangelhaften Abbildung der Realität im Datensatz“ und überhaupt dem „Problem der als ‚objektiv‘ eingeordneten quantitativen Sozialforschung nach dem kritischen Rationalismus“ die Rede ist.

Während man im letzten Fall geneigt ist zu fragen, wer den armen Mann denn bloß gezwungen hat, im Rahmen dieses Buches und auf der Basis dieser Daten diesen Beitrag zu verfassen, ist die Entscheidung von Perchinig und Troger immerhin als konsequent zu bezeichnen: Aufgrund der offensichtlich mangelhaften Eignung der EVS-Daten für ihre Fragestellung bearbeiten sie diese gleich anhand anderer Datenbestände. Um auch hier einem Missverständnis vorzubeugen: Das Thema „Migrationshintergrund“ (bzw. genauer dessen semantische Verwendung in den Sozialwissenschaften und dessen Wirksamkeit als konstituierender Faktor für Werte und Orientierungen), dem sich die Autoren widmen, ist heutzutage selbstredend – gerade auch hinsichtlich seiner theoretischen und methodischen Bedeutung für die Werteforschung – gar nicht hoch genug einzuschätzen. Auch ist der Verweis vollauf berechtigt und wichtig, dass Personen mit Migrationsgeschichte in Bevölkerungsumfragen wie dem EVS immer noch zu wenig Beachtung geschenkt wird. Und an der inhaltlichen Argumentation und Vorgehensweise ist ebenfalls überhaupt nichts auszusetzen – der Artikel stünde einer Publikation zum Thema „Migration in Europa“ gut zu Gesicht. Aber passt er ins Gesamtgefüge des hier zu besprechenden Bandes?

Als Fazit bleibt festzuhalten: Das Buch hinterlässt beim Leser einen ambivalenten Eindruck. Auf der einen Seite enthält es überwiegend interessante, originelle und qualitativ hochwertige Einzelbeiträge; auf der anderen Seite erscheint es als Ganzes EJMH 11:1-2, April 2016

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dann eben doch „nur“ als ein weiterer „Sammelband“. Eine Klammer zwischen den sehr anspruchsvollen Überlegungen im Grundlagenteil und den empirischen Beiträgen existiert ebenso wenig wie irgendeine Verbindung letzterer untereinander. Man hätte diesen doch etwas enttäuschenden Gesamteindruck vermeiden können, indem man von Beginn an „den Ball etwas flacher gehalten“, sich wenigstens auf eine rudimentäre konzeptionelle Systematik geeinigt und zumindest die Möglichkeiten der „konventionellen“ Werteforschung besser ausgeschöpft hätte.1 Einer kritischen und fairen Diskussion des derzeitigen Konzeptes des EVS hätte dies alles nicht im Wege gestanden – nur wäre der angemessene Platz dafür ein abschließender Ausblick gewesen (und nicht schon der hinführende, einleitende Teil). Angesichts der hier vorliegenden Melange aus Grundsatzüberlegungen, mehr oder weniger unverhohlener Fundamentalkritik am EVS sowie damit weitgehend unverbundener empirischer Einzelstudien bleibt der Leser in Bezug auf den state of the art und die zukünftige Entwicklung der Werteforschung (in Österreich) doch etwas irritiert bis ratlos zurück.

Referenzen Esping-Andersen, G. (1990) The Three Worlds of Welfare Capitalism (Princeton: Princeton UP).

Hagenaars, J., L. Halman & G. Moors (2003) ‘Exploring Europ’s Basic Values Map’ in W. Arts, J. Hagenaars & L. Halman, Hrsg., The Cultural Diversity of European Unity: Findings, Explanations and Reflections of the European Values Study (Leiden & Boston: Brill) 23–58.

Inglehart, R. & Ch. Welzel (2005) Modernization, Cultural Change, and Democracy: The Human Development Approach (Cambridge, UK: Cambridge UP).

1

in Beispiel etwa für eine gelungene Verknüpfung der (aggregierten) Mikrodaten des EVS mit Makrofaktoren E stellt der Beitrag von Kropf und Lehner dar, der als eine der wenigen Ausnahmen auf einer theoriegeleiteten Länderauswahl beruht, welche sich an den Wohlfahrtsregimen von Esping-Andersen (1990) orientiert. Die Autoren können in der Folge empirisch zeigen, wie bestimmte Wertmuster mit institutionellen Gegebenheiten Hand in Hand gehen: So finden sich beispielsweise in Italien, das dem mediterranen Wohlfahrtsstaat zugerechnet wird, der auf dem family bzw. kinship solidarity model beruht, vergleichsweise hohe Zustimmungsraten in Bezug auf die Frage, ob Kinder verpflichtet sind, sich um kranke Eltern zu kümmern. In Schweden dagegen, mit seinem sozialdemokratischen Modell, das durch eine umfassendere staatliche Altenfürsorge gekennzeichnet ist, fällt die Zustimmung entsprechend geringer aus (111). Vor dem Hintergrund des unterschiedlichen wohlfahrtsstaatlichen Kontextes in beiden Ländern ist es dann auch plausibel, dass Treue in der Ehe und die Tatsache, Kinder zu haben, den ItalienerInnen als hohes Gut gelten, während die SchwedInnen diesen Aspekten einen vergleichsweise geringen Stellenwert zumessen (127).

EJMH 11:1-2, April 2016

CONTRIBUTORS TO THIS ISSUE / AUTOREN DIESES HEFTES Böőr Petra Eötvös Loránd Tudományegyetem Pszichológia Intézet H-1064 Budapest Izabella utca 46.

Hungary/Ungarn overhill25@gmail.com Prof. Jozef Corveleyn Katholieke Universiteit Leuven Faculteit Psychologie en Pedagogische Wetenschappen Klinische Psychologie Tiensestraat 102 B-3000 Leuven Belgium/Belgien jozef.corveleyn@ppw.kuleuven.be Csala Barbara Eötvös Loránd Tudományegyetem Pedagógiai és Pszichológiai Kar Egészségfejlesztési és Sporttudományi Intézet H-1117 Budapest Bogdánfy Ödön u. 10.

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Dr. Jessie Dezutter Katholieke Universiteit Leuven Faculteit Psychologie en Pedagogische Wetenschappen Klinische Psychologie Tiensestraat 102 B-3000 Leuven Belgium/Belgien jessie.dezutter@ppw.kuleuven.be Dr. Jakub Doležel Palacký University Olomouc Univerzita Palackého v Olomouci, Cyrilometodějská teologická fakulta Katedry křesťanské sociální práce Na Hradě 5 CZ-771 11 Olomouc Czech Republic/Tschechische Republik jakub.dolezel@upol.cz Lene Emanuelsen Eötvös Loránd Tudományegyetem Pszichológia Intézet H-1064 Budapest Izabella utca 46.

Hungary/Ungarn lene.emanuel@hotmail.com Dr. Földvári Mónika Család-, Ifjúság- és Népesedéspolitikai Intézet H-1134 Budapest Tüzér u. 33-35.

Hungary/Ungarn monika.foldvari@csini-int.hu Gyetvai Gellért Semmelweis Egyetem Nemzeti Rehabilitációs és Szociális Hivatal H-1406 Budapest Pf. 4.

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Dr. Kis Médea Debreceni Egyetem Népegészségügyi Kar Megelőző Orvostani Intézet H-4028 Debrecen Kassai út 26.

Hungary/Ungarn medea.kis@freemail.hu Prof. Miia Kivipelto Karolinska University Hospital-Huddinge Department of Geriatric Medicine Clinical Trials Unit Novum, Floor 5 S-141 86 Huddinge Sweden/Schweden miia.kivipelto@ki.se Dr. Köteles Ferenc Eötvös Loránd Tudományegyetem Pedagógiai és Pszichológiai Kar Egészségfejlesztési és Sporttudományi Intézet H-1117 Budapest Bogdánfy Ödön u. 10.

Hungary/Ungarn koteles.ferenc@ppk.elte.hu Dr. Agnieszka Krzysztof-Świderska Benefits of Psychotherapy Independent psychotherapy and research institution Borek Szlachecki 353 PL-32050 Skawina Poland/Polen agnesswiderska@gmail.com Dr. Jenni Kulmala Seinäjoen ammattikorkeakoulu P.O.Box 412 SF-60101 Seinäjoki Finland/Finnland jenni.kulmala@seamk.fi

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Dr. Kimmo Kuosmanen Lahden kaupunki, sosiaali- ja terveystoimiala PL 202, Aleksanterinkatu 24 B SF-15101 Lahti Finland/Finnland kimmo.kuosmanen@lahti.fi Láng András Pécsi Tudományegyetem Pszichológiai Intézet H-7624 Pécs Ifjúság útja 6.

Hungary/Ungarn andraslang@hotmail.com Kirsi Lumme-Sandt Tampereen yliopisto Terveystieteiden yksikkö SF-33014 Tampere Finland/Finnland kirsi.lumme-sandt@uta.fi Prof. Norbert Mette Technische Universität Dortmund Fakultät Humanwissenschaften und Theologie Emil-Figge-Str. 50 D-44227 Dortmund Germany/Deutschland norbert.mette@freenet.de Dr. Olaf Müller Westfälische Wilhelms-Universität Exzellenzcluster „Religion und Politik” Johannisstraße 1 D-48143 Münster Germany/Deutschland omueller@uni-muenster.de

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Prof. Aulikki Nissinen Terveyden ja hyvinvoinnin laitos (THL) P.O.Box 30 SF-00271 Helsinki Finland/Finnland Ilkka Pietilä Tampereen yliopisto Terveystieteiden yksikkö SF-33014 Tampere Finland/Finnland Ilkka.Pietila@uta.fi Dr. Regina Polak Universität Wien Katholisch-Theologische Fakultät Institut für Praktische Theologie Schenkenstrasse 8-10 A-1010 Wien Austria/Österreich Dr. Suvi Rovio Turun yliopisto Sydäntutkimuskeskus Kiinamyllynkatu 10 SF-20520 Turku Finland/Finnland suvrov@utu.fi Sági Andrea Eötvös Loránd Tudományegyetem Pedagógiai és Pszichológiai Kar Pszichológiai Doktori Iskola H-1064 Budapest Izabella utca 46.

Hungary/Ungarn sagi.andrea@ppk.elte.hu Olga Shek Tampereen yliopisto Terveystieteiden yksikkö SF-33014 Tampere Finland/Finnland Shek.Olga.X@student.uta.fi

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T. Tihanyi Benedek Semmelweis Egyetem ÁOK Magatartástudományi Intézet H-1089 Budapest Nagyvárad tér 4.

Hungary/Ungarn tihanyibenedekt@gmail.com Jobi Thomas Thurackal Katholieke Universiteit Leuven Faculteit Psychologie en Pedagogische Wetenschappen Klinische Psychologie Tiensestraat 102 B-3000 Leuven Belgium/Belgien jobithomas.thurackal@ppw.kuleuven.be Tolnai Nóra Eötvös Loránd Tudományegyetem Pedagógiai és Pszichológiai Kar Pszichológiai Doktori Iskola H-1064 Budapest Izabella utca 46.

Hungary/Ungarn tolnore@yahoo.com Dr. habil. Török Csaba Esztergomi Hittudományi Főiskola H-2500 Esztergom Szent István király tér 10.

Hungary/Ungarn cstorok@gmx.net Tróbert Anett Mária Semmelweis Egyetem Mentális Egészségtudományok Doktori Iskola H-1428 Budapest Pf. 2.

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Prof. Jaakko Tuomilehto Terveyden ja hyvinvoinnin laitos (THL) PL 30 SF-00271 Helsinki Finland/Finnland tuomileh@mappi.helsinki.fi Prof. Marinus H. van Uden Tilburg University, School of Humanities Department of Culture Studies Warandelaan 2 NL-5037 AB Tilburg Netherlands/Holland m.vuden@home.nl

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Dr. Hessel J. Zondag Tilburg University, School of Humanities Department of Culture Studies Warandelaan 2 NL-5037 AB Tilburg Netherlands/Holland h.j.zondag@uvt.nl

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© Semmelweis University Institute of Mental Health, Budapest, 2016 ISSN 1788-4934 Printed in Hungary

We interpret mental health promotion to include every effort and all manner of individual and communal endeavour to realise principles and ideals of mental health at a social level. This means approach and attitude, praxis and theory, fields of activity and institutional systems alike. This approach to mental health promotion always requires cooperation and communal efforts, these days not only between individuals, specialists and groups but also between states, nations and research groups.

East Central Europeans must therefore strive to find each other and come closer together, but certainly not at the price of the hard-won contacts between the two halves of an all too long divided continent. On the one hand, our common history, the many similarities in our past pave the way for cooperation both rationally and emotionally; on the other, we all share a vision of a truly common European future, hopes and goals that unite us. Between past and future, our situation, our problems and experiences are similar but not identical. They can mutually complement and enrich each other and contribute to the achievement of our common goals, the reduction of harmful factors and the promotion of mental health. For mutual and deep understanding, however, we must develop a common language, common forums and organs in which we can share our experiences and reflect on them together. This journal seeks to contribute to that effort with its abstracts in 9 languages in order to serve, through the emergent dialogue, a colourful and many-faceted reality which consists not so much of education, social work, health care, religion, mass media, political activity and legislation as of individuals, families, communities and societies.

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Volume 11  Numbers 1-2  April

EMERITUS PROFESSOR of clinical psychology (psychoanalysis) and psychology of religion at the KU Leuven (Belgium) and retired professor of psychology of religion at the Free University of Amsterdam (Netherlands) DR. HON. C. AT SEMMELWEIS UNIVERSITY (Budapest, Hungary) and honorary professor at Universidad Nacional Mayor de San Marcos (Lima, Peru) and Pontificia Universidad Catolica del Peru (Lima, Peru) RESEARCH INTERESTS: psychoanalysis, psychology of religion, psychological factors in situations of extreme vulnerability (poverty, family violence, structural violence)

INSTITUTE OF MENTAL HEALTH FACULTY OF HEALTH AND PUBLIC SERVICES

European Journal of Mental Health Volume 11  Numbers 1-2  April 2016

JOZEF CORVELEYN, editor-in-chief PhD in psychology (KU Leuven, 1983)

Editor-in-Chief: JOZEF CORVELEYN Honorary Editor-in-Chief: TEODÓRA TOMCSÁNYI

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SEMMELWEIS UNIVERSITY

mental health promotion  multidisciplinary approaches  individual, family, community, society