Steven L Jordan's Doctoral Dissertation

THE EFFECTS OF RELIGIOUS PREFERENCE AND THE FREQUENCY OF SPIRITUALITY ON THE RETENTION AND ATTRITION RATES AMONG INJURED SOLDIERS by Steven L. Jordan

A Dissertation Presented in Partial Fulfillment Of the Requirements for the Degree Doctor of Philosophy

Capella University March 2006

UMI Number: 3206572

UMI Microform 3206572 Copyright 2006 by ProQuest Information and Learning Company.

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Š Steven L. Jordan, Sr., 2006

Abstract Using a quantitative causal-comparative approach, the researcher conducted a relational study that compared injured and rehabilitated soldiers with no religious foundation to similar soldiers possessing religious preferences and spirituality. The two primary research questions were (a) Does religious preference and spirituality have a positive impact on the retention and attrition rates of injured soldiers? (b) Does an injured soldier’s frequency of spirituality increase the likelihood of being returned to initial-entry training? The study addressed several possible variables; among these were the importance of religious preference and spirituality in returning injured soldiers to training; the determination of a soldier’s level of spirituality and its healing impact; spirituality’s effect on the injured soldier’s psychotherapy, and other related demographic factors.

Dedication Dedicated in loving memory to Lawrence and Wilma Herron, my wife’s parents, and John P. Shaw, my grandfather, and to my mother, Eleanor Shell and my father, Joseph Jackson, I am grateful to all you for my family legacy.

Acknowledgments I want to express appreciation to numerous individuals who contributed to this study.

First, I offer my sincere appreciation to the unknown participants whose data was used during this study to richly enhance our knowledge and understanding of the importance of religious preference and spirituality.

To the dissertation committee members, M. Nicholas Coppola, Manual Woods, Jim Poindexter and Shante Moore who encouraged self-reliance and self-discovery, who communicated positive affirmation for my chosen direction and valued my efforts, who occasionally corrected my course and always celebrated my achievements, I am truly grateful to each of you. And, to all of the Capella professionals like Thomas (Bill) Clyburn and Charles Tiffin who provided their adult learners’ selfless service, I am indebted to you both.

Finally, I wish to thank my family for all their love and support. I thank my mother for her sincere prayers for me and her words of encouragement. And, I thank my adult daughter and two younger children for their unwavering love. I am especially grateful to my wife who, while serving on active duty with the Air Force, and pursuing a doctoral degree herself, not to mention the additional responsibilities of raising young children and serving our church family, she also willingly and cheerfully served as a proof-reader and editor. I could not have done this without her.

Table of Contents Acknowledgments List of Tables List of Figures CHAPTER 1: INTRODUCTION

iv viii x 1

Introduction to the Problem

1

Background of the Study

3

Statement of the Problem

7

Purpose of the Study

9

Rationale

10

Research Questions

10

Significance of the Study

13

Definition of Terms

14

Assumptions and Limitations

15

Nature of the Study

19

Organization of the Remainder of the Study

20

CHAPTER 2: LITERATURE REVIEW

21

Spiritual Psychotherapy

21

The Way of Spirituality

31

Theory of Mind and Its Psychopathology

38

The “New Spirituality” and the Challenges It Brings to Psychotherapy and Medicine in General

43

Psychoanalysis and Religion

67

Further Considerations About Spirituality in Psychotherapy

71

Definitions, Symptoms, and Time Frame of Overtraining and Its Effects

76

United States: Injuries During Physical Training Exercise

86

CHAPTER 3: METHODOLOGY

122

Introduction

122

Study Design

125

The Design of This Study

126

Data Collection

129

Data Analysis

137

Limitations of Methodology

146

Ethical Issues and Timeline for the Study

148

CHAPTER 4: RESULTS

150

Overview

150

Summary of the Data

151

Analysis of the Primary Hypotheses

154

Collective Analysis of the Primary and Secondary Hypotheses

155

Summary of Findings

183

CHAPTER 5: CONCLUSION

184

Summary of the Dissertation

184

Implications

185

Contributions

186

Recommendations

187

Future Research

189

Final Summary

189

REFERENCES

195

APPENDIX A

241

List of Tables Table 1. Key steps in the injury control process and the role of surveillance, research and intervention

92

Table 2. Cumulative incidence of all injuries among U.S. Army trainees during the 8-week basic combat training cycle

94

Table 3. Injury incidence rates among soldiers in operational U.S. Army units

95

Table 4. Relative rates of injury and illness among U.S. Army trainees and infantry soldiers

97

Table 5. Frequency of injuries requiring different levels of care and ratios of less severe injuries to deaths, based on U.S. Army-wide data for 1994

99

Table 6. Risk factors for physical training injuries in military populations

101

Table 7. Risk factors for lower extremity overuse injuries among 303 U.S. Army infantry trainees followed for >12 weeks of initial training, with adjusted odds ratios (OR) from logistic regression and 95% confidence intervals (CI)

115

Table 8. Total running distance, stress fracture incidence, and final 4.8-km (3-mile) run times among 3 groups of male U.S. Marine Corps recruits during a 12-week boot camp

118

Table 9. Code Sheet to provide a summary of the instructions to be used to convert information into SPSS

153

Table 10. Spirituality and Religious Preference (Crosstabulation)

155

Table 11. Spirituality and Component (Crosstabulation)

157

Table 12. Spirituality and Gender (Crosstabulation)

158

Table 13. Spirituality and Race (Crosstabulation)

160

Table 14. Spirituality and Age (Crosstabulation)

161

Table 15. Spirituality and Education (Crosstabulation)

162

Table 16. Spirituality and Marital Status (Crosstabulation)

163

Table 17. Spirituality and Grade (Crosstabulation)

164

Table 18. Religious Preference and Component (Crosstabulation)

165

Table 19. Religious Preference and Gender (Crosstabulation)

166

Table 20. Religious Preference and Race (Crosstabulation)

167

Table 21. Religious Preference and Age (Crosstabulation)

168

Table 22. Religious Preference and Education (Crosstabulation)

169

Table 23. Religious Preference and Marital Status (Crosstabulation)

170

Table 24. Religious Preference and Grade (Crosstabulation)

171

Table 25. Religious Preference and Spirituality (Crosstabulation)

172

Table 26. Descriptive Statistics equation is to compare information regarding Age, Education and Grade

173

Table 27. Age (Descriptive)

174

Table 28. Education (Descriptive)

175

Table 29. Grade (Descriptive)

176

Table 30. Marital Status (Descriptive)

177

Table 31.Spirituality (T Test)

178

Table 32. Correlations (Race, Religious Preference, and Spirituality)

180

Table 33. Chi Square (Religious Preference and Education)

181

Table A1. Component (Frequency)

241

Table A2. Gender (Frequency)

242

Table A3. Race (Frequency)

242

Table A4. Age (Frequency)

243

Table A5. Education (Frequency)

244

Table A6. Marital Status (Frequency)

245

Table A7. Grade (Frequency)

246 xii

List of Figures Figure 1. Relationship between foot arch height and risk of lower extremity injuries among male U.S. Army infantry trainees

104

Figure. 2. Relationship between Q-angle and the risk of overuse injury in U.S. Army male infantry trainees

105

Figure 3. Relationship between genu valgus/genu varus and risk of overuse injury in U.S. Army male infantry trainees

106

Figure 4. Relationship between 1.6-kilometre (1-mile) run times and the cumulative incidence of injuries during 8 weeks of basic training among male and female U.S. Army trainees

107

Figure 5. Relationship between flexibility and the cumulative incidence of lower-extremity injuries in male U.S. Army infantry basic trainees

109

Figure 6. Relationship between self-assessed past activity level and risk of injury in male U.S. Army trainees

110

Figure 7. Relationship between self-reported frequency of running in the month prior to beginning service and risk of injury in U.S. Army trainees

111

Figure 8. Relationship between cigarette smoking and risk of injury among U.S. Army male infantry trainees

112

xiii

CHAPTER 1: INTRODUCTION Introduction to the Problem The United States Army sought to retain fully qualified soldiers to meet its increasing demands for combat operations. When initial-entry soldiers failed to meet some required standard and were discharged from the Army without fulfilling their initial obligation to serve, the attrition rate increased, exacerbating existing shortages resulting from decreased retention rates (Hayden, 2005). Retention, as it is to any corporation utilizing the human resource, is very important to the U.S. Army. Operating with an all-volunteer force since the mandatory draft ended in the 1960s, the Army has been solely dependent upon volunteers for over 40 years (USARPAO, 2005). Thus, both low retention rates and high attrition rates subtract from the availability of fully qualified soldiers.

Simultaneously, as world conditions and national and homeland defense situations continued to demand the presence of U.S. Army soldiers to meet their missions, the requirement to train adequate numbers of qualified soldiers, the foundation of the Army’s infrastructure, became a matter of critical importance to the nation (USGAO, 2005). Problems experienced at any juncture in the process consequently became highly visible issues, and usually gained the support and attention of Army leadership at the highest levels to negate its effects. Collectively, the challenge was to identify those elements of the training program that increased retention of qualified soldiers and reduced attrition, particularly among initial-entry soldiers, and duplicate them to gain the desired results (Hayden, 2005). Both low retention and high attrition contributed to the number of available soldiers for missions at home and abroad. This existing shortage was the fundamental problem; identifying effective program elements was the process by which to

Religious Preference and Spirituality 2 effect these changes. A high attrition rate and low retention rate significantly impacted and compromised the Army’s mission readiness and its ability to deploy and defend the U.S. and its interests (USGAO, 2005).

The training process was identified as one of the major opportunities for failure in this process as it had the task of taking American youths from the streets of any city or town in America and converting them into qualified and trained soldiers, and its success or failure was documented in annual statistics. When a soldier enlisted and was admitted into the service, the Army had already made a sizable investment in that person (USARRPAO, 2005). The recruiting process included numerous phone calls and letters that were as costly as advertising brochures and literature produced by civilian advertising agencies. In addition, recruitment personnel and other military entry-admission support personnel salaries and benefits packages increased the investment (USARRPAO, 2005). Because this training was designed to address numerous aspects of human capabilities, it was both physically and mentally demanding. When these physical demands resulted in injuries that tended to separate a large number of otherwise qualified soldiers, both attrition and retention were negatively affected. In an effort to promote soldier retention and reduce attrition, and realizing that vigorous physical training requirements would most likely result in injuries of various degrees, Army training managers strove to identify the elements in the training program that kept soldiers motivated in spite of injuries and allowed them to remain determined to fulfill their enlistment obligation, a strong desire for the Army (Terenzini, 1991). Seeking a return on their initial investment, and with a concern to meet the demands for soldiers wherever needed, the Army was focused on effective solutions that would result in decreased attrition rates and increased soldier retention rates (Hayden, 2005).

Religious Preference and Spirituality 3 This study focused on two aspects of the training process believed to impact soldier commitment: religious preference and spirituality. As part of their initial entry process, soldier feedback was analyzed to determine if religious preferences and frequency of religious practices resulted in positive effects upon rehabilitation and the soldier’s return to training and completion of the initial commitment; both actions would positively affect attrition and retention rates.

Background of the Study Soldier injuries are and have been one of the most serious and costly problems for the Army (USGAO, 2005). When soldiers were injured, the training process was abruptly interrupted, the initial return on investment declined, and the Army fell short of its personnel goals one soldier at a time. There were, however, those soldiers who sustained injuries in training, yet overcame them to return to training and fulfill their initial obligation to the Army.

The Army sought to analyze this success more closely in an effort to identify and duplicate successful training program elements (Hayden, 2005). This study took place at the 120th Adjutant General Reception Battalion located at Fort Jackson, South Carolina, the Army’s largest and most active Initial Entry Training Center in the United States. It trains 34% of all soldiers and 69% of women entering the Army each year. More specifically, the study took place in the Physical Training Rehabilitation Program (PTRP), a program developed exclusively for the initial-entry soldier who sustained an injury during training that removed him or her from the standard training schedule. This program required a period of rehabilitation and successful completion before the soldier was allowed to return to the normal training schedule.

As a part of this process, and as is the standard for all military installations, a chaplain was assigned to assist in the spiritual and psychological aspects of the training and its impacts

Religious Preference and Spirituality 4 upon the soldier. Under the PTRP, the chaplain’s trained staff assisted soldiers in a variety of ways ranging from spiritual and personal counseling to pluralistic religious services and educational classes. At this location, the chaplain and staff developed a comprehensive program designed to address a variety of needs called the Creative Wellness Spiritual Fitness Program (CWSFP). During the recovery period, injured soldiers were assigned to the PTRP and participated in the CWSFP. The CWSFP used the Creative Wellness Therapeutic Model (CWTM); both the CWSFP and CWTM were instruments designed to promote spiritual growth and development. The results validated the importance of spiritual fitness, religious preference, and spirituality.

Occasionally, throughout the rigorous physical demands of the training process, soldiers sustained injuries (James & Duclow, 2002). When injured during training, soldiers became frustrated and discouraged by not being able to perform normal daily tasks. They felt disappointed, rejected, and embarrassed, feelings that negatively affected their psychology (Christensen, 1999). Training for success increasingly became a balance between achieving peak performance and avoiding the negative consequences of over-training (Bravermann, 1995).

While the Army viewed over-training as the correct format for combat training, it could also result in numerous injuries (Swank & McCully, 2001). Behavioral scientists claim that attrition in organizations can be attributed to many factors, such as lack of commitment to the organization, poor skills development, a mismatch in employee expectations, lack of motivation, and failure to meet necessary performance standards (Hayden, 2005). In the case of the injured soldier, an overwhelming feeling of having failed to meet expectations was prevalent (Christensen, 1999). Training assessments that fell below what was considered optimal did not

Religious Preference and Spirituality 5 result in the desired adaptation (i.e., the greatest possible gain in performance); training requirements that fell above the optimum may have, among other things, led to a condition usually referred to as the “overtraining syndrome,” “staleness“ or “burnout” (Braverman, 1995).

Hard- or over-training could apparently be the formula for both success and failure.

The injuries came in many forms and ranged greatly in severity. Stress fractures, coupled with other athletic injuries, have been a principal cause of pain and disability for Americans under the age of 35. Collectively, 75% to 90% of these injuries were mild or moderate, and such patients usually had good potential for returning to work. Rehabilitation programs abound for this population, despite little scientific evidence as to their efficacy (Braverman, 1995). The soldier, a subset of this population, faced similar challenges when physically trained and certainly when over-trained.

In order to adequately analyze the attrition of soldiers in the Army, many factors must be considered since their attrition was due to a culmination of many factors (USGAO, 2005). These factors varied with every soldier depending on the circumstances each brought into the Army, and what occurred during the initial-entry training process (USARRPAO, 2005). Some soldiers did not desire to return to training even after successfully completing the traditional Physical Training and Rehabilitation Program (PTRP). This meant the traditional program lacked some important aspects needed to make sure that injured soldiers were recovered, ready, and willing to return to their training (Hayden, 2005). There was no existing program extensive enough to measure the complete training and recovery process as it related to spiritual influence because soldiers have different spiritual beliefs, but an attempt was made to adequately identify those spiritual elements believed to influence soldier retention (Lerner, 2000).

Religious Preference and Spirituality 6 Based on recent research, theories, and data from the U.S. Army Center for Health Promotion and Preventive Medicine (USACHPPM)’s Spirituality and Resilience Assessment (SRA), spirituality could have a positive effect on a person’s psychological wellbeing.

(USACHPPM, 2005). Consequently, it may have been introduced as a means to help injured soldiers recover and return to their duties (Duclow & James, 2002). Additionally, spirituality’s positive effect could have been a key element to help lower injured soldiers’ attrition rate (Lerner, 2000). The USACHPPM’s INSPIRIT Factor Structure, the scoring system used in the USACHPPM’s SRA, provided a category for comparative analysis to reflect upon the pros and cons of the research findings and quantified the conceptual development and related meaning of the respondent’s scores. Effective socialization programs were believed to be keys in addressing some of these factors, and the significance of spirituality and spiritual wellbeing could have been one of the basic principles used to improve the socialization experience (Feingold & Helminiak, 2000). Effectively identifying and including spirituality in the soldier’s Initial Entry Training produced awareness of untapped spiritual resiliency resources and helped to reduce the Army’s attrition rate (USACHPPM, 2005). Achieving this goal provided the critical mass of soldiers needed to maintain the forces of the Army to serve our nation in the 21st century (USGAO, 2005).

Based on the Army’s need to further analyze program elements that produced positive results for both soldier retention and reduced attrition among initial-entry soldiers, and particularly those who were injured in the process, Army commanders at every level approved the commencement of the study.

Religious Preference and Spirituality 7 Statement of the Problem The problem was twofold: First, the declining retention rate among soldiers resulted in a failure to meet annual end strength personnel requirements for the Army. The low retention rate nullified the sizeable initial investment and resulted in the premature dismissal of otherwise qualified soldiers. Secondly, the high attrition rate among initial-entry soldiers due to physical injuries and other quality-of-life issues compounded the problem and resulted in a more dramatic shortage even after the significant initial investment. The high attrition rate significantly reduced the Army Recruiting Command’s proclaimed success and resulted in failure to meet annual personnel strength goals. Both situations contributed to the lack of available qualified soldiers to meet an increasing national and international demand for the same. With an extremely high initial investment in these soldiers who were injured and did not return to training, the Army gained zero return while requesting an exorbitant amount of money for the next year’s annual training budget, only to repeat failures of previous years (USARRPAO, 2005).

The soldier retention rate, as depicted in its 2004 United States Army Recruiting Command Report submitted by the United States Army Recruiting Regional Public Affairs Offices (USARRPAO), identified the nature of this problem. This report indicated that the Army Recruiting Command reached its annual recruiting goals for the fifth consecutive year. It provided demographics of the Army’s success during fiscal year 2004 in recruiting active duty and reserve soldiers as follows: the Army recruited 77,587 soldiers for the active Army and exceeded its fiscal year 2004 mission by 587, achieving 100.8%. The Army Reserves recruited 21,278 soldiers, exceeding their fiscal year 2004 goal of 21,200 by 78, thus achieving 100.4% (USARRPAO, 2005).

Religious Preference and Spirituality 8 These numbers increased exponentially when compared to the additional cost to rehabilitate injured soldiers and their high attrition due to injuries. Once a soldier was injured, he or she remained in physical rehabilitative training at the Physical Training Rehabilitation Program (PTRP) at Fort Jackson, South Carolina from 3 months to a year with full pay and benefits. Separating thousands of soldiers early each year meant that the Army received only a partial return on the significant initial investment made in recruiting and training these soldiers.

According to the Department of Defense (DoD), the average cost of recruiting and training each soldier was $35,532. Using this figure, the USGAO estimated that the Army lost literally millions of dollars annually because of high soldier attrition related to injury and other qualityof-life issues (USGAO, 2005).

According to the United States General Accounting Office (USGAO), the high attrition rate was the result of several factors. First, an average of 31.7% of the 77,000 personnel recruited by the Army each year were separated during their initial tour of duty due to injury or quality-oflife issues. According to the USGAO statistics, 11% separated before they completed 6 months of service, and 20.7% separated after 6 months, when most had completed initial training. The USGAO recommended that effective solutions to this problem encompass program elements that would effect positive changes in both soldier attrition and retention (USGAO, 2005). This was significant to the study in that these statistics quantified the problem as stated in the main two hypotheses, namely that Army’s retention rates were low among this population, while attrition continued to escalate. Similarly, these types of injuries dictated the continued need for injury control, with a wide application in civilian sports and exercise programs as well (James & Duclow, 2002).

Religious Preference and Spirituality 9 Purpose of the Study The purpose of this study was to determine if religious preference or more broadly, spirituality, and the frequency of these practices, along with several other demographic and military experience variables, contributed to reduced attrition and increased retention rate of injured soldiers returning to initial-entry training. With focused attention on the two main variables, spirituality and religious preference, it differentiated between religious preference and spirituality. Religious preference was defined as a simple yes or no response to whether a soldier had a religious preference upon entry into the Army. Subsequent questions delineated the specific preferences further, but for the purpose of this study, religious preference simply indicated whether a servicemember had a religious preference or not. Spirituality was defined as entailing the frequency of spiritual practices and indicated a more involved, committed, and personal religious preference.

Frequency was divided in terms of how often a soldier practiced his or her religious preference or spirituality (daily, weekly, less frequently than both) and conclusions were drawn on the servicemember’s level of spirituality based on frequency. While both spirituality and a positive response to religious preference were considered part of overall spirituality, the frequency of those practices were the determining factor for the extent of spirituality the servicemember employed in conjunction with the effects of their rehabilitation.

This study proposed to determine whether religious preference and spirituality, the frequency of spirituality, and other variables to include demographics and military experiences could have an impact on recovering injured soldiers, assisting in their rehabilitation process and successfully returning them to training to complete their initial obligation to the Army. The

Religious Preference and Spirituality 10 results of the study may offer new insights into untapped spiritual resource and could justify future research in this subject.

Rationale The rationale for this study was to provide Army leaders with quantifiable data reflecting potential causes and effects contributing to the high attrition and low retention rate among initial entry soldiers. To address related concerns and explore possible causes, and to provide concrete recommendations regarding specific successful program elements that affect attrition and retention, the study considered factors such as the soldier’s psychological, spiritual, social, and emotional states as well as other practical variables, and focused on the frequency of spirituality’s impact on both retention and attrition, all characteristics believed to influence the soldier’s success.

Through this study, the Army gained insight into how religious preference and spirituality, and other related variables affected the institution’s ability to retain its soldiers (Lerner, 2000). With this information, the Army could consider the development of strategies and programs that better cultivated soldiers’ spiritual resiliency related to combat readiness challenges and thus improve the retention rate of injured initial-entry soldiers.

Research Questions This study explored these two primary hypotheses: Religious preference and the frequency of spirituality practices can have a positive impact on the retention and attrition rates for injured soldiers enrolled in the Army’s Physical Training Rehabilitation Program. “Positive” referred to a decrease in attrition rates and an increase in the number of soldiers who could be retained in the Army. The second primary hypothesis: Soldiers who identify a higher level of

Religious Preference and Spirituality 11 spirituality are more likely to graduate from PTRP and return to initial-entry training than those who have less frequent spiritual practices (Duclow & James, 2002). In other words, would injured soldiers with a higher level of spirituality continue the rehabilitation program using their daily practice of faith and other attributes of spirituality as tools for promoting internal psychological, social, and spiritual resiliency while matriculating through the Army’s Physical Training Rehabilitation Program, and would soldiers without spiritual foundations fail to graduate?

The following additional secondary hypotheses were considered as alternative causal relationships between the independent variables of retention and attrition: (a) Component: Active duty soldiers will return to training in larger numbers than those assigned to the Army National Guard and Army Reserve since active duty soldiers are generally younger and in better physical shape; (b) Gender: Male soldiers will return to training in larger numbers than female soldiers.

The rehabilitation process for females has historically been more extensive than that of their male counterparts. Additionally, injuries sustained by female soldiers result in termination of training at a higher rate than male soldiers; (c) Age: The younger soldiers are, the more likely they will be rehabilitated and returned to training. It is assumed younger soldiers will be in better physical shape, will handle the injury more effectively, and will persist in efforts to bring about healing and rehabilitation; (d) Race: White soldiers return to training in larger numbers than soldiers of other ethnic groups. White members tend to be less overweight and in better physical conditions than members from other ethnicities; consequently, they rehabilitate sooner and return to complete training; (e) Education level: The higher the soldier’s educational level, the more likely that he/she will be rehabilitated and returned to training. Environmental impacts from

Religious Preference and Spirituality 12 lower income living and the lack of a high school diploma or GED, will cause a soldier to fail in following basic rehabilitation processes and delay return to training; (f) Marital status: Single soldiers will return to training in larger numbers than their married counterparts. Married soldiers tend to have greater responsibilities dividing their attention and focus, and have a more sedentary lifestyle (one absent frequent exercising and activities). As a result, they experience more difficulties in the rehabilitation process and take longer to heal and return to training; and (g) Grade or military rank: The higher a soldier’s military rank, the more likely the soldier will be rehabilitated and returned to training. Soldiers who enter entry-level training possessing one stripe or more usually have made a more permanent commitment to the Army through other recruitment processes (i.e., high school Reserve Officer Training Corps, ROTC, college credits, length of enlistments, or Army incentive/bonus programs). They have a more extensive relationship with the Army and tend to have a higher level of commitment to the Army.

Consequently, they work harder during rehabilitation and return fully restored sooner than those who do not have such a commitment.

The following questions would produce data in support or contrary to the above hypotheses: (a) Do you have a religious preference? (b) If so, how often do you practice your faith/religious preference? (c) What is your component? (d) What is your gender? (e) What is your race? (f) What is your age? (g) What is the highest grade/educational level you have completed? (h) What is your marital status? (i) What is your rank/grade?

Religious Preference and Spirituality 13 Significance of the Study This study was extremely significant because if the two primary hypotheses were supportable, they would have provided the Army with critical missing links in its attrition and retention rates. With this information, the rehabilitation process for injured soldiers was expected to be more successful and new and untapped spiritual resources were included in the design of future therapeutic recovery plans (Park, 2000). This study was also very important because it linked spirituality to the psychotherapy of the injured soldiers as they went through the recovery process in PTRP. This type of rehabilitation contained elements of both spirituality and psychotherapy in its execution. If there was a link, programs could have been developed that facilitated or improved the effect of each upon the soldier. Further study could have been done to explore other effective ways to employ and incorporate spirituality and psychotherapy to promote healing in injured soldiers and others in similar training settings (Lerner, 2000).

The study was also significant because its findings could have been used to reach a resolution among arguments related to the impact of several other factors on the injured soldier’s recovery and create a wider selection of choices for helping professionals attempting to assist the recovering soldier (Swank & McCully, 2001). For example, research on factors believed to have an influence on soldiers’ persistence has mainly concentrated on the academic, military, and social experiences of soldiers or learners. In addition, several theoretical assumptions and conceptual frameworks have led to a sometimes confusing array of intervention strategies for the helping professional (Terenzini, 1991; James & Duclow, 2002). Not many include religious preference and spirituality. If the variables in the secondary hypotheses were supportable and

Religious Preference and Spirituality 14 found to be significant, the data could have been considered for inclusion in these efforts and offered broader perspectives and options for utilization.

Finally, this study was significant in that it contributed to the knowledge available about religious preference and spirituality and their effects on the retention of injured soldiers. In particular, it provided some detailed information for training units throughout the military that were similar to the 120th Adjutant General Reception Battalion in size, mission, and background.

There were several Army reception battalions throughout the United States and multiple Navy and Air Force reception battalions that might also have been able to use the information provided in this study as a basis for conducting their own similar studies (USGAO, 2005). The additional demographic and military experience data points proved useful in the exchange of information among various military services.

Definition of Terms The following operational definitions will be used throughout this document: PTRP (Physical Training and Rehabilitation Program): A special Army unit located at the Fort Jackson Reception Battalion with the mission to provide physical training and rehabilitation to soldiers injured during training (USGAO, 2005).

Desired Adaptation: The greatest possible gain in performance (Songer & LaPorte, 1996).

Attrition Rates/Retention Rates: A method or index for gauging the effectiveness of enlisted service members retained in service within the first term of enlistment (Evanson, 1977).

Spirituality: A practice of spirituality as indicated by religious preference. For research purposes, acknowledging spirituality will be based on the information provided by the soldier at

Religious Preference and Spirituality 15 the time of his or her in-processing into the Army at the 120th Reception Battalion and graduating from PTRP to return to training (Jose Ortega y Gasset, 1914/2000).

Assumptions and Limitations Assumptions The study made the following assumptions: (A) While there are various forms of spirituality, this study assumed the significance of the spiritual being and that this element of spirituality was at least available to all. It assumed that spirituality had an effect on the physical being. (B) Significant indicators can be realized through causal comparative research.

Conclusions such as those specified in the hypotheses were properly drawn and validated through this process. (C) The review of the literature on retention was applicable at the 120th Reception Battalion Physical Rehabilitation Training Program. While it may have been applicable to other similar training environments, for the purpose of this study the literature applied to this unit. (D) The 120th Reception Battalion had viable and accurate data. As required

by Army standards and as a normal operating procedure, the records were periodically inspected for validity and thoroughness. There was no indication that their contents would be less than accurate. (E) The review of the data resulted in an accurate picture of the religious preferences and spirituality levels of the rehabilitated soldiers. The study quantitatively illustrated these levels using a variety of tools and instruments designed specifically for this reason (Christensen, 2001). (F) Soldiers answered the questions accurately and with full understanding of what was being asked of them without coercion or influence of any sort. (G) The frequency of the elements of spirituality as practiced by the member indicated a more committed and sincere spiritual state, and can be identified in levels. While one can be “religious� about a practice alone, this study

Religious Preference and Spirituality 16 equated depth of conviction with frequency of practice. (H) Since all of the records reviewed were from soldiers who successfully returned to training, this study assumed this sample as being representative of the entire initial-entry soldier population for that training period. (I) It also assumed that the balance of remaining records (after administrative discharges, Chapter 11 discharges [for pregnancies], and other failure-to-adapt discharges) from which the 100 records came represented the entire population of soldiers trained during this period. Conclusions drawn from this data thus have the potential for wider application based on this representative sampling and with the understanding implicit in these assumptions.

Limitations The study had several limitations which include the following: limited variables, probable forecasts, limited population, limited definitions, causal relationships, theoretical model, Army leadership impacts, generalizations, restricted questions, and statistical equations and techniques.

Limited Variables:This study focused primarily upon religious preferences and spirituality (the frequency of religious practices) as factors in retention and attrition of soldiers.

Although there were other demographic and military experience variables included, the causal relationship was limited in its causal effects as defined herein. It was then understood that numerous other factors also affected solider retention and attrition such as the soldier’s quality of life and the severity of the soldier’s injury, etc., but these were not included in this study.

Probable Forecasts: This study was limited to probable forecasts and did not offer absolute answers or solutions. These forecasts were limited in that they were drawn on the same limited-dimensional assessment of total effects on retention and attrition. Any forecasts

Religious Preference and Spirituality 17 emanating from this study were limited to the variables included herein. Because these variables did not include every possible variable that could affect retention and attrition, these forecasts were limited in scope and application.

Limited Population: This study only considered the religious preference and frequency of spirituality practices of soldiers at the 120th Reception Battalion as factors in retention, attrition, and return-to-training rates. It did not explore data from other similar training organizations in the military, and therefore was limited to this specific population. The population was limited further in that it included data from the 100 soldiers who returned to training after sustaining an injury in 2004. Then, only those who responded positively to the religious preference question (N = 64) were included in the spirituality portion of the study. Effective use of this information in similar settings would require equal research and data collection in those settings.

Limited Definitions: The definitions of “no, some, low, and high� relating to both religious preferences and levels or frequency of spirituality were specific to this study and to the Army’s 120th Reception Battalion. Similar studies should develop their own criteria as they relate to the hypotheses in these studies. These definitions may differ in different military organizations (Christensen, 2001).

Causal Relationships Among Variables: There were concerns regarding the causality conclusions suggested in the study and the causal relationships among the variables. With the absence of other impacting variables (as they are not all-inclusive in this study), the causal relationship could not be supported with direct statistical inferences, but was limited to only those variables included in the study. The causal relationship was then inferred, but was not conclusive.

Religious Preference and Spirituality 18 Army Leadership Impacts: Army leadership impacts, though recognized in organizational dynamics and certainly in military settings as impacting the results on most initiatives—and in the case of this study, both attrition and retention—were not included and cannot be empirically documented from the data in this study. This limitation was particularly significant as the particular styles of military leaders’ impacting troop morale and effectiveness in battle conditions and otherwise has been validated in studies and research for several years (GAO, 2005). The absence of these variables eliminated their potential impact and removed their effects from the results. The results and conclusions drawn regarding impacts are thus limited, as these significant variables were not included.

Generalizations: This study made several generalizations in that the military training environment at the 120th Reception Battalion was assumed to represent military training environments throughout the military. Applications to other training environments could only be feasible after specific analysis and study in those environments. For example, based on mission requirements and desired results, training environments vary considerably among the services.

To assume application of these results across service lines was to generalize these varied environments. Particularly significant differences were in training environments for the Air Force as compared to the Marine Corps. Additionally, the results of this study do not apply to training environments outside the military services (Swank & McCully, 2001).

Restricted Questions: This study was limited to the questions included on a soldier’s initial intake application; there was no opportunity to add relevant questions to gain more detailed information. Unless the soldier was interviewed, there was no opportunity to acquire additional related information on the soldier’s initial response. Assumptions were made, for

Religious Preference and Spirituality 19 example, regarding the frequency of religious preference practices to conclude that daily practice suggested a higher level of spirituality. There was no opportunity to explore whether that frequency was based on tradition or true commitment to a religious preference. Frequency alone was not adequate to make such an assessment. This study does not have any quantifiable data to address such variations because questions were limited to specific contents.

Statistical Equations and Techniques: The statistical equations and techniques used in the study were limited to the basic measures of central tendencies and frequency distributions reflected in polygons and bar and pie charts. The more sophisticated and multivariate statistics could have provided more detailed analysis of the data from which more statistical inferences could have been drawn. For example, since the researcher included more demographic and military experience variables (the basis for the secondary hypotheses) and reflected their impact upon the two independent variables (spirituality and religious preference), a multivariate statistical technique was utilized. Techniques utilized in this study limit the validity of causal relationships to probable causes only.

Nature of the Study The nature of the study included reviewing existing data resident on an Army-managed computer database, organizing that data for statistical analysis, and making a quantifiable comparison of the results, utilizing various written instruments. This data, along with the documented entry and exit interviews of entry-level soldiers collected by military classifiers, was then analyzed by the researcher to draw certain conclusions regarding the hypotheses. The researcher analyzed existing data to draw conclusions regarding initial-entry soldiers and the results of their training experience, including their religious preferences and frequency of

Religious Preference and Spirituality 20 spirituality. This study looked at the permanent records of soldiers who continued military service after graduation from the Physical Training Rehabilitation Program at Fort Jackson in 2004 and those who matched the criteria for no or some type of religious preference and frequency of spirituality as defined in the definition of terms (Park, 2000). It did not include physical contact with those soldiers, nor did these records contain any personal identifiers, medical, or health-related information.

Organization of the Remainder of the Study Chapter 2 is the literature review. This chapter provides the review of relevant literature and its application to this study. Chapter 3 covers methodology. This chapter provides detailed information about the method and type of analysis that will be employed in this research study.

Chapter 4 contains data collection and analysis. This chapter presents collected data, research findings, and a summary of the analysis. Chapter 5 consists of results, conclusion, and recommendations, summarizing the research’s findings, drawing conclusions and making recommendations.

CHAPTER 2: LITERATURE REVIEW Spiritual and physical states are closely associated in human beings’ complex composition of both physical and nonphysical characteristics. Medicinal efforts to heal physical discrepancies have generally included nonphysical methods, as the relationship between the two has long existed. Even precivilized generations left behind evidence of healings through nonmedical means. Today, researchers have continued efforts to quantify these results and draw causative relationships between the spiritual and the physical. This literature review includes current trends regarding the spiritual effect on healing, a variety of therapies associated with nonphysical strategies, and the nature of injuries themselves and their physical and nonphysical healing.

Spiritual Psychotherapy There is no organized and structured school of spiritual psychotherapy; that would be antispiritual by definition. Spiritual therapy may frame other therapies, but is itself frameless.

This means that it cannot be fully contained by the human mind, just as the mind may comprehend something about itself but does not reach the ineffable depths of self (i.e., the soul).

As the philosopher Karl Jaspers (1954) observed in his Way to Wisdom, man is fundamentally more than he can know about himself, because the way to self-knowledge is twofold: the person “as object of inquiry, and as existence endowed with a freedom that is inaccessible to inquiry” (p. 63). It is the latter that is both the subject, and the object, of spiritual psychotherapy.

As such, this type of therapy does have its own tenets, not as principles of treatment but as principles of existence. Moreover, although certain nonspecific therapeutic practices may emanate from its precepts, spiritual therapy at best becomes not what the spiritual therapist does,

Religious Preference and Spirituality 22 but what he is: in Lasch’s (1978) words, a virtuous man (woman) who has little to repent of or apologize for at the end of his (her) life.

How does one arrive at this exalted state of virtue? According to the fourth of Chopra’s (1994) seven spiritual laws of success—the Law of Least Effort—such an individual tries to do nothing; he just is. He accepts people, situations, circumstances, and events as they occur, life as it unfolds. He does not struggle against the moment, in the same way that “Grass doesn’t try to grow, it just grows. Fish don’t try to swim, they just swim. Flowers don’t try to bloom, they bloom. Birds don’t try to sing, they just sing” (p. 53). For the person who aspires to such a soulful and spiritual existence, it reflects a natural and quiescent state, a union with nature characterized by the principles of fewest words (i.e., profound silence) and least actions (i.e., inner harmony) (Chopra, 1994).

Venturing beyond the boundaries of science and medicine, life of the spirit and soul is directed toward devotional belief in the influences of the ethereal, incorporeal, and immaterial aspects of beings, as distinguished from the influences of one’s physical, concrete, and evidential existence. Comparing the essence of both of these perspectives, the sacred and the nonsacred, it can be said that spirit is to the soul what blood is to the body. More specifically, spiritual psychotherapy conceptualizes care and compassion within the dual contexts of love and belief beyond one’s self. Some examples are: love of others, love of work, and love of belonging or belief in the sacred, belief in unity and belief in transformation (Chopra, 1994). In this context, a clinician who belongs to any school of psychotherapy or profession can become a spiritual therapist, if regardless of his own ardent allegiances, he conducts his practice according to these six tenets of transcendence (Chopra, 1994).

Religious Preference and Spirituality 23 An overview of the vast variety of psychotherapies of the last century reveals their attempts to resolve the individual’s past and present conflicts and remedy his or her deficits by three major change agents: cognitive mastery, affective experience, and behavioral modification (Doran, 1977). Yet even when this entire armament is applied, psychological conflicts are relatively resolved, deficits filled, and defects corrected, ultimately patients still experience posttherapeutic dysphoria, a loss of meaning or sense of emptiness, a nonluminous hollow. These diverse strategies have shed limited light and left patients bereft, because in the process of treatment (if not the psychopathology itself) the person’s soul has been neglected and spiritual connections severed (Doran, 1977).

Of course, all therapies may provide at least transitory relief simply by the presence of someone who is interested in the patient, provides an explanation for his or her condition, offers some semblance of comfort and support, and even expressly teaches coping mechanisms in the form of alternative modes of thinking and behavior (Feingold, 1995). However, traditional approaches eventually reach an impasse, a place where the therapist himself resides and in which he and his patients can become irretrievably trapped. This invariably occurs when confident clinicians, regardless of their respective schools, present themselves as prototypes of health and salvation for their recipients to emulate (Feingold, 1995). Alas, they are limited by an inherent constraint: they can take their patients only as far as they themselves have come. Then the question—and the quest—remain: How do they get beyond this barrier? More aptly, how do they venture toward, and eventually attain, a soulful and spiritual existence?

The soldiers in our study who answer the questions regarding spirituality and religious preferences affirmatively also indicate that they believe in something more than just themselves.

Religious Preference and Spirituality 24 Their spiritual journey or “quest” will be reflected even more as they describe the frequency of those practices.

A Soulful and Spiritual Existence The soul and the spirit are frequently used interchangeably as equally rarefied concepts.

Although they reside neither in consciousness nor unconsciousness, they may be “found” (i.e., infused) in objects and events from the sacred to the secular, from the divine to the ordinary (Feingold, 1995). They are related as transpersonal abstractions, but are also quite different.

According to Hillman (1992), the soul calls one “down and in” whereas the spirit calls one “up and out” (p. 26). The soul immerses itself within the world through intimacy, relationships, pleasure and pain, and aspires to egoless attachment and engagement. It views human suffering and illness with reverence, by “honoring symptoms as a voice of the soul” (Hillman, 1992, p. 3).

It is personal as much as transpersonal to the extent that it cultivates depth and sacredness in everyday life. Alternatively, the spirit aims for the impersonal and towards detachment. As Kovel (1991) has pointed out, “Spirit is the more general term, connotating a relationship between the person and the universe; while soul is the more self-referential term” (p. 33).

Moreover, the soul is the seat of human emotions and sentiments with all its lowly limitations and descents, whereas the spirit is the repository of the moral and religious; it has the highest inspirations and can soar. In addition, the spirit’s road can be straight and well paved, while the soul’s road is more rough and roundabout. Moore (1992) refers to the latter as meandering, likened to “the odd path of Tristan, who travels on the sea without oar or rudder, making his way by playing his harp” (p. 259). Based on the myths of the ages, Campbell (1949)

Religious Preference and Spirituality 25 suggests a more difficult and demanding route, referring to “a dangerous journey of the soul, with obstacles to be passed” (p. 366). Moore (1994) clearly contrasts their dual courses: In spiritual literature the path to God or to perfection is often depicted as an ascent. It may be done in stages, but the goal is apparent, the direction fixed, and the way direct.

Images of the soul’s path are quite different. It may be a labyrinth, full of dead-ends...or an odyssey, in which the goal is clear but the way is much longer and more twisted” (p.

259).

In sum, they are both archetypally distinct entities from the physical body and physical world. They are immaterial in nature, but can make their appearance in all earthly matter. The soul penetrates the plain particulars of life, the spirit transcends them. The soul gazes at life inwardly, while spirit gazes beyond it. The discovery of our true self is only possible by allowing our soul to wander and wind its way, and however circuitously, bring us closer to our spiritual selves. Whereas the soulful and the spiritual each may be pursued separately, one opens the door for the other. In tandem, they form a divine union (Feingold, 1995).

Effective spiritual psychotherapy must tend to the patient’s soul (Karasu, 1992). In early Christianity, tending to the needs of people was known as cura animarum, the cure of the soul, and the role of the curate was to maintain the individual in a religious and spiritual context to sustain him for the inevitabilities of fate. The care of the psyche and soul thus began as a sacred act by its practitioners and priests, originating in the church. Then medicine and psychology as secular sciences started to differentiate between the two. In fact, these sciences removed the soul from their vocabulary by objectifying subjective experiences. They even went one step further, emphasizing the individuation of the person at the expense of belonging and believing. Thus,

Religious Preference and Spirituality 26 modern man was subjected to the demise of his soul-making connections (Feingold, 1995). As a result, not only did the original illnesses not disappear, but they were compounded by the individual’s lack of spirituality and faith (Ellison and Smith, 1991). The colloquial cure was worse than the disease itself. In ancient Greece, therapy meant service to the gods. In modern psychology, however, it has more often meant coming to terms with the death of God—and its success has brought with it the impoverishment of the soul. Indeed Moore (1992) refers to “loss of soul” as the great malady of the twentieth century (p. xi).

The ways to soulfulness and spirituality are inherent in our basic ontological dispositions, yet these fundamental capacities tend to get overlooked, if not destroyed, in contemporary living.

Thus they need to be cultivated if they are to be preserved, bearing in mind that they are separate, albeit often overlapping and at times even contradictory roads (Ellison and Smith, 1991). More specifically, the way to soulfulness is achieved by transformation of the extraordinary to the ordinary—and its only required ingredient is love. Comparably, the way to spirituality is achieved by transformation of the ordinary to the extraordinary—and its only required ingredient is belief (Moore, 1992). Taken together, they collectively comprise six tenets of transcendence: Three on The Way to Soulfulness—Love of Others; Love of Work; Love of Belonging, and three on The Way to Spirituality—Belief in the Sacred; Belief in Unity; Belief in Transformation.

Soldiers in this study fall into one of the categories of either recognizing that they have a soul (affirmative replies to the frequency of spirituality practices) or that they believe they have a soul (affirmative replies to religious preferences). Negative replies could mean that the soldier is unaware of the existence of his soul or that he does not believe that religion is the way to the soul.

Religious Preference and Spirituality 27

The Way to Soulfulness Love of others. The love of others is, first, a matter of self-differentiation. Love demands attachment, yet requires a healthy distance. Here the subject is separate from the object, heading toward subjective selflessness. For such love to occur, one must make sure that the other’s separateness is secured independent of one’s own. As the poet Rainer Maria Rilke so eloquently advised, each person has to protect the solitude of the other. As explorations of intimacy inevitably reveal, it is only by being separate that one can truly be together with another; enmeshment is not intimacy. Love that strips the other person of his or her sense of self, in which privacy is invaded and boundaries are blurred, is not real love. Neruda asserts, “Indeed, getting to know and love someone deeply may require not seeing too clearly or being too close.” In this sense, the magic of any loving relationship is in part maintained by taming one’s desire for fusion, not obliterating the other through merging—in short, honoring each member’s freedom.

In revering the wonders of love and relatedness, it has thus been wisely proffered that “the soul...needs flight as much as it needs embrace” (Neruda, 1994, p. 21).

Love also means forgiving. The soul soars when one concedes to one’s loved ones their freedom and cherishes what they are willing to give without asking more (Feingold, 1995). There is no categorical goodness or badness, and one must expect failings, betrayals, and also (if one is fortunate) expressions of contrition. Then one must forgive. After any ethical transgressions, the slate must be wiped clean and the relationship permitted to continue as if the wrongdoing never existed (Ellison and Smith, 1991). Humanness is always imperfect, relative, and tainted by sin

Religious Preference and Spirituality 28 and folly. This view might help to tolerate our own shortcomings and many uncertainties, including interpersonal, moral, or religious waywardness. Forgiving frees one from the corrosive effects of anger, hate, humiliation, and embarrassment. It allows people to save otherwise unsalvageable relationships among spouses, parents and children, and friends. At its core, love means totally accepting the other person. As Adam was formed out of the mud of the earth, so were the rest of mankind. Any attempt to destroy the impurities of nature also removes the fertile soil that can be nourished for growth (Feingold, 1995).

Love of work. Work is liber mundi, monks said, a life literacy, whereby their religious duties were highly intertwined with daily labors. Both activities could be paths to divinity, if they were carried out with the same profound regard. Although contemporary secular work is far from early monastic life, it could be equally sacred if people were to accept its special calling. Every act of labor, no matter how seemingly commonplace and trivial, if attended to with a depth of devotion, can open the path to soulfulness. In this sense, God is not only in the details of prayers, but also in the details of everyday chores. Not only through the rituals of the temple, but through the hard work of ordinary tasks, does one enter a higher plane. Rituals of the church (liturgy literally means “the labor of laity�) and the divine acts of the worshiper need to be transported to the commonplace. The ultimate purpose is not to differentiate between the sacred and the secular, but to bring a reverence to everyday living.

One cannot search for soul only from within; it cannot be divorced from one’s relations in the outside world. In the quest for coherence of the self, Storr (1988) suggested that work in the form of creative acts, such as making art, music, or literature, or other human interests and labors that may be more mundane, can also serve as a substitute for good objects. They may

Religious Preference and Spirituality 29 function as compensation for early losses or later difficulties in fruitful interactions with others, in Eagle’s (1981) words, “interests as object relations” (p. 527). One of the indispensable ingredients of the transmutation into soulfulness is the sheer love of work, through which the self and other can be unified. In cultivating depth and sacredness in everyday life, “The love that goes out into our work,” says Moore in his Care of the Soul, “comes back as love of self” (1992, p. 187).

Love of belonging. Belonging is living together; it is outer communion—conviction, celebration of “the sweet communion of life, the demonstration of love and splendor, the food of good will, the seasoning of friendship, the leavening of grace” (Neruda, 1994, p. 39).

Conviviality requires some degree of sacrifice of one’s self-centeredness and being part of communal life. It means not focusing on one’s own success, but that of the society; not striving to possess things individually, but viewing all of life’s riches as shared. It means appreciating the simple life, honoring basic virtues, and above all, promoting selflessness. One does not lose one’s self by such conviviality; in fact, it is the only way that one can truly find one’s self. As Kovel (1991) has pointed out, “the group is the larger being from which individual being emanates and to which it returns...the group, be it family, clan, tribe, class, nation, or church, becomes the intermediary representation of being to the self, a way station between the isolated particle of consciousness and the universe” (p. 78).

Belonging means believing together. It provides communal meanings and finds faith through kinship and mutual accord. Expressions of faith, however, need not always be strictly religious. In his book Gods and Games, which aspires toward a theology of play, David Miller (1973) describes faith as “being gripped by a story, by a vision, by a ritual....It is being seized,

Religious Preference and Spirituality 30 being gripped by a pattern of meaning that affects one’s life pattern, that becomes a paradigm for the way one sees the world” (p. 144). It is difficult for every individual to formulate such a personal paradigm, and religion provides a ready-made one. Such a shared world view is more likely to facilitate an identity of universal being, embodying the spiritual power of belonging to the group.

Kovel (1991) further suggests that religions always engage spirit, but to differing degrees; they are particular historical ways of binding spirit and socially expressing it.

Nevertheless, to the extent that they are an institutionalization or regimentation of spirit, they ipso facto become less than fully liberating. Although religious institutions, at least superficially, serve the process of belonging by believing, at its foundation, spirituality has the capacity to transcend religion in that “the quality of spirituality, religious or not...depends...on the social relations it advances” (p. 4). Thus religious congregations can perform the role of communal cement, a shared belief system serving to establish and reinforce cohesive relationships. As the rabbi Harold Kushner (1981) concluded, “One goes to a religious service, one recites the traditional prayers, not in order to find God (there are plenty of other places where He can be found), but to find congregation, to find people with whom you can share that which means the most to you” (pp. 121–122).

In the military training environment, these elements are present in different degrees.

Many soldiers find friendships during initial training that last them for their entire careers. The demanding physical and mental challenges of the training tend to draw one closer to those sharing the same experience, similar to what happens on the battlefield among comrades. A love of others and a feeling of belonging both present opportunities during the training period.

Religious Preference and Spirituality 31 The Way of Spirituality Believing in the Sacred This refers to believing in the sanctity of everything around us, whereby ordinary things are experienced as truly extraordinary. Seeing the luminosity of nature transports all of our experiences, including health and illness, pleasure and pain, joy and sadness, gain and loss, success and failure, birth and death. They become life events that are not dualistic, but reflect a dialectic of the ineffable, equally worthy of veneration. Such sense of sacredness demands detachment from worldly possessions, yet endows them with the wonder of life. As in the poet Pablo Neruda’s (1994) famed exaltation, Odes to Common Things, one looks at everyday objects as one might at stars in the sky. It is a beholding of the universe in all its majesty. It is an epiphany that may come as a form of revelation, not as a matter of logic. Just as God surpasses logos and is exempt from proof or disproof, in Jaspers’ (1954) words, “distant,...hidden..., and undemonstrable” (p. 50), so are those aspects of nature. Rather, “God is accessible not through thought, but through faith” (p. 41).

The sacred experience demands some detachment from others. As soulful as belonging is, it does not mean never being alone. Man also needs solitude for his spiritual growth (Ellison and Smith, 1991). Being with people for long periods of time, no matter how loving, wonderful, or interesting they might be, interferes with one’s biopsychological rhythm, with one’s synchrony with the nature, with one’s own authenticity. Solitude synchronizes the body with nature and reinforces man’s belonging to a larger presence. Private religious devotion provides similar harmony, in that the person who prays in private feels himself to be alone in the presence of God (Feingold, 1995).

Religious Preference and Spirituality 32 According to Storr (1988), who posits a return to self through solitude, this is a way of putting the individual in touch with his deepest feelings. In a reciprocal process, the more one is in contact with one’s own inner world, the more he or she will establish connections with the sacredness of the outer world. It is only by becoming a part of the sacredness of nature that one may unearth one’s spirituality. It is there waiting for transformation. In his attempt to transform the everyday into the sacred, the visible into invisible, the poet Neruda (1994) said in an early letter, that our task is to “stamp [the] earth into ourselves...deeply...so that its being may rise again invisibly in us.” Miller (1995), who presents a program for achieving balance and contentment in a demanding world, offers Albert Camus’ wise words on the road to discovering the magic of ordinary existence: “If there is a sin against life, it consists perhaps not so much in despairing of life as in hoping for another life and eluding the implacable grandeur of this life.”

The initial-entry training environment certainly is a time for forming close relationships with fellow trainees, and soldiers are rarely alone because of a strict “buddy” rule; however, it also offers several opportunities for time alone with one’s self.

Believing in Unity Believing in unity means a sense of being undifferentiated from the outside world— natural and supernatural—in Buddhist words, “a feeling of oneness” (Bergin and Richards, 1996, p. 4). This unity brings meaning and serenity to the self, as life’s burdens become too heavy to bear if one can find no universal meaning. Universal meaning, of course, is not a quantifiable and measurable entity. As Jaspers (1954) noted, “Unity cannot be achieved through any rational, scientific universal process. Nor does unity reside in a universal religion...Unity can be gained only...in boundless communication” (p. 106). It is a sense of responsibility for all, a sense of total

Religious Preference and Spirituality 33 commitment, a selfless way of relating to the world around us. Moreover, believing in unity ultimately reflects the seamlessness of mind, body, and spirit. Kovel (1991) asserts, “If mind and body is a unity, then spirit can be seen as the coming-to-be of that unity. And this coming-to-be depends on the way we act and on our relationship to the world” (p. 20).

Rinpoche (1994) refers to an “unfolding vision of wholeness” (p. 352), a sense of a living—and implicitly loving—interconnection with humanity. The glue for that mysterious unity is a kind of love that differentiates one’s self from other persons, other things, and finally, from the universe, extending limits, a stretching of boundaries. According to Peck (1978), “In this way the more and longer people extend ourselves...the more blurred becomes the distinction between the self and the world” (p. 95). People become identified with the transpersonal and begin more and more to experience the same sort of feeling of ecstasy that they had when they “fell in love,” but instead of having merged temporarily with a single beloved object, they have merged more permanently with the universe—a primordial unity.

Such transpersonal love is praised by religions and exalted as the ultimate goal to be attained, surpassing one’s knowledge, skills, power, and all worldly possessions. “I may understand all mysteries and have all knowledge. I may even have enough faith to move mountains. But if I don’t have love, I am nothing” (Gratton, 1995). Variations of love, be they passionate love, maternal love, affectionate love, or spiritual love, are at times differentiated and even mutually exclusive; but if one doesn’t love others, he or she cannot love God or vice versa.

One who doesn’t love animals, couldn’t possibly love humans and all of nature (Feingold, 1995).

There is an undifferentiated base of faith and love from which other variations spring. This love

Religious Preference and Spirituality 34 is not possessing or capturing and isn’t doing something (Gratton, 1995). Love is a way of existing, a way of being with people, animals, nature, and God. Such unity brings compassion. This compassionate unity is inculcated by all religions.

Jesus’s crucifixion is to awaken our heart to compassion, and turn our minds toward shared suffering (Feingold, 1995). Such is the Hindu story of Menon: When Menon arrived in Delhi to seek a job...all his possessions...were stolen at the railroad station. He would have to return home on foot, defeated. In desperation he turned to an elderly Sikh, explained his troubles, and asked for a temporary loan of fifteen rupees to tide him over until he could get a job. The Sikh gave him the money. When Menon asked for his address so that he could repay the man, the Sikh said that Menon owed the debt to any stranger who came to him in need....The help came from a stranger and was to be repaid to a stranger. (Fulghum, 1988, p. 152) Soldiers witness firsthand the importance of unity and are given opportunities throughout the training period to show compassion to a fellow soldier.

Believing in Transformation Believing in transformation is believing in spiritual continuity and rebirth. Mankind may be finite in its presently expressed form, but eternal in its true nature. As Rinpoche (1994) concludes in The Tibetan Book of Living and Dying, “in death all the components of our body and mind are stripped away and disintegrate. As the body dies, the senses and subtle elements dissolve, and this is followed by the death of the ordinary aspect of our mind, with all its negative emotions of anger, desire, and ignorance. Finally nothing remains to obscure our true nature, as everything that has clouded the enlightened mind has fallen away. And what is

Religious Preference and Spirituality 35 revealed is the primordial ground of our absolute nature, which is like a pure and cloudless sky” (p. 259). For Campbell (1949), transformation is a brave “reconciliation with the grave” (p. 356), akin to the departure of the hero (who would not be a hero if death held for him any terror).

Mankind inherits spiritual as well as physical and psychological elements from parents as well as from the previous generations. Similarly, each generation is endowed by the experience and knowledge of all the prior ones. Whereas physical and psychological qualities carry the assimilated elements of past lives, wherever and with whomever they have been, they are relatively limited to genetics and familial life (Karasu, 1992). When these are inhabited, they give humankind its unique physical and psychological essence. Spiritual essence, on the other hand, possesses the assimilated elements of past lives of the community, history, arts, cosmic world, and beyond. When these spiritual elements are inhabited within for the duration of corporeal life, they give to them their souls.

The soul evolves in a particular existence. After the death of the person, the soul fragments again to its spiritual elements and coalesces again in someone else (Feingold, 1995).

Every culture is rich with the telling of this process of transmutation. Their mythology, their songs, their religion, their rituals gravitate towards that spiritual realization. The Chinese tell of a crossing of the Fairy Bridge under guidance of the Jade Maiden and the Golden Youth. The Hindus picture a towering firmament of heavens and a many-leveled underworld of hells (Gratton, 1995). The soul gravitates after death to a story that assimilates the whole meaning of its past life. When the lesson has been learned, it returns to the world to prepare itself for the next degree of experience (Gratton, 1995). Thus gradually it makes its way through all the levels of life-value until it has broken past the confines of the cosmic egg. Dante’s Divina Commedia is an

Religious Preference and Spirituality 36 exhaustive review of the stages: “ ‘Inferno’, a misery of the spirit bound to the prides and actions of the flesh; ‘Purgatorio,‘ the process of transmuting fleshly into spiritual experience; and finally, ‘Paradiso,‘ the degrees of spiritual realization” (Campbell, 1949, p. 368).

Transformation starts by coming to terms with one’s ending. Coming to terms with one’s beginnings is difficult and ambiguous; it may occur in different ways (regression, analysis, selfreflection) and mean different things (forgiveness, charity, or simply the end of an addictive litany of issues from the past). Coming to terms with one’s ending, one’s finiteness, is clearer but even more difficult. Socrates said, “Practice dying” to youngsters asking for wisdom of life. On a less lofty level, Rinpoche (1994) speaks of the necessity of “letting go of attachment” (p. 224). In fact, Moore (1994) paradoxically views loss of love and intimacy as a form of initiation, suggesting that although initiation means beginning, the most powerful initiations always involve some sort of death.

Summarily, all endings are potential beginnings and all beginnings have an end. To the soul, death is the ultimate beginning, for all the particulars of precious ordinary living creatures, famous or not, human or not, are still transformed into another form (Moore, 1994). As Chopra (1993) says, in nature “death is part of the larger cycle of birth and renewal....Human atoms are billions of years old and have billions of years more life left in them. In the remote future, when they are broken down into smaller particles, atoms do not die but just get transformed into another configuration” (p. 303). Similarly, the human body is programmed to cease as a specific functional unit, but its elements are capable of taking quite different physiological forms: animals, flowers, ice, salt. Substances that make up living and nonliving things are one and the same (Chopra, 1993). People are not diverse from things, from space, from light, from time, but

Religious Preference and Spirituality 37 one product. This ultimately reflects the reanimation of life, finding the soul in everything, anima mundi.

The most cherished thoughts of eternity are the bright side of ending in this world and are often associated with beauty and light. Its realm and its nature change from one culture to another, from one religion to another, but it is typically a transporting destination (Gratton, 1995). It is being forever, and can hold the promise of a state of ecstasy or grace, an intrinsic radiance, or a hidden fellowship with other immortals, and even rebirth. Death, on the other hand, is often construed as the dark side of ending, an oblivion, nothingness (Feingold, 1995).

Full joyful living now and in eternity nonetheless requires understanding of this nothingness, in Rinpoche’s (1994) phrase, “living in the mirror of death” (p. 3). In fact, only “nothingness” can become everything. And one cannot enter into this nothingness without giving up everything. The spiritual self is obtained by the negation of the ordinary self, letting go of the subjective sense of being. This subjective selflessness is not an absolute state of nonbeing or nonexistence. Rather, it is a state of nondifferentiation from overall existence and reflects deeply on impermanence. It is giving up differentiating self-awareness from the universe. It is living everywhere and in every thing. It sees our own flesh in continual exchange with the whole of nature.

To reconcile “being” and “nonbeing” simultaneously, to live within the external world while striving for inner transformation, and to search for the grail while not grasping its nature, provides a transcending state. Salvation for ordinary mortals is not radical negation of living; nor is it waiting for a better life. Rather, it is an embodiment of the contradictions of life and death as a transformative harmony. Believing in transformation also applies to our selfhood. More

Religious Preference and Spirituality 38 specifically, Christensen (1999) talks of the “dialectical self,” borrowed from Buddhism. It does not deny that the self exists, but rather has diametrically opposed qualities, in sum, (1) has structure (form) and is impermanent (empty), (2) is unsatisfactory (associated with suffering) and also liberated (joyful), and (3) has no separate essence (interdependent), and is also separate. In the harmonious words of Shobogenzo Genkoan, Zen Master Eihei Dogen: “To study the self is to forget the self. To forget the self is to be at one with ten thousand phenomena. To be at one with ten thousand phenomena is to free one’s body and mind and those of others.”

In this study, the soldiers experienced various aspects of each of these areas of discussion ranging from the love of work to the love of belonging. In their training environment, these spiritual elements were available and encouraged as they matured into fully qualified, fully rehabilitated soldiers ready for duty. Having to adopt as reality the possibility of having to give their lives in the service of their country, as so many others have already done, these soldiers must make adjustments in their thinking about death. They usually begin to understand a greater good and start to commit their very lives to that good.

Theory of Mind and Its Psychopathology Spiritual psychotherapy considers all theories about the human mind as temporary attempts of filling the gaps of knowledge and, at times, justification of their therapeutic techniques. Nevertheless, even contradictory techniques, i.e., the resolution of past and present conflicts (when there is no before and after), or the remedying of deficits and strengthening the individual’s capacity to cope, are all potentially useful—provided that one recognizes their relativity (Lerner, 2000). The spiritual therapist thereby sees no contradictions amongst various

Religious Preference and Spirituality 39 schools. In fact, such conflictual polarities invite an offering of faith. Then psychopathology, as defined by all these schools, becomes merely the surface reading of the human condition; similarly, symptoms of conflicts and deficits thus become manifestations of problems at the deeper levels of the soul—spiritual arrests, conflicts, and deficits (Feingold and Helminiak, 2000).

In spiritual psychotherapy, the mind does not comprise only conscious and unconscious forces (the prohibitive superego, the impulsive id, or the executive ego), but also collective spiritual forces that are prestructured to love and to believe (Duclow and James, 2002). This makes the mind not a simple mechanical mind, but a spiritual one. It carries with it a remembered oneness, a sacred belonging. There is no royal road to it, simply a sacred one (Crossan, 1998).

What Spiritual Therapy Is Not Spiritual therapy is not religious counseling (Corey, 1996). The Church and its religious counselings typically represent a structured and organized form of spirituality with highly specific traditions, proscriptions, and rites; they impose God as a separate and superior theological conception, accompanied by required rituals of seeking His hand (Crossan, 1998).

By contrast, spiritual psychotherapy rejects strict formality and substitutes flexibility and freedom. It embodies a contemporary religious view that is universal and nonsectarian, best portrayed as perennial wisdom or philosophy (Huxley, 1944) or the transcendent unity of religions (Schuon, 1975). Accordingly, it warrants no piety, nor worshiping. Rather, in Campbell’s (1949) words, “The contemplation of life thus is undertaken as a meditation on one’s

Religious Preference and Spirituality 40 own immanent divinity” (p. 319). In short, the divine being is viewed as a revelation of the omnipotent self that dwells within everyone. Sheikh and Sheikh (1989) put it as follows: All of us have the potential for transcendent experiences. The great saints and sages of human history are said to differ from the rest of us by virtue of attainment and realization, not by some unsurpassable God-given ontological state that forever sets them off from us as a separate order of being (p. 546).

Similarly, spiritual psychotherapy makes no godly claims beyond man’s own human realization (Campbell, 1949). Spirituality is a path of quiet contemplation, in which we find the divine in the given world and within ourselves. The lesson is “know this and be God” (Campbell 1949, p. 319). Spiritual existence—and spiritual therapy—is a journey; one makes the way by going.

Spiritual therapy is not existential psychotherapy. Existential therapy negates the spiritual to the extent that its fundamental negativity, anguish, doom, and sense of man’s finitude are diametrically opposed to an emphasis on beauty, rebirth, and reanimation of life (Clinebell, 1995). In addition, with its phenomenological reduction to immediate experience as the only valid data, it deliberately doubts all notions that are inferred, invisible, or carried over from the past—those that are easily embraced by spirit (Frankl, 1995). Since it believes that “human living is torn from the un-self-consciousness of objects or plants and animal existence” (Gurman and Messer 1995, p. 233), it construes consciousness as making human life qualitatively different from that of any other species, thus setting man apart from the unity of nature. And although its method of doubt is intended to create freedom from existential isolation, instead it can generate freedom from faith (Frankl, 1995). In contrast, in spiritual therapy, the person is viewed as a

Religious Preference and Spirituality 41 perpetual beginner, whose uninitiated positivity generates hope, creates harmony with one’s self, and continuity with the universe (Feingold and Helminiak, 2000).

Spiritual therapy is not like analytic psychotherapy. Analytic psychotherapy is founded on the model of sickness. It is pathomorphic; it makes diagnoses; it seeks the cure of patients’ illnesses. In addition, it is deterministic (if not overdetermined) and is concerned with etiology and cause. In particular it has a mission; it seeks to crack personal unconscious codes in linear time. In its most orthodox form, analytic psychotherapy is an artificial induction of therapeutic illness by transforming form (the transference) into content (Frankl, 1997). It aims at knowing, i.e., insight, and such self-knowledge is its end point. Thus, any puzzlement or obscurity must be undone. Furthermore, as the analyst makes transference-driven demands on the patient, he paradoxically creates an iatrogenic hothouse that itself cultivates psychopathology (Duclow and James, 2002).

By contrast, spiritual psychotherapy is founded on a model of health; it is normative; it eliminates (if not transcends) diagnoses. It is interested in salvation and healing (not cure) (Feingold and Helminiak, 2000). It is undetermined, transformative, and noncausal, a transpersonal journey in omnidirectional time. In its most ardent form, spiritual psychotherapy is the induction of stillness, the cultivation of quiescence and harmony between mind, body, and soul (Corey, 1996). Spiritual psychotherapy aims not at “knowing” but at enlightenment, whereby self-knowledge is not the culmination, but the starting point. In so doing, it seeks the regaining of lost innocence in order to experience—not answer—the eternal riddles of life. In fact, the spiritual therapist stays observant until things gradually become obscure (Crossan,

Religious Preference and Spirituality 42 1998). He or she knows that puzzlement is a necessary state that precedes enlightenment (Christian, 1999).

Spiritual therapy is not like academic psychotherapies. Spiritual psychotherapy cannot be standardized in operational manuals that homogenize all treatment (Corey, 1996). It is not based on large-scale bureaucratic research requirements, efficacy, efficiency, or cost-effectiveness. It does not steer in shallow water, is not superficial or strictly short term; it does not prescribe and predict. Rather, it is highly improvisational and fully accepts (if not promotes) heterogeneity. Its N equals 1 and is by definition immeasurable. It is not a matter of science and proof, but belief and faith (Feingold and Helminiak, 2000). It steers in deep waters.

Spiritual therapy is not like New Age therapy. New Age psychotherapies promote search for the self but never get beyond it (Park, 2000). They are geared toward self-actualization, selfprotection, and self-love (in the smallest sense of the word). They primarily offer quick and easy answers that derive from pleasure, not insight or enlightenment (Christensen, 1999). In fact, they don’t ask questions or look beneath the surface—of one’s own myopic life. In this sense they are selfish—never selfless. In seeking instant gratification, they are indulgent, excessive, and exalt only the immediate moment—never eternity. They reject the simple life and instead urge their recipients to indulge hedonistic desires and pleasures, to seek narcissistic gains (Corey, 1996). In short, you can only get there by riding others.

In contrast, spiritual therapy seeks the self beyond itself in order not to be selfpreoccupied; in short, it is egoless (Lerner, 1998). It is geared toward self transcendence, the love of others in a universal, timeless, and spaceless field. Spiritual therapists help their recipients to

Religious Preference and Spirituality 43 relinquish self-serving actions, to express compassion and forgiveness (Duclow and James, 2002). And you get there by carrying others.

In the consolidation of a soulful and spiritual existence, the person continues to come closer to an authentic self. Only such authenticity contains meaningful therapeutic tools, because what endures ultimately emanates from within (Feingold and Helminiak, 2000). Then spiritual psychotherapy becomes not so much a profession as a way of being in a harmonious relationship to man and infinite nature. In Kovel’s (1991) words, “We do not have a spirit; rather, we are spirit” (p. 20). This does not mean, however, that we reside in a realm that is lofty and elusive, unable to be touched. Instead it is a unified quality of mind and heart and soul, a commitment to a spiritual existence (Duclow and James, 2002).

The “New Spirituality” and the Challenges It Brings to Psychotherapy and Medicine in General A curious phenomenon has occurred in the American culture in recent years. It has become permeated with what has been called the “New Spirituality,” which differs in significant ways from the kinds of spirituality expressed historically in major spiritual traditions (Inchaust, 1998).

The new spiritual explosion involves a multitude of diverse beliefs and practices. Many of these are free-floating fragments of teachings from other times and places, now no longer connected to theoretical or traditional contexts or to experience (Moore, 1998). The situation is confusing. It might be useful to ask whether we ought to take seriously what we read and hear about spirituality in the mass media as well as in some professional journals, workshops, and conferences. Without such critical questioning we might easily conclude that to become truly

Religious Preference and Spirituality 44 spiritual, what we need to do, among other things, is to meditate; use crystals; trust our intuition; love and forgive everyone; communicate with the dead, with angels, or with channeled spirits.

We could also think positively; respect the planet; read inspirational literature; attend inspirational workshops; maintain tranquility; engage in Western religious practices; engage in ritual practices of Native American, Asian, or Middle Eastern religions; perform kind acts for people and animals. In addition, we could eat organic foods; visualize; pray; breathe mindfully; consult the I Ching; consult an astrologer, a psychic, a past-life therapist, an energy worker, a feng-shui specialist, or some kind of healer or guru; and, finally, plan for a transcendent death and a happy reunion with our loved ones (Inchaust, 1998). (Some of these considerations bring to mind the line from Gilbert and Sullivan’s The Mikado, “There’s the idiot who praises with enthusiastic tone every century but this and every country but his own.”) Theodore Roszak’s description of The New Age of the 1960s still applies today: “We begin to resemble nothing as much as the cultic hothouse of the Hellenistic period [in ancient Greece], wherever manner of mystery and fakery, ritual and rite intermingled with marvelous indiscrimination” (Roszak 1969/ 995).

Spirituality is often regarded as being free from the shackles of reason and intellect.

Some people view it as anti-intellectual and antiscientific, and associate it with the occult, magic, mysticism, and beings from outer space (Crossan, 1998). Some regard it as separate from the body; others regard the path to it as being through the body. Sometimes spirituality is equated with religion; sometimes it is not. When it comes to health, it is often assumed that any belief or practice labeled “spiritual” is ipso facto healing. Many people seeking cures for specific problems consult practitioners they regard as spiritual.

Religious Preference and Spirituality 45 Beyond a lack of agreement about what spirituality is, there is also no consensus concerning standards for judging ideas about spirituality. People use different criteria to determine whether a statement in this area has meaning, whether a line of reasoning has validity, or a theory has coherence (Lerner, 2000). Unfortunately, many people believe that knowledge is subjective, so that any belief about spirituality is regarded as true as any other and any theory as sound as any other. Because spirituality is often considered to be separate from reason and therefore free of its constraints, disparate notions, no matter how far removed from experience, are often adopted without questions and grafted somehow onto a body of accepted beliefs (Feingold and Helminiak, 2000). Many thoughtful observers have remarked on the emptiness and the self-satisfying ideas and practices of the New Spirituality.

The philosopher Jacob Needleman (1977) has commented, “We use concepts that are naive and hollow, and adopt the terminology, the props and the practices without changing anything essential in our inner lives� (p.23). Needleman also observed the absence of an ethical element: Although it [the new spiritual movement] preaches unconditional love, it seldom advocates the responsibility to demonstrate this with the people around us. Rather, it often seems to be about self-absorption and about ways to feel good, with no meaning beyond that. Real spiritual development [in the West] calls for action. (1977) Thomas Moore (1998), a former monk and the author of The Care of the Soul, has objected to the equation of spirituality and self-improvement: We in America are losing our deep spirituality even as many celebrate an apparent renaissance of the transcendent kind. This researcher is not so enthusiastic about the

Religious Preference and Spirituality 46 supposed renaissance because the researcher sees narcissism in it...in the prospect of making a superior self. (p. 27) Robert Inchausti (1998), author of Thomas Merton’s American Prophesy, has commented on a contradictory effect of the New Spirituality: The problem with these new “spiritual” practices is that they do not fully question the ends they serve. In their emphasis upon process over product and upon the quality of the internal experience itself, they tend to elevate the practitioner’s own spiritual aspirations to a newer absolute. But these desires—however “spiritual” they may seem to the person holding them—may simply reflect the narcissism of the culture at large—and so instead of liberating the individual from the idols of the marketplace, bind us even more profoundly to them. (p. 23) John Dominic Crossan (1998), professor emeritus of religious studies and the author of several works on early Christianity, has questioned the foggy, shallow thinking of the New Spirituality, its self-centered aims, and the meaninglessness of its use of the word “spirituality” itself: Is there anything now, that spirituality does not or could not mean as long as it supports spirit over flesh, and individual needs or desires over social systems or structures? But how, exactly, in such a situation, do you distinguish between spirituality and sentimentality or, indeed, between spirituality and Prozac? (p. 13) Gilbert and Sullivan put the matter succinctly in a lyric from Patience: “The meaning doesn’t matter if it’s only idle chatter of a transcendental kind” (Park, 2000, p. 9). But it is not all only idle chatter. The New Spirituality clearly has arisen in response to universal needs for

Religious Preference and Spirituality 47 meaning and purpose that are not being adequately filled in our society today. They are universal in that we know of no culture or period of history without evidence of these needs. In every culture we know, people have perceived that there is a dimension of human beings that cannot be described or accounted for in psychological, intellectual, or physical terms alone. That “something more” can best be called our “spiritual” aspect. It is this aspect of human experience and aspiration that the New Spirituality expresses.

On the other hand, the New Spirituality offers no serious or profound understanding for making inner change (Park, 2000). All the great spiritual traditions of the world involve ideas that cannot be grasped, much less lived, without extraordinary commitment and intelligence, as well as prolonged help from others who have gone through the necessary stages of the path themselves (Needleman, 1997). The New Spirituality requires no commitment of disciplined study, training, and practice. Further, unlike every major spiritual movement in history, which include a deep conviction of concern and help for others, the New Spirituality has no ethical component (Needleman, 1997). It is a kind of street bazaar with vendors hawking their wares while customers fill shopping bags with jumbles of ideas, objects, rituals, and practices.

This study focused specificallyon the New Spirituality’s destructive effects on the psychological profession, and on the important challenge it brings to this profession and to medicine in general. The New Spirituality has had two deleterious effects on the practice of psychology. First, as it has washed over American culture, it has encouraged people to believe that spirituality is somehow a quick and easy fix for psychological and physical problems (Inchaust, 1998). Equally unfortunate is that it has encouraged some therapists to include in their practices so-called spiritual words, ideas, and perspectives that have no more substance than the

Religious Preference and Spirituality 48 marketplace array of the New Spirituality (Moore, 1998). To put all this bluntly, clients, influenced by the New Spirituality, while legitimately yearning for “something more,” come for therapy with absurd notions about spirituality and encounter therapists with equally nonsensical ideas (Corey, 1996).

Of course, if psychology had a sound, meaningful, and rooted concept of spirituality, the effect of the New Spirituality would be minimal, even if clients did arrive for therapy with silly ideas (Lerner, 1998). But professional psychology has traditionally ignored, discounted, or even pathologized clients’ statements about their spiritual or religious experiences and beliefs. For the most part, spirituality itself has been viewed as a foolish and irrelevant notion, despite the efforts over the past 50 years of a number of psychiatrists and psychologists to develop fruitful theories attempting to integrate spirituality into psychotherapy (Corey, 1996).

Consequently, professional psychology faces a critical challenge. Many people who come for psychotherapy are seeking ways to touch something deep inside themselves that has been untouched in their everyday lives. They are seeking purpose, wholeness, meaning, and intensity of experience. Many seek to discover what is of value for themselves, or try to resolve difficult moral conflicts (Needleman, 1997). They want to transcend who they are now.

The New Spirituality has pushed professional psychologists to open themselves more broadly than ever before to the spiritual concerns of both their clients and themselves. But given the nonspiritual tradition of professional psychology, therapists as a group have no clear, cogent standards by which to acknowledge and meet those concerns or to allow clients their own integrity in the course of therapy.

Religious Preference and Spirituality 49 What might such standards be? That is, how can we include spirituality in professional practice in a clear, disciplined, and meaningful way? This is the question addressed here. The researcher’s use of the word “spirituality” is not intended to imply a necessarily religious connotation. Spirituality and religion are not the same. Spirituality is the basis or core of religion; religion is the systemization or codification of spirituality. As Rabbi Michael Lerner (2000) has pointed out, religion can, and often does, exist without spirituality. While spirituality sometimes takes the form of a religious commitment, it can, and often does, exist without religion. While there are a variety of religions, spirituality is common to all human beings (Lerner, 2000).

It is also important to note that while some of the practitioner–patient interactions described here are most likely to occur in psychotherapy or psychiatry, most of the considerations apply to other areas of medicine as well (Roszak, 1995). Discussions about psychotherapists apply to health practitioners of all kinds.

Destructive Beliefs As noted above, the New Spirituality has helped seed many clients with nonsensical ideas about spirituality. At least three of these ideas are psychologically toxic. It is also likely that they do physical harm, for there is little doubt that the beliefs people hold can influence their health and the course of their illness (Park, 2000). The researcher focused on these particular ideas because he encountered them often in his practice working with people who have cancer.

The researcher is not saying that these three ideas are “spiritual,” that they arise out of a sense of spirituality, or even that they are exclusive to people who view themselves as spiritual.

The researcher is asserting that these ideas are simply baseless pseudometaphysical presumptions, and have proliferated as a result of the prevalence of the New Spirituality

Religious Preference and Spirituality 50 (Crossan, 1998). Again, while psychotherapists are more likely than other health practitioners to hear these beliefs from clients, health practitioners of all kinds would do well to recognize the implications of these beliefs for their patients and to prepare themselves to respond to them.

The Belief: We Create Our Own Reality This means that we also create our own misfortunes, including our illnesses. In a book widely read by health professionals and counselors, now in its 57th printing, the well-known author Louise Hay (1999) claims exactly that: “We are each responsible for all our experiences” and “We create every so-called illness in our body.” (p. 15) This idea that we are responsible for our illness is often used against people who are ill and by people who are ill against themselves (Corey, 1996). At the time of this writing, the researcher’s young patient, in treatment for a brain tumor, told the researcher that he had spoken with a “mystic and healer.” The healer informed him that “most people’s illnesses come from within,” and advised him to “look deeply inside yourself and try to figure out what actually created your cancer.” He had done so, and decided that because he had smoked marijuana several times, he must have indeed caused his cancer. He told the researcher that he had confided this belief to his radiologist, whose incredulous expression caused the young man to discuss his beliefs again with the researcher.

This researcher has found that many clients with cancer believe that, consciously or unconsciously, they chose to cause their illness, or at least that they could have prevented it.

(Some patients volunteer this information. If not, this researcher has learned to dig for it.) This insidious idea can take a variety of forms. If only they had left a stressful job or relationship, they say, or had eaten more healthfully, or if they had meditated or visualized more or better, or

Religious Preference and Spirituality 51 maybe if they had not felt so angry or anxious, or sought psychotherapy sooner, they would not have cancer (Park, 2000). If they are not getting well, they shoulder the blame for that, too, and see their continued illness as their failure, so that cancer becomes a punishment for what they did wrong (Bawer, 1997). On top of their illness, they load themselves down with the additional weight of their self-condemnation and guilt.

It is sad and frustrating to try to help people understand that they are not responsible for being ill. We do not know what causes cancer. Apparently, it is the result of a combination of genetic, environmental, and psychological factors. We do know, however, that thoughts and feelings cannot cause cancer. (No one is that good.) The important question is not what caused it, but what we can do to work constructively with the challenge of getting well (LeShan 1994).

Of course, there is a great deal we can do in terms of our behavior and attitudes to change the course of cancer, just as there is much we can do to influence the course of many other kinds of events (Doran, 1990). Years of theoretical and clinical development of mind–body science leave no doubt of this. We can increase our chances of healing through the treatments we seek, and through our attitudes, beliefs, actions, and expectations (Duclow and James, 2002).

However, this does not mean that we cause our illnesses. We are all far too interconnected with one another and with our environment for a simplistic statement like “You create your own reality” to be true (Wilber 1988). This statement is bad metaphysics as well as bad psychology.

To Be Truly Spiritual: Banish “Negative” Emotions A variation of this belief is that to be physically healthy, we must banish negative emotions. In particular, we should do away with our anger, forgive those who have wronged us, and love them as well. We should also rid ourselves of fear and grief. It seems necessary to first

Religious Preference and Spirituality 52 help a person realize and understand that their emotions are natural, healthy responses to the situations they are in, and that acknowledging and expressing these feelings is healing. After a cancer diagnosis, anyone is likely to experience wild emotional fluctuations. Most people are afraid they will die. They are fearful of being in pain, of losing strength and energy, and of receiving surgery, chemotherapy, or radiation. They fear their next medical test results. They are apprehensive about the emotional and financial burdens their illness will place on their families, and about its effects on their own lives. They are often angry at the injustice of being ill: angry at God, furious with their doctors, and even resentful of the healthy people around them. They are often sad, grieving for their health, their energy, the lives they once had, and their dreams of the future (Duclow and James, 2002). Unfortunately, many people believe that by feeling these emotions they are making themselves sicker or preventing their own recovery (Doran, 1990).

One problem with the belief that we should not have any so-called “negative” emotions is that it is not at all clear what we are supposed to do with them. Presumably, in the language of the New Spirituality, we should just “let them go,” “detach,” “think positively,” and then “get on with our lives.” Precisely how we are to get beyond these empty words to accomplish this, however, is not explained. We cannot choose to feel some (positive) emotions and not feel other (negative) ones. Emotionally, we are either turned off or turned on.

Even if we are able to suppress or put aside emotions that are too unacceptable or too dangerous to confront, and even if we do so in the name of spirituality, we pay a heavy price.

Emotions are natural responses to our inner and outer experiences (Clinebell, 1995). So long as we acknowledge them and in some way express or deal with them, they aid our survival and help us experience what life offers. When we deny or suppress them, we run into problems. When

Religious Preference and Spirituality 53 emotions are repressed, they can become distorted (Kubler-Ross, 1987). For example, when anger is not acknowledged, it can fester and distort into resentment, a desire for revenge, bitterness, hatred of others and self, or rage, manifesting as hostility, powerlessness, violence, suicide, or depression. Grief unacknowledged can distort into self-pity, bitterness, depression, or martyrdom. Fear, when repressed, can turn into anxiety, panic, or phobias (Kubler-Ross, 1987).

Only when we are able to confront our anger, fear, and grief can we deal with the reality of our situation.

To Be Spiritual: Strive to Be Serene at All Times A variant of this is the belief that to be physically healthy we should be serene. This notion, too, arouses guilt and a feeling of failure in many of my patients who have not managed to maintain serenity in the face of an illness that threatens their life. Viktor Frankl’s statements about tension serve as a response to this idea. Frankl (1992) pointed out that the search for meaning in our lives may arouse inner tension rather than inner equilibrium. Precisely such tension, he said, is “a prerequisite of mental health, which...is based on a certain degree of tension between what one has already achieved and what one still ought to accomplish, the gap between what one is and what one should be.� Such tension is inherent in the human being and therefore is indispensable to mental well-being (Frankl, 1992. p. 12).

Being serene in certain circumstances is also an avoidance of reality. The person who is calm and serene when a child is being beaten is not perched high on the spiritual ladder. Rather, such a person has revoked membership in the human race. All three of these beliefs are expressions of the more general idea that by the power of the mind alone we can cure illness (as Deepak Chopra has claimed), cause illness (as Louise Hay claims), and make all kinds of things

Religious Preference and Spirituality 54 happen. For the New Spirituality, apparently we live in a universe in which everything is possible (Park, 2000).

Requirements for a Concept of Spirituality How can spirituality be conceived so that it can counter such ideas and, more importantly, be included in professional practice? The primary aim of any school of psychotherapy is the growth and health of the individual as an integrated whole. The primary aim of any form of mind–body medicine is the health of the whole person. However spirituality is conceived, to be incorporated into professional practice it must be consistent with these aims and further them.

Toward this end, the following requirements for a concept of spirituality need to be met (a) Spirituality must be conceived as one dimension of the total human being, inseparable from all the others, (b) Spirituality must be regarded as being compatible with all other dimensions of the total person. This means that it may not be conceived as being in opposition to any of them.

Thus a model of spirituality for psychotherapy may not involve exclusion, mistrust, devaluation, or rejection of the intellect, the emotions, or the body. Neither can such a model exclude the sociocultural environment that is an aspect of every human being, (c) Spirituality must reflect a practical approach to living that includes the total person, (d) It must be applicable to both theistic and nontheistic beliefs and practices, (e) It must be applicable to any major “school” of psychotherapy, or any form of psychiatry or mind–body medicine, (f) It must allow for the phenomena of spiritual as well as physical and psychological health and illness.

Symptomatology of health and illness must be conceived as occurring in any or all human dimensions, and (g) It must allow for the phenomena of spiritual as well as physical and

Religious Preference and Spirituality 55 psychological change and growth. Change and growth must be conceived as occurring in any or all dimensions. (Because the human being is an organic whole, we do not understand how growth can occur on fewer than all levels, but that is simply the way it is.)

A General Concept of Spirituality Spirituality involves far more than just believing something, talking about something, reading or thinking about something, or even just doing something. It is an attitude, a perspective, a way of looking at the world that is expressed in the way we live and the way we experience our lives (Feingold, 1995). At the core of this way of being in the world is one fundamental principle that informs it: that life is sacred. This principle is what Albert Einstein (1982) called “the supreme value to which all values are subordinate.” Albert Schweitzer (1998) called it the “reverence for life,” which he described as “the principle in which affirmation of the world and ethics are joined together.”

This foundational principle is what might be called a “living axiom” in that it comes not from reason alone or from knowledge of the world alone but is rather a perception, an awareness that comes from experience and reflection (Christensen, 1999). With this awareness, ethical behavior (Good) is seen as preserving life, promoting life, and developing life that is capable of being developed. Unethical behavior (Evil) is seen as disrespecting life, injuring life, destroying life, or repressing life that is capable of development (Schweitzer, 1998). With this awareness, rather than accepting life as a given, we can view it as something unfathomable, wondrous, and mysterious, and respond with awe, appreciation, and gratitude.

Religious Preference and Spirituality 56 Spirituality for Psychotherapy For psychotherapy and all areas of conventional, alternative, and complementary medicine, the most relevant part of this fundamental principle is that human life is sacred. When we recognize the sanctity and inviolability of all human beings, this recognition becomes the living axiom from which relevant aspects of spirituality can be derived. This axiom holds for both theistic and nontheistic beliefs; it holds, that is, whether or not God is posited as the source of the sanctity of life. With either view, the axiom has to do with the presence of the Divine in humankind.

It is the thesis of this study that spirituality in mind–body practice is about the sacredness of human beings. An intrinsic preciousness in human beings is not present in insentient matter.

The practitioner’s constant awareness of this sacredness is what brings spirituality into the treatment room. This concept of spirituality is at least as old as the Old Testament, in which it is written that man was created in the image of the Divine. The concept is expressed clearly by Rabbi Michael Lerner, author of Spirit Matters and editor of Tikkun, a journal featuring articles by people from all religious traditions seeking their spiritual roots. Lerner (1998, p. 12) wrote: Spirituality is, first and foremost, a way of orienting to the world, a way of being and knowing, that emphasizes awe, wonder, and radical amazement at the glory of creation and the splendor of the universe. Without rejecting the important place for science and for control of some aspects of our physical environment, spirituality emphasizes the limits of our control, the need to live in harmony with the rhythms of our planet and of the universe. Spirituality suggest the need to recognize the sanctity of other human beings and to treat them as essentially valuable not for what they can do for us, but for who they

Religious Preference and Spirituality 57 are as beings who reflect the ultimate spiritual or divine energy in the universe. Without negating the importance and value of individual difference and individual freedom, the spiritual orientation simultaneously stress the unity of all human beings and the unity of all beings. Above the proscenia in the Ethical Culture Society are the words, “The place where people meet to seek the highest is holy ground.” It is this perspective that brings spirituality to psychotherapy and medicine in general (Needleman, 1997).

Implications for Professional Practice In terms of practice, the axiom that human life is sacred has two major implications: First, it follows that the self is sacred and is to be regarded and treated accordingly. This facet of spirituality entails the recognition that it is the task of all of us to cultivate and nurture ourselves as unique beings. Frankl (1983) asserts: Every human person constitutes something unique; each situation in life occurs only once. The concrete task of any person is relative to this uniqueness and singularity. In psychotherapy this task for each patient becomes the aim of developing as an individual. This is “self-realization” (“self-actualization”), which the psychiatrist Frieda FrommReichmann (1980) defined as the person’s “using his talents, skills, and powers to his satisfaction within the realm of his own freely established realistic set of values.” It is also the person‘s “ability to reach out for and to find fulfillment of his needs for satisfaction and security, so far as they can be attained without interfering with the law or the needs of his fellow men” (Reichmann, 1980, p. 17).

We need to use ourselves. We crave meaning, purpose, goals, and ideals in life, and feel great emotional distress when they are lacking. There are many kinds of meaning. One is the meaning that comes from exercising our creativity, talents, and abilities. Another is the meaning

Religious Preference and Spirituality 58 that comes from a dedication to causes outside ourselves, or from an involvement with others.

There is cosmic meaning, which may involve a sense of the unity of being or of God; there is meaning that comes simply from living fully, enjoying and savoring what life offers (Yalom, 1980).

When psychotherapy stresses the unique individuality of each person, as does the approach developed by psychologist Lawrence LeShan (1994) for work with people with cancer, the psychotherapy process becomes the search for the individual’s own meaning and for the best way of “being, relating, and creating” that uses the most of oneself. This changes the traditional focus of therapy. Much of psychotherapy has focused on pathology and on past causes of current problems—on what is wrong with the person and how he or she got that way—rather than on what is right with the person and healthy. To understand a person, we have to know what he (or she) is trying to accomplish, or trying to become, or what his dreams are, not merely how he got to be the way he is (Corey, 1996).

When the focus is on encouraging clients to make inner changes and changes in lifestyle to create their own best way of living, the past becomes relevant only insofar as it blocks the way to the future. What is “wrong” with the person is relevant only insofar as it blocks the person’s designing a life that can bring meaning and enthusiasm. Exploration of the past becomes simply a means to the primary aim: that of cultivating the self to creating a life that reflects who the person truly is (LeShan, 1994).

This approach has physical as well as psychological effects. After having used this approach for more than 10 years with people with cancer, this researcher has found that people with life-threatening illnesses who have a sense of meaning, purpose, and, consequently,

Religious Preference and Spirituality 59 excitement about their lives fare far better than others. Nearly 50 years of research with this approach has shown that there is reason to believe that in a number of cases inner changes and changes in lifestyle are linked to remissions of cancer and improvement of physical health (Moore, 1998). At the same time, those facing death do so with more acceptance than those in whose lives meaning and purpose are absent (Kubler-Ross, 1989).

A psychotherapist cannot give meaning or purpose to patients but can help them discover their own meaning and purpose, and grow to their fullest potential (Clinebell, 1995). This psychotherapeutic aim in effect mirrors the principle at the heart of the Western spiritual tradition, the idea that when we are born, we are each given our own special seed, our soul, to cultivate, nourish, and bring to full flower, so that when the gift is called back it will be worthy of the One who gave and recalled it (LeShan, 1996).

The great spiritual teachers all said that there is a different spiritual path for each person.

Thomas Aquinas said that the greatest good is to seek your own nature (LeShan, 1990). The Benedictine mystic Dom Baker said that the task of Spiritual Directors is to usher people along their own individual ways, “the way that is proper for them” (LeShan, 1994). The Seer of Lublin, asked to name the one general way to serve God, said that it is impossible to tell men the way they should take, whether through learning, prayer, fasting, or eating, for everyone should observe the way his heart draws him to, and then choose to follow that way with all his strength (LeShan, 1996). Saint Theresa of Lisieux wrote that the hardest task of Spiritual Directors, “harder than making the sun rise at night,” is to give up one’s own likes and dislikes in order to guide each person along the special path God indicates for them (LeShan, 1994).

Religious Preference and Spirituality 60 The Ba’al Shem Tov, founder of classical Chassidic Mysticism, said that from the dawn of creation no two people are alike; each is unique. It is the task of each person to further this uniqueness, he said, and it is the failure to fulfill this task that holds back the coming of the Messiah (Inchaust, 1998). Such spiritual leaders as Thomas Merton and Saint Theresa of Avila have also pointed out that for each person the path of inner development is different, and each must find his or her own individual way (LeShan 1990,1994, 1996). And Stuart, Dreko and Mandle (1989) summarized the relationship between health and spirituality with these words: “The roles of spirituality and health have been interrelated from the earliest of times.” M. E. McGlone (1990), writing in her article on Holistic Nursing Practice, succinctly stated it this way, “…the path toward health is necessarily a spiritual one” (McGlone, 1990, p. 70).

Secondly, from the axiom that human life is sacred, it also follows that not only the self but all other human beings are sacred and are to be regarded and treated as inviolable. This facet of spirituality entails ethical awareness and social responsibility. In both professional and popular literature, spirituality is often conceived as being unconnected to the ethical realm of interpersonal responsibility. At its worst, the literature treats the individual as an unencumbered spiritual being, free to grow and explore with little attention to obligations and concern for others, the community, or society. Some writers assume that spiritual enlightenment automatically leads to morally sensitive behavior, but historically this has not been the case (Doherty, 1999a).

Psychotherapy has no explicit moral tradition. While it purports to be value-free, in practice it is not. It has supported and espoused the value of individual self-interest. Concepts of right and wrong, commitment, and obligation have had little or no place in the therapeutic

Religious Preference and Spirituality 61 dialogue. William Doherty, a family therapist who clearly makes this point about the need for moral responsibility in therapy, observes that therapists usually presume that a client’s expressions of obligation and commitment are unhealthy until proven otherwise. Relationships, including marriages in which children are involved, are discussed not in terms of responsibilities but rather in terms of a self-interested cost-benefit analysis for the client. Psychotherapy has traditionally promoted “a morality of individual self-fulfillment, with relational and community commitments seen as means to the end of personal well-being, to be maintained as long as they work for us and discarded when they do not” (Doherty, 1999b).

Morality is not just an individual matter. The social context in which the individual lives is part of self-identity (Needleman, 1997). The psychology literature includes little mention of the individual’s responsibility to the community. “We have been trained to use microscopes, which make the heavens invisible,” Doherty (1999a) writes. However, the personal and social are inextricably entwined.

Perhaps it is becoming more apparent that individual growth and self-realization cannot occur when responsibility is only to oneself. Self-realization has to do with the development and fulfillment of possibilities of the self (Needleman, 1997). One of these is the moral sense, one of compassion and concern for others. The individual without a commitment to others is not a fully developed human being. Neither is such an individual likely to find meaning and fulfillment in life (Doherty, 1999a). Another nursing practitioner put it this way: “A person’s perception of and experience with the transcendent will in great measure influence how that person views life and copes with life’s crises of illness, suffering, and loss” (Stoll, 1989).

Religious Preference and Spirituality 62 In recent years, value-free psychotherapy has been seen more and more to be untenable, and has been supplanted more and more by perspectives involving values (Bergin et al., 1996).

There appears to be a growing recognition that “being ‘free’ of value judgments leads to loss of self-respect, identity and self-image.” If we attribute an individual’s undesirable behavior to influences of the family or the culture, we leave no room for the possibilities of selfresponsibility, change, and growth (Needleman, 1997).

Edgar Jackson (1986), a psychologist who studied people in crisis, concluded that “research into the nature of the kind of person most adequate to cope with life shows a quality of concern, a capacity for love, and a depth of awareness of others—the super-healthy person is socially responsive” (p. 27). Self-respect and respect for others are inextricably intertwined.

DeVries (1982) wrote, “One can respect others only to the extent that one respects himself” (p.

322). Doherty (1999a) put it this way: “To be true to myself, I must be true to other people. I have an obligation to them because I am one of them and they are part of me. There is no inherent contradiction between self-fulfillment and moral responsibility to others” (p. 15).

Beyond these two major implications for practice, the principle that human life is sacred has two additional implications concerning the interconnection of human beings with the natural and the social communities. These implications, unlike the first two, are not intrinsic parts of psychotherapy and do not guide it. They are: Thirdly, when life is seen as sacred, it follows that all that sustains life and on which life depends is sacred. This facet of spirituality entails ecological awareness and responsibility for the natural world. Jose Ortegay Gasset (1914/2000) expressed this awareness by saying, “I am I plus my surroundings, and if I do not preserve the latter, I do not preserve myself” (p. 37). Another philosopher defined spirituality in these terms:

Religious Preference and Spirituality 63 “…a way of being and experiencing that comes about through awareness of a transcendent dimension characterized by certain identifiable values in regard to self, others, nature, life, and whatever one considers the Ultimate.” (Elkins, 1988, p.9) Lastly, when life is seen as sacred, it also follows that there is a unity of all being. The poet John Donne’s well-known lines about the interconnectedness of all human beings come to mind here: No man is an island, entire of itself; every man is a piece of the continent, a part of the main...Any man’s death diminishes me, because I am involved in mankind; and therefore never send to know for whom the bell tolls; it tolls for thee (Neruda, 1994, p. 22).

This facet of spirituality entails the awareness of how life’s designs fit together. It involves some form of the view that we are all an inseparable part of something greater than any one of us. The “something greater” might be understood as God—as the creator, the designer, or the source of the sanctity of life. Whether our view is theistic or nontheistic, with this kind of cosmic perspective we can see the universe as friendly and can feel at home in it. As Plotinus wrote, “No man walks on an alien earth.”

With this perspective, we do not regard adversity as a personal punishment or assault.

Rather, we are better able to see events as part of a larger process to which we can adapt with greater understanding and acceptance. When we assume that we are greater than the sum of all our abilities and our experiences, we can take a transcendent view of our lives, and look for meaning and purpose (Jackson, 1986). The National Interfaith Coalition on Aging described the relationship between spirituality and self in these words. Spirituality was seen as: “…the Ultimate Other which exists throughout and beyond time and space.” (NICA, 1990, p.4)

Religious Preference and Spirituality 64 The Central Application In the practice of psychotherapy, there are no rules or “correct” methods for applying the fundamental spiritual axiom that the person is sacred. In general, we apply it when our perceptions, attitudes, decisions, and behavior are shaped by this awareness. When we have this awareness, it is as if each patient we are with speaks the words of the poet Neruda, who quoted William Butler Yeats, (1994), “I have spread my dreams under your feet. Tread softly because you tread on my dreams” (p. 51).

When we see human beings as sacred, our practice will be informed by three considerations that have already been alluded to. They merit a fuller exposition.

First, there is the consideration that each person is an organic whole, with inseparable physical, intellectual, psychological, social, creative, and spiritual aspects. Any view of a human being as a purely physical being ignores the complexity of the person. Similarly, any view of a human being as a purely intellectual or rational being, or as a purely spiritual being, does not do justice to the person.

Further, any view of the human being that fails to include a social and cultural environmental context also does violence to the person. We are born into families, communities, and cultural, religious, and ethical traditions that shape us and become part of who we are. A view of the human being without this context can lead only to a pseudospirituality of narcissism.

Many therapists have viewed the human being atomistically, as pieced together out of separate parts. In this way they destroy the unified whole of the person, and then create for themselves the task of reconstructing the whole person out of pieces (Frankl, 1997). With the holistic view of humans as multidimensional, there is no reason to speculate about the

Religious Preference and Spirituality 65 relationships between the various aspects (most notably the relationships of mind and body, and of body and spirit) and how they fit together, for they are one.

Just as the facets of a diamond are of one diamond, human facets are of a totality. It is helpful to think of these facets as “dimensions” or “aspects” to emphasize their unity. When they are regarded as dimensions of one and, at the same time, the same being (rather than as separate parts or layers of which a person is composed), the person can be seen clearly as a whole (Frankl, 1985). Only from this holistic viewpoint is it possible to derive a spiritual approach to living that involves the total person.

The attitude most fitting is that of the psychiatrist Kurt Goldstein who was quoted as having said, “Before I see a patient, I close my eyes and repeat three times, ’Now I must give up all my preconceptions’” (Corey, 1996, p. 24). Carl Jung (1999) made the same point when he wrote: Experience has taught me to keep away from therapeutic “methods” as much as from diagnoses. The enormous variation among individuals and their neuroses has set before me the ideal of approaching each case with a minimum of prior assumptions. The ideal would naturally be to have no assumptions at all (p. 32).

The heart of the psychology of the psychiatrist Milton Erickson was that each patient, like each research problem, requires a unique approach. The psychiatrist Abraham Myerson used to tell his students, “As soon as you have decided on the basis of long experience and theory that all patients who have characteristic A also have characteristic B, and that this can be absolutely depended on, you can be certain that within days a patient will come into your office with A and

Religious Preference and Spirituality 66 not the slightest sign of B. The only question is, will you be too blind to see it?” (Clinebell, 1995, p. 42).

To view a person as an example of a diagnostic category or any kind of abstract grouping is to fail to see the living individual at all. As Jung (1989) also pointed out, “A concept is not a carrier of life. The sole and natural carrier of life is the individual, and so throughout nature” (p.

33). Generally speaking, the more a person appears to us to fit into a diagnostic category, the less we know about the person because we have lost the individual.

A Healthy Person: Making Choices, Bringing About Change, and Continuing to Grow Viewing a person as a product of heredity and environment, for example, or as a pawn of instinctual drives and reactions, is logically inconsistent with seeing the person as having a spiritual dimension. Such deterministic views can lead only to a kind of nihilistic, mechanistic behaviorism. We can legitimately incorporate spirituality by viewing the person as determined in the past but free in the future. In short, when we see each human being as sacred, we see a unique biological organism, a unique psychological organism, a unique social/cultural organism, and a unique spiritual organism—a unique multidimensional entity who can choose the directions in which to live and grow.

How to apply the fundamental axiom of the sacredness of human life can be clarified further by citing some examples of situations in which we act in ways that are contrary to the axiom. These situations would not arise if we maintained the spiritual conviction that human life is sacred.

Religious Preference and Spirituality 67 Psychoanalysis and Religion Freud wrote extensively on the psychology of religion (Freud, 1907/1959, 1913/1953, 1927/1961b, 1928/1961c, 1930/1961a, 1939/1964; Freud & Pfister, 1963) providing us with a rather thorough discussion of some of the psychological roles that religion can play. According to Freud, religion gives expression to unconscious guilt. At the cultural level, this guilt stems from the repressed memory of having killed the father of the primal horde (believed by Freud to be a historical truth), while at the individual level it stems from a fear of retaliation due to a son’s unconscious wish to kill his father because of his possession of the mother, the son’s preferred sexual object.

On the one hand, therefore, according to Freud’s views, religion can be understood as one of the regulatory products of civilization aimed at controlling the inherent destructiveness of human instincts (i.e., sexual and aggressive), which, if left untamed, would lead to extinction (Freud, 1961c). In this light, Freud views religion as a symptom of the struggle between this necessity for civilization and the price that has to be paid for the renunciation of instinctual demands. On the other hand, Freud argues that the inherent helplessness of a child (leading him to seek his father’s protection despite his wish to kill him) is never really overcome in adulthood, because human beings’ lives are always ultimately contingent on the strength and uncontrollability of nature. Human beings, therefore, tend to continue wishing for a father figure.

According to Freud, it is this wish for protection, then, that motivates the development of the concept of God (Freud, 1961c).

In summary, Freud’s justification of the concept of God is to be found in the dynamics of his Oedipus complex, while the idea of religion in general is related to the need of civilizing

Religious Preference and Spirituality 68 aggressive and sexual drives (Freud, 1961b). Freud (1927/1961b) also speaks of religion as an illusion because its truth content cannot be proven, and possibly as a delusion because its truth content is not only difficult to prove but also highly unlikely. According to Freud, it takes an active avoidance of the use of reason not to realize that religion is only the product of mental activities. Illusions, according to Freud, can be useful in some contexts, such as in controlling anxiety, but in order for them not to be noxious they must be open to correction. Religion, however, is not open to criticisms and therefore is not a useful illusion. Freud was influenced by the positivistic epistemological stance of his time and considered science and rationality to be appropriate answers to the existential quest. Instead, religion, being only the expression of a wish, hence the equivalent of a childhood or obsessive (Freud, 1927) neurosis, had to be overcome for an adult mature person to develop.

Most post-Freudian authors mainly address, directly or indirectly, one or more of the three fundamental Freudian claims regarding the nature of religion: (a) Religion is a form of delusion and (b) religious beliefs are defenses against worldly wishes or fears, both of which imply that (c) religious involvement necessarily entails a regressive stance. These authors revisit such claims by offering alternative theoretical perspectives on religion that lead them to conceptualize a more positive or simply more complex view of the role that religion plays in psychological functioning than the one Freud offered. To do this, these authors usually borrow from the advances made either within one or more of the contemporary psychoanalytic schools, or from more general epistemological turns characteristic of the 20th century.

Within the tradition of ego-psychology, Erikson seems to question Freud’s belief that religion entails a regressive stance. Without disregarding the importance of sexuality as a

Religious Preference and Spirituality 69 motivator for behavior, Erikson deems the importance of developing a cohesive sense of identity as central to the human concern and strongly considers the influence of society on such a development (Erikson, 1959). In Erikson’s work, it is within the “basic trust versus basic mistrust” stage (Freud’s oral stage)—during which the infant is thought of as attempting to master the environment (Hartmann, 1958) by learning how to trust that his or her caregiver will care and provide for him or her—that an individual begins to learn the meaning of “hope” and “faith.” These are concepts both central to religious thinking and deemed appropriate ways of adapting to one’s environment by Erikson. It is then within the “integrity versus despair” stage that the elder must look back at his or her own life and derive satisfaction from recognizing his or her life’s threads and meaning. Such a process will lead the elder to the acquisition of the virtue of “wisdom.” Erikson uses the term homo religiosi to describe those people for whom the struggle to achieve integrity, wisdom, and meaning—the greatest or most developed task that a human being must master—is a lifelong process and does not simply start in old age (Erikson, 1962, 1969; Wulff, 1991).

Working within object relations theory, applications of Winnicott’s (1971) concept of “transitional space” to the relationship between psychology and religion (Jones, 1991, 1996; Leavy, 1990; Meissner, 1984, 1990; Rizzuto, 1979, 1991; Schlauch, 1990) lead to a new conceptualization of the psychological function and meaning of illusion. Transitional objects and transitional phenomena (“transitional” between the internal world of an individual assigning meaning to his or her experiences and an external element to which the meaning is assigned) seem to offer a model according to which illusion does not slide on the plane of delusion (as it did in Freud’s view), but on the contrary becomes an essential element in coming to recognize

Religious Preference and Spirituality 70 and appreciate reality as well as in the development and maintenance of mental health. In this light, illusion, rather than being considered a form of delusion, becomes the center of human creativity. Furthermore, several authors (Meissner, 1984; Rizzuto, 1979) claim, contrary to what Freud thought, that atheism can be the manifestation of neurosis as much as religious beliefs.

According to Rizzuto (1979), for instance, we all develop an image and/or an idea of God—due to the inevitable impact of the larger culture. There are then psychological reasons both for believing and for not believing.

Finally, within self psychology, it is Kohut’s elaboration of a second line of narcissistic development that allows him to conceptualize religion as playing a potentially positive role in structuring and maintaining the cohesiveness of the self (Strozier, 1985, 1987). Kohut saw religion as having potentially therapeutic roles not simply in terms of internalization processes, but also as far as psychic growth (i.e., transmuting internalization) is concerned, because of the self-psychological focus on interdependence. In this light, people’s search for psychic sustenance both in others and in cultural entities is not simply essential to early human development but must continue throughout the course of one’s life (Strozier, 1985, 1987).

We could therefore argue that the particular perspective adopted by the various psychoanalytic schools with respect to religion depends on whether religion, within each theory, could make a positive contribution to mental health: (1) In classical psychoanalysis, it was the acceptance of a certain kind of truth (i.e., positivist truth) that led to psychic development and mental health. In this context, religion was not able to play a constructive role. (2) Within ego psychology, the theory’s focus on adaptation, on mental health (rather than psychopathology), on the influence of the environment, and on identity development leads religion to be thought of as

Religious Preference and Spirituality 71 a context in which the mastery of one’s environment and a sense of identity can be successfully achieved. (3) Within object relations theory, it is no longer objective truth but the (Winnicottian) capacity for symbolization and the quality of object relations that lead to psychic development and mental health, and religion, understood as a cultural entity, can then play a potentially positive role. (4) In self psychology, it is not truth per se but a lifelong self object sustenance (within which idealization acquires a growth-promoting connotation and “needs” are to be fulfilled) that leads to psychic development and mental health, and within this context religion has again potentially much to offer.

Further Considerations About Spirituality in Psychotherapy Making Judgments and Prescriptions About Religion This researcher has discussed three approaches to addressing spirituality in psychotherapy: validation, reinterpretation, and rejection. The treatment may appear facile or even irreverent. Breaking a taboo in U.S. society and in psychotherapeutic circles, this treatment has freely arrived at judgments and prescriptions about people’s religious and spiritual life. This treatment claims the right to make such judgments on the basis of an elaborated account of spirituality (Feingold and Helminiak, 2000).

Once the core of spirituality is discerned and formulated normatively, a powerful tool is available. It not only allows the competent treatment of spiritual matters in secular psychotherapy, but also allows incisive criticism of spiritual matters that are attached to religion (Corey, 1996). Developments in the medical field provide an analogous case. An understanding of infection allows not only the prescription of appropriate antibiotics but also the criticism of hallowed folk practices that are unhygienic. In a similar way, a breakthrough in the

Religious Preference and Spirituality 72 understanding of spirituality reconfigures the relationship between psychology and religion.

Such a breakthrough is what Lonergan’s (1957, 1972) analysis of the human spirit seems to allow, and it is the foundation of the present attempt to develop a psychology of spirituality.

Psychotherapists are always making and acting upon assessments of spirituality; that is to say, they are always facilitating the adjustment of the meanings and values that structure people’s lives (Andrews, 1987; Assagioli, 1965/1976; Bergin et al., 1996; Beutler, 1981; Beutler & Bergan, 1991; Clinebell, 1995; Corey, 1996; Doherty, 1999; Frankl, 1962, 1969/1988; Fromm, 1947; Helminiak, 1989; Kelly, 1990; Koch, 1971, 1981; MacLeod, 1944, 1970; Menninger, 1973; Moore, 1992; Richardson & Guignon, 1999; Rogers, 1961; Taylor, 1989; Tjeltveit, 1991, 1992, 1996; Wilber, 1995, 1996; Yalom, 1980). Every psychotherapeutic system has an implicit metaphysical worldview (Bergin et al., 1996; Browning, 1987; Tjeltveit, 1986, 1991, 1992, 1996; Woolfolk & Richardson, 1984). The approach described is merely quite direct about the matter, quite explicit about the criteria of assessment it uses, and quite bold in claiming a unique validity for its criteria. This forthrightness makes judgments relatively easy, but the conclusions are far from superficial.

The key to the matter is the articulation of a coherent and comprehensive psychology of spirituality (Helminiak, 1996a, 1998), including (a) the differentiation of psyche and spirit within the human mind, (b) the elaboration of spirit as structured on four levels, (c) the normativity of spirit as expressed in the transcendental precepts, (d) the ongoing integration of spirit and psyche as the substance of spiritual growth, and (e) the self-transcending nature of this process that is open to theist extrapolation and to elaboration in a wide range of religious formulations. There is the further consideration that anyone who would oppose this approach in the name of genuine

Religious Preference and Spirituality 73 openness, tolerance, and pluralism is in practice only demonstrating its validity and exemplifying its intent by urging further discussion toward a shared, correct understanding (Kane, 1994, 1999; Lonergan, 1972, p. 16–20).

Comparison With Pastoral Counseling Much of what this researcher has presented may seem to be covert pastoral counseling, but there is a difference. Pastoral counseling is psychotherapy that goes on within the explicit context of the shared faith of an organized religion (Clinebell, 1995; Crabb, 1975, 1977; Rayburn, 1985; Wicks, 1985). The shared religion has a tradition of beliefs, symbols, rituals, ethics, and texts. The skilled pastoral counselor may easily use any of its elements to guide the therapeutic intervention. For example, knowing the Gospels, he can cite the example of Peter, who repented of denying Jesus, to cancel a person’s identification with Judas, who hung himself after betraying Jesus. The pastoral counselor uses the client’s religion to effect wholesome change. Thus, validation, reinterpretation, and rejection of spirituality proceed within the boundaries of the mutually accepted religion (Clinebell, 1995).

The approach this researcher has described is similar because it sometimes appeals to various facets of religion to reinterpret or reject certain other facets. This approach presupposes more knowledge about religion than has been indicated. Nonetheless, one can learn the intricacies of a person’s religion by asking, listening, and reading (Lovinger, 1984, 1990; Shafranske, 1996; Stem, 1985).

Knowledge about someone’s religion is not the key issue. More important is a psychological understanding of spirituality within which to situate the specifics of the person’s religion. To supply this understanding as a generic, humanist, and normative analysis is the

Religious Preference and Spirituality 74 novelty in the approach this researcher has described. This novelty allows three things that pastoral counseling does not: (a) sorting out and interrelating the theist and humanist facets of the religion, (b) conceptualizing the religion’s spiritual wisdom in humanist terms (i.e., coherently integrating psychology and religion), and (c) identifying and correcting pathological facets of the religion. Psychotherapy that addresses spirituality only on the basis of openness to, and respect for, every client’s religious beliefs (Bergin et al., 1996; Beutler, 1981; Beutler & Bergan, 1991; Kelly, 1990; Tjeltveit, 1986, 1991, 1992, 1996) functions as pastoral counseling does, which is ultimately self-constrained by the worldview that the religion in question requires.

Respecting One’s Religion A person’s religion must be respected. Modifying it is a delicate undertaking that calls for sensitive care (Bergin et al., 1996; Beutler, 1981; Beutler & Bergan, 1991; Kelly, 1990; Tjeltveit, 1986, 1991, 1992, 1996). Treating spirituality in psychotherapy involves adjusting the client’s credo and commitments; it involves revamping a client’s meaning-and-value system. Of course, by its very nature, psychotherapy does this all the time. Naming it merely highlights the sacredness of the psychotherapeutic project.

Dismantling people’s meaning systems means leading people, at least temporarily, to face the void. It means turning them toward the existential angst of open-ended freedom (Yalom, 1980) and helping them in the face of this angst to find new meaning and purpose in life. This is challenging and scary stuff. Religion usually provides the compass and comrades for life’s journey. Disqualifying people’s religion by transforming their spirituality is a dangerous enterprise. As long as a person‘s religious worldview is not a threat to self or others, it ought not to be challenged, unless, of course, there is reasonable assurance that something better can

Religious Preference and Spirituality 75 replace it (Clinebell, 1995). In spiritual matters as in all others, good judgment requires that one does not push a person where they do not want, or are likely unable, to go.

The capacity to live with openness, ambiguity, and uncertainty is a measure of advanced development (Loevinger, 1977). Only a person with this capacity can be quietly and securely open to another human being who is facing these same monsters. Only a person of advanced integration (i.e., spiritually developed; Helminiak, 1987) can effectively facilitate such integration in others. As the Scholastic axiom had it, Nemo dat quod non habet: No one can give what he or she does not have. The work of psychotherapy is really a ministry of spiritual healing.

This study made it clear that more effective psychotherapy will be more deeply authentic and more spiritually integrated. That is, effective psychotherapy involves open honesty and commitment to wholesome values. This is not just a professional facade that would allow one to deal with clients cleanly and efficiently and to collect one’s standard fee. Jesus’ contrast (John 10:11–13) between the hireling and the good shepherd provides a relevant image. Appeal to this religious image suggests once again what is at stake in this whole discussion: the radical transformation of aspects of traditional religion into a secular form that respects the distinctiveness, while embodying the humanist core, of the engendering religion (i.e., the psychology of spirituality; Helminiak, 1996a, 1998, 1999). Psychotherapy’s low ratings on measures of religiosity may be another matter (Shafranske & Gorsuch, 1984; Shafranske & Malony, 1990), but the commitment to live spirituality is a requirement.

Religious Preference and Spirituality 76 Definitions, Symptoms, and Time Frame of Overtraining and Its Effects While religion and spirituality are integral parts of this study, physical training— specifically, the complex training routines soldiers experience during training—is equally important to the results. This type of training both results in the injuries that place the soldiers into the PTRP program for rehabilitation and serves as the vehicle used to reinstate them into the initial training program. It will be discussed in detail as it relates to the final outcome and process by which the determination is made to return soldiers to training.

Physical training for success has increasingly become a balance between achieving peak performance and avoiding the negative consequences of overtraining. Training volumes below what can be considered optimal do not result in the desired adaptation (i.e., the greatest possible gain in performance), whereas training volumes above the optimum may, among other things, lead to a condition usually referred to as the “overtraining syndrome,” “staleness,” or “burnout.”

Hard training can apparently be the formula for both success and failure.

To date, rest (physical inactivity) is the best known treatment for soldiers and athletes who have reached an undesirable state because of prolonged excessive training (Raglin, 1993; Lehman et al., 1993; Kuipers & Keizer, 1988; Morgan et al., 1987). Most soldiers and athletes, however, avoid rest, since it is diametrically opposed to their instinctive response when a decline in performance occurs. Highly motivated soldiers and athletes and trainers and coaches usually respond to a plateau or drop in performance with increases in training load (Raglin, 1993; Lehman et al., 1993). Consequently, it has been asserted that the greatest training-related factor leading to negative states is a failure to include enough recovery in the training program (Bompa,

Religious Preference and Spirituality 77 1983). It follows that an imbalance between training and recovery will have mild to severe negative consequences for performance (Kuipers & Keizer, 1988).

There are no generally accepted definitions of terminology concerning the negative consequences associated with excessively hard physical training. Furthermore, the terms used have different meanings in different contexts. Terms used in connection with overtraining include overtraining syndrome, overtrained, overstrained, overused, overworked, overstressed, overreaching, stagnation, staleness, staleness syndrome, burnout and chronic fatigue syndrome (Raglin 1993; Kuipers & Keizer 1988; Fry et al., 1991; Hooper et al 1995; Fry & Kraemer 1997).

In this study, the conditions overreached and staleness are used and are considered to be at opposite ends of an overtraining-response continuum. A soldier failing to recover within 72 hours has presumably negatively overtrained and is in an overreached state (a short-term effect).

The long-term effect (staleness) resulting from more severe overtraining is at the other end of this continuum.

Originally, “burnout” was most often used in the literature in connection with studies of the human service and helping professions (Maslach, 1976). More recently, Smith (1986) extended the use of the term to include athletes. There is, however, some disagreement about whether burnout really should include “stale” athletes and soldiers or not. Raglin (1993) has argued that burnout should be distinguished and viewed separately from staleness. The main difference between the 2 related syndromes, according to Raglin (1993), is that loss of motivation (and withdrawal in severe cases) is a central characteristic of burnout but not of staleness. A stale soldier may still be highly motivated to continue training and may even

Religious Preference and Spirituality 78 increase the training load to compensate for a decrease in performance. Thus, it is important to consider them separately.

Taken together, the various terms used seem, nevertheless, to describe a single syndrome, most often referred to in the literature as the staleness (or overtraining) syndrome (Raglin, 1993; Lehman et al., 1993; Kuipers & Keizer, 1988; Morgan et al., 1987; Fry & Kraemer 1997; Fry, Grove et al., 1994; Fry, Kraemer et al., 1994). Many negative consequences have been associated with this syndrome, and some of those most commonly reported include poorer performance, severe fatigue, muscle soreness, overuse injuries, reduced appetite, disturbed sleep patterns, mood disturbances, immune system deficits, and concentration difficulties (Fry, Grove et al., 1994; Marion, 1995; Mackinnon & Hooper, 1994).

In addition, decreased submaximum and maximum heart rates and decreased maximum oxygen uptake, as well as decreased submaximal and maximal lactate levels, have also been reported in connection with the negative consequences of too much training with too little recovery (Lehman et al., 1993;). Many of the variations reported in the literature are, however, equivocal. That is, some studies associate staleness with increases in some specific variable, such as heart rate, whereas other studies associate staleness with decreases with that variable (Lehman et al., 1993; Fry et al., 1991; Marion, 1995). One possible explanation might be that different forms of staleness exist.

Two distinct and separate types of staleness have also been proposed, namely the sympathetic and parasympathetic overtraining syndromes (Lehman et al., 1993; Kuipers & Keizer, 1988; Fry et al., 1991). The sympathetic form is characterized by increased sympathetic activity at rest, while the parasympathetic form is characterized by decreased sympathetic

Religious Preference and Spirituality 79 activity with parasympathetic activity dominating at rest and during exercise. It is believed that the sympathetic overtraining syndrome is an intermediate stage before parasympathetic overtraining. Markers associated with parasympathetic overtraining are low resting heart rate and relatively low exercise heart rate, while markers associated with sympathetic overtraining are increased resting and exercise heart rates (Lehman et al., 1993; Fry & Kraemer, 1997; Kuipers, 1996).

Markers and Symptoms of the Negative Effects of Overtraining The difference between positive and negative overtraining depends on the outcome of the training process. A soldier failing to recover within 72 hours of training has presumably worked too hard, thereby experiences negative overtraining, and can be considered to be in an overreached state. This time frame is chosen from the soldier’s perspective; if >72 hours are needed to recover, this is definitely regarded as a failure in the training program. The fierce competition among soldiers means that a loss of training days and disrupted training (i.e., forced rest for >72 hours) would be extremely undesirable. Thus, our definition of positive overtraining conforms to the definition of the overtraining process by Raglin (1993).

In addition, Morgan et al. (1987) emphasized the need to view, define, and separate the cause (process) and consequence (product) of overtraining. Raglin (1993) later defined the training stimulus as “…an overtraining process involving progressively increased training to a high absolute level that is in excess of more routine training undertaken to maintain performance.” Raglin’s definition actually describes 3 degrees of training: (i) overtraining (in this case, positive overtraining) for eliciting gains in performance; (ii) maintenance training to remain at a certain level of performance; and (iii) undertraining when the stress is insufficient to

Religious Preference and Spirituality 80 maintain performance (resulting in a decrease in performance). Negative overtraining may result in the same decrease in performance capacity as undertraining, which is noteworthy. All training programs will fall into one of these categories. Hence, the actual training performed (process) will determine the result (product).

Fry et al. (1991) defined four major categories of symptoms associated with the staleness syndrome, namely physiological, psychological, biochemical, and immunological symptoms. To date, studies of the staleness syndrome have often tried to identify reliable early warning signs (markers) to prevent the undesired negative outcome of hard physical training. Although observed physiological and biochemical symptoms have been effective in confirming the staleness syndrome, they have not been useful in preventing it (Morgan, 1994). Other reports corroborate these findings by stating that the value of physiological and biochemical markers is still unclear (Lehman et al., 1993; Hooper & Mackinnon, 1995). One reason for this is the inherent difficulty of distinguishing between adaptation, a result of thoughtfully devised training programs, and maladaptation, the point at which the benefits of adaptive training begin to wane because of excessive training. This is particularly evident during the course of heavy training when some decrease in performance capacity is expected. In most soldiers, it is only possible to determine whether a training cycle is adaptive or maladaptive after it has been concluded. In some extreme instances, this can be difficult even after the training cycle.

A recent example illustrates the difficulty in distinguishing between adaptation and maladaptation. A Swedish world class cross-country skier maintained heavy training for 20 years and never won a gold medal in the 50 km event at the national level. He took 1 year off (only engaging in light training) and returned to competition in 1996, when he won his first gold medal

Religious Preference and Spirituality 81 at the age of 35. In this skier, it might have been difficult to clearly distinguish between adaptive and maladaptive training at any stage during the 20-year period.

A closely related problem seems to be the uncertainty of whether the symptoms noted precede staleness (or occur early in the development of the disorder [overreaching]) or are merely manifestations of the staleness syndrome (Raglin, 1993). To distinguish between preceding markers or early warning signs with prognostic value and symptoms with diagnostic value (when the disorder has been verified) is extremely difficult in most applied situations.

Hence, markers and symptoms are used synonymously throughout this article unless otherwise indicated.

Partly because of these aforementioned difficulties, Shephard and Shek (1994) concluded that psychological testing provides both easier and more effective methods for detecting the staleness syndrome than methods dependent on various physiological or immunological markers (Raglin et al., 1995; O’Connor, 1998). O’Connor (1998) has reported four advantages of using psychological markers to identify and monitor the overtraining process.

Psychological changes are more reliable, i.e., mood shifts coincide with increases and decreases in training and are also highly replicable; some mood states are highly sensitive to increases in the training load (changes in these states occur early on and have large effects) while others are more sensitive to the staleness syndrome; variations in measures of mood often correlate with those of physiological markers; and the titration of training loads based on mood responses to overtraining appears to have good potential for preventing staleness.

Religious Preference and Spirituality 82 It should be noted that a study reported that 1 out of 3 stale athletes did not show the anticipated mood response (Hooper et al., 1997). This suggests that mood inventories may not always differentiate between “stale” and “not stale” athletes and soldiers. However, there are several limitations of this study that should be highlighted. For example, response distortion was not controlled for, no preseason mood assessment was made to obtain baseline scores, and mood was only assessed 5 times. Nevertheless, this study emphasized the need for well-designed, longterm monitoring studies to determine how to prevent staleness (Berglund & Säfström, 1994). The 4 major categories of symptoms mentioned need to be considered since they are interrelated.

This in turn lends support to the view that the staleness syndrome should be regarded as a psychobiological phenomenon (Raglin, 1993).

To summarize, there are various ways to classify the different staleness symptoms and markers (i.e., negative consequences). We suggest including all of the consequences of negative overtraining into the physiological, psychological, biochemical (or neuroendocrinological), and immunological categories defined by Fry et al. (1991) This list could easily be extended to include behavioral and perceptual changes, for example, but even with more categories, it remains difficult to fit some symptoms into a single category. Some symptoms can show different characteristics depending on how they are viewed. Appetite, for example, is primarily regulated physiologically but also has some psychological dimensions. It seems that most of the symptoms overlap between 2 or more categories. Nevertheless, the 4 categories provide a good semantic overview of the different bodily symptoms that are associated with the staleness syndrome.

Religious Preference and Spirituality 83 Long-Term Versus Short-Term Aspects of the Overtraining-Response Continuum The overtraining process and its associated symptoms may be viewed over a continuum from short term (acute) to long term (chronic), as described by Marion (1995) and Kuipers.

(1996). It follows that some borderline soldiers will be difficult to diagnose as being either “stale” or “not stale” when their condition is measured on a continuum (Hooper et al., 1995).

Thus, the border between adaptation as a result of optimal training and the beginning stages of maladaptation due to excessive training is fluid, especially during a phase of heavy training (Lehman et al., 1993). This is why optimal training can so easily lead to an overreached state.

Because of the overtraining-response continuum, it is also difficult to know whether observed symptoms are related to normal training fatigue, short-term overreaching, or long-term staleness (Fry et al., 1991). Some symptoms occur along the whole continuum while others only occur at a particular stage. Interestingly, a recent report asserts that fatigue and vigor are sensitive to shortterm conditions while depression is more sensitive to long-term conditions (O’Connor, 1998).

Declines in performance, which are regarded as the hallmark of staleness (Raglin, 1993), occur together with increases in perceived effort during training along the whole continuum (O’Connor et al., 1991; Snyder et al., 1993). No consensus has been reached regarding the extent to which performance will decline at different stages along the continuum (Hooper & Mackinnon, 1995).

The decline in performance may also vary with overtraining across different sports, although published data on this are very scarce. If the comparison is extended to cover performance decline in, for example, all the distances for running events, the problem becomes even more complex. The effects of these confounding factors need to be addressed and related to the 4 different categories of symptoms.

Religious Preference and Spirituality 84 Individual differences in recovery potential, exercise capacity, nontraining stressors, and stress tolerance may explain the different degrees of staleness syndrome experienced by soldiers under identical training stresses (Lehman et al., 1993). In soldiers with less severe staleness, the markers are milder and soldiers can still train at their usual level, but at the cost of greater difficulty to maintain any given submaximal performance (e.g., running speed) and increased perception of effort (Raglin & Morgan, 1994). Hence, there is convincing evidence to support the view that the staleness syndrome exists on a continuum from short-term to long-term effects.

Consequently, general and simplified guidelines for diagnosing staleness should allow for mild through to severe symptoms. Milder symptoms generally predict a shorter time for sufficient recovery from the staleness syndrome and more severe symptoms, following larger declines in performance, require a longer time for recovery. “Stale� soldiers, for example, do not respond well to reductions in training compared with overreached soldiers. As well as the problem of setting diagnostic criteria for different degrees of the staleness syndrome, another difficult question is whether to look for qualitative or quantitative symptoms. To avoid oversimplified distinctions, the whole continuum will be defined in this study as the overtraining-response continuum (Raglin & Morgan, 1994).

As explained earlier in this study, overreached and staleness are regarded as opposite extremes of the overtraining-response continuum. This continuum excludes acute fatigue that occurs immediately after exercise, acute muscular overstrain, undertraining, maintenance training, and all other prefatigued states considered normal training responses and which are always followed by a full recovery in the short term (Raglin & Morgan, 1994). The overreached state was chosen as the starting point on the overtraining-response continuum because it is

Religious Preference and Spirituality 85 beyond this point in the training process that negative overtraining (maladaptation) can occur if a soldier is not carefully monitored (Lehman et al., 1993).

Staleness is thus regarded as a severe long term effect of an imbalance between the total stressors (training and nontraining) and total recovery, which is largely determined by the overall capacity (stress tolerance) of the individual. Overreaching is regarded as a far less severe, shortterm effect, also resulting from an imbalance between total stress and total recovery and determined by the overall capacity. Both conditions are regarded as possible products of negative overtraining (Lehman et al., 1993).

Reasons for the Confusing Terminology The lack of consensus regarding the terminology of overtraining is a factor of great concern. This was stressed by O‘Connor (1998), who stated that perhaps the greatest barrier to further progress in this area of research is: (i) the existing confusion over terminology; and (ii) the lack of established diagnostic criteria for staleness. Other authors address this problem by proposing the development of an international standard with regard to terminology (Fry et al., 1991; Hooper & Mackinnon, 1995).

The confusion in terminology is in part due to different theories and types of research. It is also caused, to a considerable extent, by language barriers and poor translation of reports. One reason for poor translation is the lack of equivalent terms. Other factors for confusion can be explained by tradition and different cultures. European authors have mainly used the terms overstrained, overtraining, overstrain, and overtraining syndrome to indicate what some U.S. researchers refer to as staleness or the staleness syndrome (O’Connor, 1998).

Religious Preference and Spirituality 86 When studies are performed within various disciplines, for example physiology and psychology, differences in terminology may occur. These differences could simply be due to the different perspectives in the deductive research on the psychophysiological overtraining phenomenon. Physiological studies by Fry et al. (1991) and Kuipers and Keizer (1988) use the term overload to describe the training process, whereas psychological studies by Morgan et al.

(1987) and Raglin (1993) use the term overtraining. Physiologists and psychologists also differ in the use of terminology regarding the short-term to intermediate stage of the staleness syndrome. The term overreaching is mainly used by physiologists (Kuipers & Keizer, 1988; Fry et al., 1991; Fry & Kraemer, 1997), whereas distress has been used by the psychologists (Raglin, 1993; Morgan et al., 1987) to describe a less severe state of staleness. Historically, it seems that once a term has been established, the related studies adopt it regardless of whether it is ultimately useful or confusing.

United States: Injuries During Physical Training Exercise Medical surveillance data from the U.S. Army indicates that unintentional (accidental) injuries cause about 50% of deaths, 50% of disabilities, 30% of hospitalizations and 40 to 60% of outpatient visits (Braverman, 1995). Epidemiological surveys show that the cumulative incidence of injuries (requiring an outpatient visit) in the 8 weeks of U.S. Army basic training is about 25% for men and 55% for women; incidence rates for operational infantry, special forces and ranger units are about 10 to 12 injuries per 100 soldier-months (Braverman, 1995). Of the limited-duty days accrued by trainees and infantry soldiers who were treated in outpatient clinics, 80 to 90% were the result of training-related injuries (Braverman, 1995). Army studies document a number of potentially modifiable risk factors for these injuries, which include high amounts of running,

Religious Preference and Spirituality 87 low levels of physical fitness, high and low levels of flexibility, sedentary lifestyle, and tobacco use, amongst others. Studies directed at interventions showed that limiting running distance can reduce the risk for stress fractures, that the use of ankle braces can reduce the likelihood of ankle sprains during airborne operations, and that the use of shock-absorbing insoles does not reduce stress fractures during training (Braverman, 1995).

The U.S. Army continues to develop a comprehensive injury prevention programs encompassing surveillance, research, program implementation, and monitoring. The findings from this program and the general principles of injury control therein have a wide application in civilian sports and exercise programs (James & Duclow, 2002). Soldiers must develop and maintain high levels of physical fitness in preparation for military missions, in a similar manner as athletes preparing for competition. The potential demands of combat and other duties require military personnel (particularly the U.S. Army and Marine Corps) to routinely engage in vigorous physical and operational training to sustain a high level of readiness (Braverman, 1995). Typical training activities include running, marching, calisthenics, climbing, hurdling, crawling, jumping, digging, lifting, and carrying loads while hiking (Swank & McCully, 2001).

As with other groups engaged in vigorous physical activity and training (Koplan et al., 1982; Macera et al., 1989; Garrick & Requa, 1978; Watson, 1993) injuries frequently occur in military populations. Tomlinson et al., 1987, Knapik et al., 1993, Jones et al., 1993, and Jones et al., 1992 further stated that these injuries concern the military, not only because of their frequency, but also because they result in significant loss of personnel resources and can eventually compromise operational readiness. To reduce the incidents of injuries and their effect

Religious Preference and Spirituality 88 on individuals and military objectives, the Army determined that a systematic program of injury prevention was necessary.

The foundation of a systematic approach to the prevention and control of injuries is medical surveillance. Unlike research, medical surveillance implies a linkage between health information and preventive action (Tentsch & Churchill, 1994; Thacker & Stroup, 1994).

Routine surveillance provides the information necessary to determine the magnitude of problems affecting the health of populations and provides the basis for prioritizing and targeting injuries and diseases for prevention or research. Research is necessary to determine the underlying risk factors for and causes of injuries and diseases. Prevention of injuries requires identification of modifiable risk factors and causes (Robertson, 1992). Once a strategy for prevention has been devised, research may also be necessary to determine whether the interventions work. Following implementation of a prevention strategy, surveillance of the ongoing effectiveness of that strategy is necessary (Tentsch & Churchill, 1994; Thacker & Stroup, 1994).

Surveillance and Survey Data on Injuries The first step of the public health process of injury control/prevention is to determine whether a problem exists. This can be easily accomplished for military populations because comprehensive medical and fatality records are maintained for all military personnel on active duty. The sizes of unit populations are known at all times, copies of all military hospital discharge summaries are filed in individual medical records, and demographic, occupational, and medical information from hospital discharge summaries is coded and entered into central computerized files (Tentsch & Churchill, 1994). Injury diagnoses are coded using International Classification of Disease Codes (ICD-9 Codes); all acute injury diagnoses receive an external

Religious Preference and Spirituality 89 cause code using North Atlantic Treaty Organization codes, which are similar to the cause codes in ICD-9 (E-Codes). Hospitalization rates and trends are now routinely reviewed and published (Tentsch & Churchill, 1994). Computerized databases of disability discharges and deaths are also maintained. Virtually all outpatient visits to military medical treatment facilities are documented in the records of individual personnel. Because computerized military-wide databases were unavailable for “sick call� (outpatient) visits until recently, the primary source of data on the incidence of injuries requiring only outpatient management is focal periodic surveys of individual medical records for entire targeted unit populations (Robertson, 1992).

Incidences of Injury-Related Hospitalization, Disability, and Death Surveillance of hospital records, patients with disabilities, and fatalities provides perspective on how injuries of varying degrees of severity affect the U.S. Army in terms of personnel resources and readiness. Direct comparisons of incidence rates and frequencies across levels of injury severity are complicated by differences in categorization of information and how specific diagnoses are defined (Songer & LaPorte, 1996). Nevertheless, data on hospitalizations, disabilities, and deaths provide a valuable perspective on the magnitude of the problem (Department of Defense, in press).

Since 1989, the Standard Inpatient Data Record has provided a common register of hospitalizations in all U.S. military hospitals regardless of service (i.e., Army, Navy, or Air Force). In 1994, musculoskeletal conditions and injuries accounted for 28% of U.S. Army personnel hospitalizations (Department of Defense, in press). The next most common category was digestive diseases, at 12%. This information indicates that acute injuries associated with physical activity, training, and athletics are potentially serious, as well as frequent, in the U.S.

Religious Preference and Spirituality 90 Army. In 1994, the rate of hospitalization for injury in U.S. Army personnel was estimated at 45 hospitalizations/1000 person-years (Department of Defense, in press). Athletics-and sportsrelated injuries accounted for 12% of the cases where an external cause of injury was recorded.

Other potential training injuries accounted for an additional 14% (Department of Defense, in press). Days lost (“noneffective days”) due to hospitalization for injuries caused by sports and athletics alone were 26 days/1000 soldiers per year (Department of Defense, in press).

Tracking of patients with disabilities is performed by the Army Physical Disability Agency (APDA) which keeps a computerized list of reviewed patients (Songer & LaPorte, 1996). In 1994, the rates of disability were about 15 cases/1000 person-years, with about 53% of these being due to injury. The coding scheme used by the APDA does not allow determination of the contribution of physical training-related injuries to disability; however, a pilot study in an infantry division suggested that the injuries sustained by 28% of personnel requiring disability evaluations may be attributable to athletics (Department of Defense, in press).

Deaths in the military are routinely reported by the Military Services’ Casualty Offices to the Department of Defense Directorate of Information and Operations Reports (DIOR). DIOR publishes the Worldwide Casualty Report, which provides mortality data broken down into 5 categories—accidents, suicides, homicides, illness and combat (hostile action)—for all of the services. In 1994, the U.S. Army fatality rate was 87 deaths per 100,000 person-years, with unintentional injuries (accidents) accounting for 49% of all deaths. All illnesses and diseases accounted for only 18% of deaths in the U.S. Army (Tentsch & Churchill, 1994).

Religious Preference and Spirituality 91 Incidence of Outpatient Injury Visits Episodic surveys of outpatient medical records (“sick call� visits) have also documented the incidence of injuries among military trainees and soldiers. The greatest amount of documentation exists for U.S. Army basic training because of the intentional surveillance research. (See Table 1.)

Religious Preference and Spirituality 92

Table 1 Key steps in the injury control process and the role of surveillance, research and intervention

Step 1: Surveillance

Document the existence of a problem and its magnitude, frequency, and distribution rates and trends.

Step 2: Research

Identify the cause and risk factors for a problem (epidemiology, Pathophysiology, biomechanics, and ergonomics).

Step 3: Intervention

Determine what measures are effective in preventing the problem (Training, testing/trials in the development of safer products, and equipment engineering changes).

Step 4: Program implementation

Disseminate information to those who need to know and activate education regulations. Implement rules and laws, follow safety guidelines and policies and protect equipment.

Step 5: Program monitoring

Determine effectiveness of injury prevention programs.

Religious Preference and Spirituality 93 As shown in Table 2, the cumulative incidence of male trainees seeking medical care for one or more injuries during the 8 weeks of basic training varied between 23 and 28%; injuries for women ranged from 42 to 67% (Kowal, 1980; Bensel & Kish, 1983; Jones et al., 1993; Bell et al., 1996; Westphal et al., 1995). The estimated injury rates are 12 to 14 and 21 to 29 injuries per 100 person-months for male and female trainees, respectively. Male U.S. Army Infantry trainees undergoing a 12-week period of basic training experience a cumulative incidence of injury of 46% (Jones, 1993) about 15 injuries per 100 person-months. Rates of this magnitude have also been observed for U.S. Marine Corps recruits (Bensel, 1976). (See Table 2.)

In contrast to trainees, injury rates in operational military units can vary more widely, probably because of the varied nature of the occupational tasks performed in the 277 military occupational specialties of the U.S. Army (U.S. Army, 1994). These specialties require varying degrees of physical exertion and stamina. On the highly dangerous end of the spectrum (infantry, airborne, rangers, Green Beret/Special Forces, etc.), injuries occur at a much more frequent rate.

Delays in return to duty can be viewed as failing miserably among one’s peers, so returns tend to occur sooner than expected. By the nature of the job, injuries persist.

Religious Preference and Spirituality 94

Table 2 Cumulative incidence of all injuries among U.S Army trainees during the 8-week basic combat training cycle Legend for chart: A - Study B - Year data collected C - Incidence (%) men(a) D - Incidence (%) women(a) ND - no data.

A

B

C

D

Kowal[14]

1978

26

54

Bensel & Kish[15]

1982

23

42

Jones et al.[16]

1984

28

50

Bell et al.[17]

1988

27

57

Westphal et al.[18]

1994

ND

67

As shown in Table 3, male soldiers in infantry, Special Forces and Ranger units have documented injury rates of between 10.1 and 12.1 injuries per 100 soldier-months (Tomlinson et al., 1987; Knapik et al., 1993; Reynolds et al., 1994), similar to those of U.S. Army trainees.

Artillery and aviation units have lower rates (Tomlinson et al., 1987). (See Table 3.) Injury rates among military trainees, infantry soldiers and Special Forces and Ranger units are comparable with those experienced by high school and collegiate athletes participating in endurance events; however, rates are generally lower than for those involved in contact sports (Bell et al., 1996).

Religious Preference and Spirituality 95 Table 3 Injury incidence rates among soldiers in operational U.S. Army units Legend for chart: A - Study B - Year data collected C - Type of unit D - Incidence rate (events/100 soldier-months) new injuries E - Incidence rate (events/100 soldier-months) clinic visits for injuries A

B

Tomlinson et al.[5]a

1984-1985

C

D

E

Infantry

11.2

ND

Special forces

12.1

ND

Rangers

10.1

ND

4.5

ND

11.8

18.3

Artillery and aviation Knapik et al. [6]b

1989

Infantry

Reynolds et al.[21]

1989-1990

Infantry

Reynolds et al.c

1996

Artillery

ND 10.7

15.1 18.8

a

Annualized data based on 8 weeks of data collection. bAnnualized rate based on 6 months of data collection.

c

Reynolds et al., unpublished data (n = 189, 1-year follow-up).

Causes of Morbidity: Injury Versus Illness Comparisons of the number of limited duty days resulting from injuries versus those resulting from illnesses provide another perspective on the importance of injuries to overall U.S. military physical readiness. Table 4 contains data on the relative rates of morbidity from injury

Religious Preference and Spirituality 96 and illness and the rates of limited duty days. For male and female U.S. Army trainees, the ratio of the rates of injury and illness (soldiers with 1 or more “sick call� visits) is about 1:1; however, for injury, the rates of limited duty days are much higher than for illness. (See Table 4.) Among infantry soldiers, the rates for injury are slightly higher than those for illness, but the rates of limited duty days are roughly 10 times higher. Injuries requiring outpatient care clearly cause significantly more temporary disability than do illnesses (Tomlinson et al., 1987; Knapik et al., 1993; Reynolds et al., 1994).

Religious Preference and Spirituality 97

Table 4 Relative rates of injury and illness among U.S. Army trainees and infantry soldiers

Legend for chart: A - Category B - Sample C - Injury rate (cases/100 soldier-months) D - Illness rate (cases/100 soldier-months) E - Rate ratio (injury rate/illness rate) A

C

D

E

Male trainees Female trainees Male infantry

13.7 25.2 12.8

17.7 24.2 12.0

0.8 1.0 1.3

Total ‘sick call’ visits

Male trainees Female trainees Male infantry

22.1 39.6 19.6

26.4 37.2 12.0

0.8 1.0 1.6

Days of limited duty

Male trainees Female trainees Male infantry

Soldiers with 1 or more ‘sick call’ visits

B

40 129 113

Note. Reynolds K, unpublished data on U.S. Army infantry soldiers, Fort Drum (NY), 1989 (n = 351, 72-day follow-up).

8 6 11

5.0 21.5 10.3

Religious Preference and Spirituality 98 Overview of Injury Impact Data on morbidity and mortality across the spectrum of health indicate that injuries are an important problem both in terms of absolute rates and relative to disease and illness. Based on these data, the relative numbers of injuries from each category of injury (death, disability, hospitalization, and outpatient) can be estimated. The frequency data presented in table 5 show clearly that outpatient sick call visits account for the largest number of injuries—almost 2,000 for every death that occurs. Consequently, although the injuries in this category are less severe than those in other categories, injuries treated on an outpatient basis have the largest impact in terms of personnel resources and military readiness. Sports and physical training-related injuries account for a large percentage of the total injuries in all categories. (See Table 5.) Furthermore, most injuries treated in U.S. Army outpatient clinics are lower extremity training-related injuries (Reynolds et al., 1994). The sheer number of training-related injuries warrants investment in research and prevention programs to reduce the incidence of such events.

Religious Preference and Spirituality 99

Table 5 Frequency of injuries requiring different levels of care and ratios of less severe injuries to deaths, based on U.S. Army-wide data for 1994

Legend for chart: A - Patient category B - Estimated injuries (cases/year) total C - Estimated injuries (cases/year) training- or athletics-related D - Ratio of other injuries to accidental deathsa A Accidental death Disability Hospitalization Outpatient ‘sick call’b a

B

C

230 4500 23 000 440 000

60 2400 6000 240 000

D 1 20 100 1900

Calculated as source of injury/total accidental deaths. bEstimated from data of Tomlinson et al.[5]

For vigorously active U.S. Army populations, the data clearly indicate that physical training-related injuries cause more limited duty days than all of the other outpatient conditions combined. The relative magnitude of the injury problem compared with illnesses is a strong argument for a systematically coordinated training injury prevention program. While surveys and surveillance indicate that injuries are an important problem, these tools alone do not provide the information necessary to prevent injuries. The foundation of an effective injury prevention program is detailed knowledge of injury risk factors and the causes of injury, which requires focused research (Reynolds et al., 1994).

Religious Preference and Spirituality 100 Research on Risk Factors for Training Injuries When a problem such as training injuries has been identified, the next step in the control process (see Table 1) is to identify causes and risk factors. Table 6 lists some risk factors for training injuries, which have been identified by military and civilian sports medicine studies (Neely, 1998). (See Table 6.)

Religious Preference and Spirituality 101 Table 6 Risk factors for physical training injuries in military populations Intrinsic factors Demographic characteristics: age race gender other Anatomical factors: high arches (pes cavus) ‘knock knees‘ (genu valgus) excessive Q-angle other Physical fitness level: low cardio respiratory endurance (slow run times) low muscle endurance (low number of push-ups and sit-ups) high and low flexibility (toe-touching ability) other Behavioral traits: sedentary (inactive) lifestyle tobacco use other past injury Extrinsic factors Training parameters: high running mileage frequent marching and running other Equipment factors: boots not ‘broken in‘[24] ankle braces other

Religious Preference and Spirituality 102 These risk factors may be categorized as either intrinsic or extrinsic in nature. Intrinsic factors are inherent characteristics of individuals, for example, age, race, gender, anatomical characteristics, or physical fitness. Extrinsic factors are variables that are external to the individual, such as physical training programs, equipment, terrain, and weather conditions, which influence the risk of injury (Neely, 1998).

Demographic Characteristics Demographic data (i.e., age, race and gender) is routinely maintained in administrative and medical records for all military personnel. Data on U.S. Army basic trainees indicate that older individuals are more likely to sustain injuries (Brudvig et al., 1983; Gardner et al., 1988).

In contrast, infantry soldiers and mixed groups of soldiers with many different occupational specialties show a declining trend for injuries with increasing age. This discrepancy between trainees and soldiers may be explained by the fact that all trainees engage in the same type of physical training. However, in operational U.S. Army units, older soldiers tend to be of higher rank and are, consequently, in staff or supervisory positions; they may have less exposure to occupational physical hazards compared with younger soldiers (Brudvig et al., 1983; Gardner et al., 1988). The decline in injuries with increasing age in operational U.S. Army personnel is in consonance with data from civilian populations (Rice et al., 1989).

Ethnicity (Wagener & Winn, 1991) and gender (Rice et al., 1989) also appear to influence injury incidence. Several reports suggest that White[trainees experience more stress fractures and other training injuries than Black trainees and those of other non-White ethnic origins(Brudvig et al., 1983; Gardner et al., 1988). Black soldiers also experience fewer blisters on the foot compared with individuals of other ethnic origin (Knapik et al., 1997). Regarding

Religious Preference and Spirituality 103 gender, studies of U.S. Army basic trainees consistently report injury rates among female trainees that are 1.5 to 2.0 times higher than those for male trainees (Jones et al., 1993; Jones et al., 1992; Kowal, 1980; Bensel & Kish, 1983; Jones et al., 1993). Interestingly, multivariate analyses, which control for physical fitness, indicate that men and women with similar cardiorespiratory endurance (run times) experience the same risks for injury (Jones et al., 1992).

While age, race, and gender themselves are not modifiable risk factors, altering training programs and modifying other risk factors, such as improving individuals’ physical fitness levels, may reduce the risk of injury for some of these higher risk demographic groups.

Anatomical Factors Mass population screening techniques have been employed to study the possible association between injury risk and anatomical variables, such as “flat feet,” bowed legs, and leg length discrepancies (Cowan et al., 1988; Cowan et al., 1993; Cowan et al., 1996; Giladi et al., 1985). Observations from a study of computer-digitized photographs of the feet of male U.S. Army infantry trainees indicated that recruits with flatter feet are at a lower risk of lower extremity injuries during training than those with “normal” and high arches (Cowan et al., 1993).

(See Figure 1.)

Religious Preference and Spirituality 104

Figure 1. Relationship between foot arch height and risk of lower extremity injuries among male U.S. Army infantry trainees. Arch height is the ratio of navicular height to medial metatarsal phalangeal joint length. For the flattest 20% compared with the highest 20%, relative risk = 2.3, p < 0.05. (Cowan et al., 1993) This study added support to the conclusions of a study of lower extremity stress fractures among soldiers of the Israeli Defense Force, which demonstrated that individuals with the flattest feet had the lowest injury incidence (Giladi et al., 1985). Besides high foot arches, excessive Q-angle (>15째) of the knee has been shown to be associated with higher risk of lower extremity stress fractures and other injuries. (See Figure 2.)

Religious Preference and Spirituality 105

Figure 2. Relationship between Q-angle and the risk of overuse injury in U.S. Army male infantry trainees. Q-angle is the angle formed by 2 lines, one drawn from the midpoint of the patella to the tibial tuberosity and the other from the midpoint of the patella to the anterior superior iliac spine. For trainees with Q-angles < 10° compared with those with Q-angles > 15°, relative risk = 1.5, p = 0.10. (Cowan et al 1996) Genu valgus (“knock knee”) was also found to be related to risk of overuse injuries. (See Figure 3.) Some of these findings are contrary to commonly held beliefs (Kelsey, 1982) and indicate the need to examine generally accepted but unproven hypotheses regarding the association of anatomical and other factors with injuries.

Religious Preference and Spirituality 106

Figure 3. Relationship between genu valgus/genu varus and risk of overuse injury in U.S. Army male infantry trainees. Genu valgus/genu varus was measured as the ratio of pelvic width to patellar width with large values indicative of valgum and small values indicative of varum. For quintile 1 compared with 3, relative risk = 1.9, p = 0.02 (Cowan et al., 1996).

Physical Fitness Important components of health-related physical fitness include cardiorespiratory endurance, muscle strength, muscle endurance, flexibility, and body composition (Caspersen et al., 1985; Pate, 1983). The U.S. Army and other military populations routinely measure and record information related to these fitness components. The U.S. Army Physical Fitness Test (APFT) is performed twice yearly by all soldiers and consists of tests related to cardiorespiratory endurance (3.2-kilometre, [2-mile] run times), muscle endurance (push-ups and sit-ups), and surrogate measurements for body composition (height and weight). For other fitness factors not routinely assessed by the military services, suitable methods for mass screening have been devised and employed in military research. These include toe touching and joint range of motion to evaluate flexibility (Bauman et al., 1982), maximum voluntary force exertion to assess

Religious Preference and Spirituality 107 strength (Ramos & Knapik, 1979; Knapik et al., 1980), and circumferential measurements to estimate body fat (Vogel et al., 1988).

The most consistently documented risk factor for injuries in U.S. Army populations is low cardiorespiratory endurance, measured by running performance. For men, the relative risk (quartile 2 compared with 4) = 4.2, p < 0.10; for women, the relative risk (quartile 2 compared with 4) = 1.7, p < 0.10; for trends in men and women, p < 0.05 (Jones et al., 1992). Figure 4 depicts the association between 1.6-kilometre (1-mile) run times and cumulative incidence of injuries during 8 weeks of basic training. (See Figure 4.)

Figure 4. Relationship between 1.6-kilometre (1-mile) run times and the cumulative incidence of injuries during 8 weeks of basic training among male and female U.S. Army trainees. For men, the relative risk (quartile 2 compared with 4) = 4.2, p < 0.10; for women, the relative risk (quartile 2 compared with 4) = 1.7, p < 0.10; for trends in men and women, p < 0.05. (Jones et al., 1992) Trends for both men and women indicate increasing risk of injury for groups with increasingly slow run times (Jones et al., 1992; 1993). Similar trends have been documented in active duty infantry and combat engineer populations (Reynolds et al., 1994). This observation

Religious Preference and Spirituality 108 makes sense given the ubiquitous nature of weight-bearing training (running and marching) in the U.S. Army. Individuals with low aerobic capacity will experience greater physiological stress relative to their maximum capacity at any given absolute level of performance.

Flexibility is another component of physical fitness associated with risk of injury in military populations. Prospective measurements of toe touching ability indicate that U.S. Army trainees at both the high and low extremes of back and hamstring flexibility experience more injuries. (See Figure 5.) This bimodal association with higher injury risk in individuals at the extremes of flexibility is similar to observations reported for female collegiate athletes in a study that employed goniometric techniques to measure hip range of motion (Knapik et al., 1991; 1992). This data suggest a need to re-examine the widely held belief that greater flexibility protects against injury (Morris, 1984).

U.S. Army studies have also found less consistent and less significant associations between other physical fitness measures and risk of injury (Knapik et al., 1993; Jones et al., 1993; 1992; Reynolds et al., 1994). These include the ability to perform only low numbers of push-ups and sit-ups and higher percentages of body fat (estimated from skin fold thickness or circumference measurements). This type of data emphasizes the need to systematically investigate the association of suspected physical fitness components and other risk factors with the occurrence of injuries.

Religious Preference and Spirituality 109

Figure 5. Relationship between flexibility and the cumulative incidence of lower-extremity injuries in male U.S. Army infantry basic trainees. For quintile 1 compared with 3, relative risk = 2.2, p < 0.05 (Jones et al 1993).

U.S. Army studies have also found less consistent and less significant associations between other physical fitness measures and risk of injury (Knapik et al., 1993; Jones et al., 1993; 1992; Reynolds et al., 1994). These include the ability to perform only low numbers of push-ups and sit-ups and higher percentages of body fat (estimated from skin fold thickness or circumference measurements). This type of data emphasizes the need to systematically investigate the association of suspected physical fitness components and other risk factors with the occurrence of injuries.

Lifestyle and Behavioral Characteristics Questionnaires have been used to study associations of injury risks with lifestyles and habits (e.g. physical activity and smoking) among U.S. Army trainees and soldiers. Simple questions about the level of physical activity prior to entering the service and frequency of running, for example, have provided important clues about the effect of past activity on current

Religious Preference and Spirituality 110 risks of physical training-related injuries. Outcomes from these questionnaires demonstrate the value of asking individuals for information on specific behavioral characteristics.

Several prospective studies of U.S. Army trainees and U.S. Marine Corps recruits have reported that sedentary lifestyle prior to entering the service is associated with higher risk of injury during initial-entry training (Jones et al., 1993; 1992; Gardner et al., 1988). Figure 6 depicts the association of self-assessed past activity level with risk of injury during U.S. Army basic training. The trend of decreasing risk for those trainees who were previously more active than other individuals of the same age and gender is a consistent finding among male trainees (Jones et al., 1993; 1992; Gardner et al., 1988) but not among female trainees (Jones et al., 1993; 1992). (See Figure 6.)

Figure 6. Relationship between self-assessed past activity level and risk of injury in male U.S. Army trainees. For inactive compared with very active trainees, relative risk = 2.5, p = 0.06 (for trend) (Jones et al., 1992).

Also, male infantry trainees who run more frequently prior to entering the U.S. Army experience fewer injuries during basic training (Jones et al., 1993). (See Figure 7.) These

Religious Preference and Spirituality 111 observations suggest that past physical activity is protective against future injuries associated with physical training, at least among men.

Figure 7. Relationship between self-reported frequency of running in the month prior to beginning service and risk of injury in U.S. Army trainees. For running on < 1 day/week compared with ] 4 days/week, relative risk = 2.2, p < 0.05. (Jones et al 1993) Tobacco smoking is another behavioral health risk factor reported to be associated with higher risk of injury among U.S. Army trainees and soldiers. Figure 8 demonstrates the relationship between the amount of smoking and cumulative incidences of injury in male infantry trainees (Jones et al., 1993). Similarly, higher injury risk has also been associated with increased smoking by infantry soldiers (Reynolds et al., 1994). (See Figure 8.) In addition, the use of smokeless tobacco has been associated with risk of foot blisters during military road marching (Knapik et al., 1997). Whether the association between injury risk and tobacco use is behavioral or physiological remains to be demonstrated. Psychosocial factors such as greater risk taking behavior and specific cognitive deficits have been reported in smokers (Amoroso et al., 1996). Physiological factors such as delayed wound healing, increased bone demineralization,

Religious Preference and Spirituality 112 and immune suppression are also more frequently present in tobacco users than nonusers (Amoroso et al., 1996). Determination of the underlying mechanism of the association between tobacco use and injuries will certainly require experimental as well as epidemiological investigation.

Figure 8. Relationship between cigarette smoking and risk of injury among U.S. Army male infantry trainees. For never having smoked compared with > 20 cigarettes/day, relative risk = 1.7, p < 0.05 (Jones et al., 1993).

Training Factors For U.S. Army infantry trainees, risk of injury is higher in units whose members run a greater total distance. Daily log books completed by training company staff and direct observations have been used to document training. One study (Jones et al., 1994) observed that infantry trainees running an average of 17.6 kilometres(11 miles) per week experienced 27% more lower extremity injuries than those running 8 kilometres (5 miles) per week (42 versus 33%, respectively). Ironically, individuals in the 2 training units in this study ran about the same average times on the 3.2-kilometre (2-mile) run test at the conclusion of basic training (13.8

Religious Preference and Spirituality 113 versus 13.5 minutes, respectively, for the high- and low-mileage groups; p = 0.37), indicating the achievement of similar final levels of cardiorespiratory fitness. Survival analysis of these data indicated that trainees in the high-mileage unit experienced significantly more injuries at all points in time; however, no differences existed in the cumulative incidence of injury per cumulative distance run. These data suggest that there may be a finite risk of injury per mile run (or perhaps per running stride). These findings are consistent with the literature on civilian distance runners, which indicate higher risks of injury with greater distances run per week (Marti et al., 1988; Macera, 1992).

Research undoubtedly affirms that training factors other than the amount of running and marching influence the risks of injury to recruits and trained soldiers. Documentation of these factors will require more detailed studies and the use and development of better, more quantitative, methods of measuring exercise and training.

Multivariate Models of Injury Risk Factors determining risk of injury are clearly multifactorial and complex. For this reason, multivariate analytical techniques are necessary to determine which constellations of intrinsic and extrinsic risk factors are most associated with risk of injury and to control interrelationships between these factors. Methods employed in studies of risk factors for exercise-related injuries include Mantel-Haenzsel stratified ^² tests (Jones et al., 1992), logistic regression analysis (Jones et al., 1993; Reynolds et al., 1994; Gardner et al., 1988; Knapik et al., 1997), survival analysis (Jones et al., 1994), and proportionate hazard models (Macera et al., 1989).

Multivariate analysis of data on male infantry trainees identifies the most significant risk factors for overuse injuries of the lower extremities (i.e., stress fractures, Achilles tendonitis,

Religious Preference and Spirituality 114 plantar fasciitis and overuse knee syndromes) occurring during 12 weeks of infantry basic training. Table 7 summarizes the risk factors for overuse injuries identified among infantry trainees (Jones et al., 1993). These factors include older age, White race, history of an ankle sprain, lower amounts of running and physical activity prior to entering the army, and higher unit training mileage during basic military training. (See Table 7.) Variants of analyses such as these can also be employed to identify combinations of risk factors that place soldiers and others at particularly high risk.

Religious Preference and Spirituality 115

Table 7 Risk factors for lower extremity overuse injuries among 303 U.S. Army infantry trainees followed for >12 weeks of initial training, with adjusted odds ratios (OR) from logistic regression and 95% confidence intervals (CI) (Jones BH, et al., previously unpublished data)

Legend for chart: A - Risk factor B - Injury OR C - 95% CI for OR

A

B

C

Age (years) <24 ]24

1.0 2.5

1.2-5.2a

Ethnic group Black Other White

1.0 2.3 3.7

0.5-9.4 1.2-11.7 a

Previous ankle injury None Sprain

1.0 2.0

1.1-3.8 a

Previous physical activity at work Moderate-heavy Light

1.0 2.0

1.1-3.7 a

Previous physical activity Above average Average or below

1.0 2.0

1.1-3.5 a

Running in last month >4 days/week <4 days/week

1.0 3.1

1.2-8.7 a

Unit training distance (miles/week) Low (5) High (11)

1.0 2.0

1.0-3.5 a

Religious Preference and Spirituality 116 Studies of U.S. Army recruits also illustrate the need to control for confounding factors.

For example, in all studies of U.S. Army trainees reported in the literature, women experience more injuries than men (Kowal, 1980; Bensel & Kish, 1983; Jones et al., 1993; Brudvig et al., 1983); however, a number of these studies also indicate that the physical fitness of the female trainees is lower than that of the male trainees entering the army. When the effect of aerobic fitness (measured by maximal effort run times) is controlled for by either stratified analysis or logistic regression analysis, gender ceases to be a risk factor. In other words, the risk of injury is similar among men and women of the same relative level of aerobic fitness. Observations such as this illustrate the need to explore not only the associations of single risk factors with injury but also the effects that multiple variables exert on risks and on each other. Analysis should begin with a thorough exploration of univariate associations but should progress to multivariate models to control for confounding and to illuminate interactions.

In summary, the results of U.S. Army training injury research illustrate the need to systematically study risk factors for injury. In some reports, the results of military research confirm and extend the findings of studies of civilian populations. For example, higher training mileage (Marti et al., 1988; Macera, 1992) and past injuries (Macera, 1992) are risk factors among civilian runners and exercise participants as well as military trainees. In other reports, Army research appears to contradict or only partially support commonly held beliefs about the causes of injury. (Cowan et al., 1993; Giladi et al., 1985) For example, â&#x20AC;&#x153;flat feetâ&#x20AC;? and lower flexibility are widely believed to increase injury risk, but these beliefs are founded primarily on clinical suspicions; little systematic epidemiological research has been performed prior to these

Religious Preference and Spirituality 117 military studies. More civilian and military research is needed to validate the risk factors discussed and to discover others.

Injury Prevention Strategies Simply identifying risk factors is only part of a systematic, comprehensive injury prevention program. Once risk factors have been identified, it is important to devise and test promising prevention strategiesâ&#x20AC;&#x201D;the third step of the injury control process. Findings from the implementation of these strategies can prove to be more complex than the simple hypothesis from which the strategies were originally generated.

Modifications of Training Programs A study conducted by the U.S. Naval Health Research Center provides an example of a successful prevention strategy that was adequately tested prior to implementation. The study examined the effectiveness of reducing running activity to reduce the incidence of stress fractures. As noted in section 2.5, an observational study indicated that training mileage was associated with a high cumulative incidence of injuries (Jones et al., 1994). Naval research personnel studied 3 groups (1 control and 2 test groups) with more than 1,000 marine recruits in each. The groups performed different amounts of organized running during their 12-week boot camp. Individuals with stress fractures were tracked during the 11-week training cycle and traineesâ&#x20AC;&#x2122; final 4.8 kilometer (3-mile) run times were obtained. (See Table 8.) Comparing the highest and lowest mileage groups shows that a 40% reduction in running distance resulted in a 54% reduction in stress fractures with only slightly slower (2.5%) run times at the end of boot camp. Thus, stress fractures could be reduced with minimal losses in cardiorespiratory endurance (Shaffer, 1996).

Religious Preference and Spirituality 118 Table 8 Total running distance, stress fracture incidence, and final 4.8-km (3-mile) run times among 3 groups of male U.S. Marine Corps recruits during a 12-week boot camp

Legend for chart: A - Number in group B - Total running distance (km) [miles] C - Stress fracture incidence (number/100 recruits) D - Final run time (min)

A

B

C

D

1136 1117 1097

89 (55) 66 (41) 53 (33)

3.7 2.7 1.7

20.3 20.7 20.9

Modifications of Equipment Use of an ankle brace to prevent parachute jump-related injuries provides another example of a successful prevention trial. Military parachuting injuries have been reported to be 8 to 14 injuries/1000 aircraft exits, with ankle injuries accounting for about 30 to 60% of the total (Craig & Morgan, 1997; Amoroso et al., 1998; Lillywhite, 1991). Studies in the sports medicine literature strongly suggest that ankle bracing can reduce the incidence of ankle injuries (Rovere et al., 1988; Sharp et al., 1998). An experimental study was conducted on 745 military airborne students who performed a total of 3,725 aircraft exits for which about half of the students wore ankle braces and half did not (Amoroso et al., 1998). Ankle sprain incidence was 1.9% in nonbraced students and 0.3% in brace wearers (relative risk 6.3, p < 0.04). For all injuries, the

Religious Preference and Spirituality 119 braced group had a 4.3% incidence whereas the nonbraced group had a 5.1% incidence (relative risk 1.2, p = 0.92) (Amoroso et al., 1998). The brace did not influence other types of injuries.

While investigating the effect of footwear choice, a study of Israeli Defense Force trainees revealed that a high-top athletic shoe worn during training prevented foot injuries compared with the standard combat boot (Finestone et al., 1992); however, the overall lower extremity injury rates for the 2 groups were the same.

These latter two studies (Amoroso et al., 1998; Finestone et al., 1992) suggest that the incidence of specific injuries can be reduced without influencing the incidence of total injury. It may be prudent to balance the injury reduction capability of a specific intervention against the total injury picture before costly interventions are instituted.

Even unsuccessful prevention trials are valuable since they save further expenditure of resources on strategies that may not work. In the mid-1980s, the U.S. Marine Corps was prepared to purchase shock-absorbent boot insoles for issue to all incoming recruits in order to reduce the incidence of stress fractures. The sports medicine literature suggested that such an intervention could reduce the likelihood of some injuries (James et al., 1978;). Before committing funds, however, a study was commissioned to determine the efficacy of the insoles.

Gardner et al. (1988) followed more than 3,000 U.S. Marine recruits who were randomly assigned to wear a shock-absorbent insole or a non-shock-absorbent insole. The incidence of stress fractures did not differ between the 2 groups, indicating that the shock-absorbent boot insoles under consideration did not prevent stress fractures in this population. This study saved the U.S. Marine Corps considerable expense and demonstrated the cost-efficiency of such testing.

Religious Preference and Spirituality 120 The first step of the injury control process (see Table 1) is to determine whether a problem exists. Medical surveillance data indicates that injuries are an important problem for the U.S. Army. Unintentional (accidental) injuries cause about 50% of deaths, 50% of disabilities, 30% of hospitalizations and 40 to 60% of outpatient visits. For every unintentional injury death, there are about 20 injury disabilities, 100 hospitalizations and 1,900 outpatient visits.

Furthermore, epidemiological surveys and surveillance data indicate that physical trainingrelated injuries in the U.S. Army result in significant, usually temporary, losses of personnel resources. Eighty to 90% of limited duty days for trainees and infantry soldiers who visited outpatient clinics result from training injuries. Medical surveillance data further helps to prioritize the allocation of resources for prevention and research. Because of data such as those presented, greater emphasis is being given to injury surveillance, prevention, and research. For this reason, U.S. Army and Navy research programs have been developed to study trainingrelated injuries.

The second step of the injury control process is identification of modifiable causes and risk factors. U.S. Army research documents a number of potentially modifiable risk factors for these injuries, including (a) low levels of physical fitness, (b) high and low levels of flexibility, (c) sedentary lifestyle, and (d) tobacco use. Some risk factors, such as body morphology, flexibility, and smoking, warrant further study.

Demonstrating that a problem exists and identifying risk factors for injury is not sufficient to prevent the occurrence of injury. Knowledge of injury rates and risk factors provided by surveillance and research are of limited value unless they are integrated with other essential elements of an injury prevention program. The ultimate goal of injury surveillance and

Religious Preference and Spirituality 121 research is injury prevention. The third step of the control process is the determination of what is effective in preventing injuries. Prevention strategies should be tested prior to program implementation.

The fourth step of the injury control process, dissemination of information from surveillance and research programs directly to those who can use it to prevent injuries (military commanders, soldiers, policy makers, etc.), is the key to successful prevention of injuries in the U.S. Army. Once programs are in place, program effectiveness should be monitored. This is the fifth and final step of the injury control process.

In the U.S. military services, the infrastructure for a comprehensive injury prevention program integrating surveillance, research, intervention, program implementation, and program monitoring has been developed. The same general principles of injury prevention and control apply to civilian sports and exercise.

CHAPTER 3: METHODOLOGY Introduction The study will determine the relationship of religious preference and spirituality, and the frequency of the practices associated with that spirituality, along with the presence of certain demographics and military experience, on the retention and attrition of soldiers in the PTRP at the 120th Reception Battalion at Fort Jackson. It considered the causes or effects of religious preference and spirituality and determined the relationship between the related variables (Duclow & James, 2000). This supposition is supported through prior investigative findings, theories and data from the U.S. Army Center for Health Promotion and Preventive Medicineâ&#x20AC;&#x2122;s (USACHPPM) Spirituality and Resilience Assessment (USACHPPM, 2005). This was the basis for the problem statement and both the primary and secondary hypotheses.

The researcher conducted a causal-comparative study. Causal-comparative studies used quantitative methods that attempted to uncover a probable cause-and-effect relationship among variables. The independent variable caused a certain phenomenon or effect to the dependent variable (Christensen, 2001). There were many times while conducting research that the researcher was unable to control the independent variable, it would have been unethical to control the independent variable, or it was simply too difficult to control the independent variable (Gay & Airasian, 2000). According to Gay (1996), causal-comparative analysis is a form of non-experimental investigation in which researchers categorized groups of individuals who have the independent variable and then determined whether the groups disagree on the dependent variable. Gay (1996) explained that â&#x20AC;&#x153;non-experimental studies are organized,

Religious Preference and Spirituality 123 observed, and queried and the results are analyzed to see if the hypothesis or question is supported” (p.38).

All of the data used in this study existed and were available at 120th Adjutant General Reception Battalion’s PTRP at Fort Jackson. This information was computerized data stored and managed at the 120th Adjutant General Reception Battalion. The information was collected from the 120th Adjutant General Reception Battalion’s PTRP computerized data information system (CDIS) and was a composite of all initial-entry soldiers’ personnel record information on soldiers who had been processed through this reception station since 1996. The CDIS software system compiled soldier application information and survey material into computer records. The researcher requested approval to pull this data from the computer, but did not conduct any personal interviews or surveys with the selected soldiers. The selected records met the criteria as outlined in Chapter 1. The total number of records was 100.

Records were selected based on the dates of enrollment (January through December 2004; soldiers completing 12 months of training indicated that the soldier completed PTRP and returned to basic training). Once these records were selected, the researcher selected relevant questions that provided demographical information as well as the required data on religious preferences. Since these replies were on the same surveys and applications containing several other unrelated questions, the researcher selected specific questions that pertained to the information being sought for this purpose. During an injured soldier’s pre-exit transition out of the Army or back to training, while he or she was still in the PTRP program, the soldier was interviewed by the leaders in the command and leaders in the Creative Wellness Program to determine what could have been done to preclude their failure to recover and return to training or

Religious Preference and Spirituality 124 what was done to successfully promote their return to training (Feingold & Helminnik, 2000).

Questions regarding both religious preference and spirituality (frequency of practices) were included in these questionnaires. The questions asked pertaining to this study were (a) Do you have a religious preference/spirituality? and (b) Do you practice your religious preference/spirituality daily (a personal living faith) or weekly (church attendance)?

A series of other questions relating to soldier well-being and quality of life was asked by commanders and helping professionals during the interview, while the two primary questions indicated here represented only the religious concerns. All the responses to the questions were entered into the analysis software system and the computerized data was used to compile courses of actions that could be taken to reduce the attrition rate and increase retention. Among the questions were the spiritual fitness and religious preference and spirituality-type questions.

Again, this researcher selected two of the numerous questions asked during the interview.

There were nine questions that covered the demographics (age, gender, race, marital status, education level, and rank), military background and experience, and then, for this studyâ&#x20AC;&#x2122;s purposes, religious preference and spirituality. Once these questions were isolated and identified, the researcher extracted record files for the 100 soldiers that were included in their responses to the 10 selected questions. A preliminary investigation of statistics on attrition rates revealed that approximately 1,130 injured soldiers matriculated through the Physical Training Rehabilitation Program in 2004 with only 100 injured soldiers successfully graduating and being returned to initial-entry training. Based on the findings, 1,030 injured soldiers were released from the military. Unfortunately, since only 100 injured soldiers were returned to initial-entry training during 2004, the researcher was limited to working with that number of files for soldiers. The

Religious Preference and Spirituality 125 sample then was drawn from the universe of 1,130 entries and those meeting the initial criterion of being returned to training after an injury. These preliminary analyses were conducted as a part of the researcherâ&#x20AC;&#x2122;s previous normal duties and not in conjunction with this study.

The researcher conducted a records review on data from existing soldier records; 100 percent of those returned soldiersâ&#x20AC;&#x2122; records were then included in the study, adding to the validity of its findings (Yin, 2000). The sample size is 100 percent of the records of all eligible returning soldiers.

Study Design Model Overview: Causal-Comparative versus Correlational Research Causal-comparative investigation attempts to establish reasons for the present condition of the fact being studied (Rossi & Lipsey, 1999). Correlational research does not attempt to establish cause-and-effect connections; however, correlational research does attempt to establish if, and to what level, a connection is present among proven variables (Yin, 2000). One reason for the lack of a clear distinction between causal-comparative and correlational investigation is that every causal-comparative study can be reconceptualized as a correlational study by altering how the variables are calculated or evaluated, or both (Creswell, 2003). The differences in degree are ignored in causal-comparative design. Still, researchers often choose to apply a causalcomparative design for two reasons: Forming groups to compute the independent variable commonly is more consistent with what researchers reflect about humanity and the statistical outcomes usually are easier to understand and construe (Zikmund, 2003).

Causal-comparative and correlational studies also differ on the scaling of the independent and/or dependent variables. Neuman (1997) explains that nearly all causal-comparative research

Religious Preference and Spirituality 126 contains, as a minimum, one definite or nonmanipulative variable and correlational research contains a quantifiable variable or variables that can be expressed numerically. Attribute variables are the most frequently used independent variable in causal-comparative research and correlational research (Creswell, 2003). According to Creswell (2003), these variables can be used to represent characteristics of different people. Causal-comparative research provides probably the simplest quantitative approach to a relational study.

Pros and Cons of Causal-Comparative Research Causal-comparative research provides some advantages to the researcher. It allows a cause-effect relationship study when subject manipulation is impossible. It also allows for study of many relationships within a given population at one time (Cooper & Schindler, 2003).

A major disadvantage of this type of study includes the uncertainty of the degree of cause-and-effect. Since the independent variable does not allow for manipulation, causalcomparative studies cannot offer as strong of a confirmation of causality as can research based on a randomized experiment or a strong quasi-experimental design (Cooper & Schindler, 2003).

The Design of This Study The studyâ&#x20AC;&#x2122;s design included two primary hypotheses, each with a dependent and an exclusive independent variable, believed to have a causal relationship: religious preference and spirituality on the retention and attrition rates of injured soldiers in the Army. For this study, religious preference was a yes/no question on the soldierâ&#x20AC;&#x2122;s intake form; there were no related degrees for religious preference. Either a person had one, or they did not. Spirituality was based on the soldierâ&#x20AC;&#x2122;s reply to a follow-on question after indicating a religious preference affirmatively.

(Those who indicated no religious preference did not have to answer the follow-on question

Religious Preference and Spirituality 127 about spirituality.) For those who indicated that they had a religious preference, the level of spirituality was determined by the frequency with which the soldier practiced (in whatever form he or she deemed appropriate) that religious preference. Consequently, there was a distinct difference between simply having a religious preference and the level at which one practiced that religious preference. Spirituality was reflected by frequency; the more often a soldier practiced his or her religious form constituted a higher spirituality level.

The study required two distinct, primary hypotheses to delineate between these two major differences and to infer the causal relationship on the dependent variables (attrition and retention) and the host of other variables ranging from age to marital status. A clear distinction was also necessary as a positive trend for one dependent variable was not necessarily the same for the other. For example, a decline in attrition would be a positive trend, while an increase in retention would be a positive trend. As a result, the first hypothesis suggested a cause-and-effect relationship between retention, the other variables, and spirituality; while the second hypothesis suggested a similar relationship between religious preference, the other variables, and attrition.

In the first primary hypothesis, a high level of spirituality combined with the impacts of the other variables, affected an increase in retention. In the second primary hypothesis, the existence of a religious preference, combined with the impacts of other variables, caused a decrease in the attrition rate.

The second primary hypothesis derived from a review of the literature, observation, common sense, and conversations with Army retention experts. The analysis of credible substitute hypotheses often is referred to as strong inference (Zikmund, 2000). Zikmund (2000) asserts that whenever feasible it ought to be used in causal-comparative research to formulate the

Religious Preference and Spirituality 128 variable on which the comparison groups are to be compared. In other words, the researcher should choose and evaluate variables that he or she thinks are probable causes of the effect being studied. These variables can be generated using common sense or, more formally, by examining different theories that have been developed to explain the phenomenon being studied. This was preferable to administering a large number of measures simply because they appeared interesting or were available (Zikmund, 2000). The majority of the variables were demographics and military history.

Because the study attempted to establish causal relationships between the dependent and independent variables, it was necessary to include other demographic and military experience levels that could have potentially impacted the causal relationship and for which the researcher made several secondary hypotheses. For example, if the results from the two primary hypotheses suggested no causal relationship, then the researcher would not have collected data on any other potential causes for the attrition and retention rates. Because this relationship could be the result of several other variables, though not all inclusive in this study, and because these demographic and military experience levels were available on the soldier intake forms, the researcher included some other demographic and military experience level data points from which to draw inferential statistical conclusions. These included (a) Component (or military service affiliation); (b) Gender; (c) Age; (d) Race; (e) Education level; (f) Marital status; and (g) Grade or military rank.

The following additional secondary hypotheses were considered as alternative causal relationships between the independent variables of retention and attrition: (a) Component: Active duty soldiers will return to training in larger numbers than those assigned to the Army National Guard and Army Reserve, (b) Gender: Male soldiers will return to training in larger numbers

Religious Preference and Spirituality 129 than female soldiers, (c) Age: The younger the soldiers are, the more likely they will be rehabilitated and returned to training, (d) Race: White soldiers return to training in larger numbers than soldiers of other ethnic groups, (e) Education level: The higher the soldierâ&#x20AC;&#x2122;s educational level, the more likely that he/she will be rehabilitated and returned to training, (f) Marital status: Single soldiers will return to training in larger numbers than their married counterparts, and (g) Grade or military rank: The higher a soldierâ&#x20AC;&#x2122;s military rank, the more likely he/she will be rehabilitated and returned to training.

The researcher used information collected from asking the following questions: (a) Do you have a religious preference? (b) If so, how often do you practice your faith/religious preference? (c) What is your component? (d) What is your gender? (e) What is your race? (f) What is your age? (g) What is the highest grade/educational level you have completed? (h) What is your marital status? (i) What is your rank/grade?

Data Collection Primarily, all forms of measuring mechanisms can be used in causal-comparative studies.

Questionnaires, observations, interviews, and standardized tests all are practical for assembling data about assumed cause-and-effect relationships (Creswell, 2003). In this study the researcher reviewed existing secondary data on injured soldiers to include the religious preference and spirituality, along with demographics and military experience, of those soldiers who successfully graduated from PTRP and returned to initial-entry training. This data was in the form of computer-generated files or records maintained on each soldier. These records did not contain any personnel information or health or medical records. They were gained from responses to survey questions asked during the initial processing of every soldier and were entered into a

Religious Preference and Spirituality 130 database to which the researcher requested access. As the universe for this specific population was already defined, only the records for those soldiers were included in the process. Using their status as being returned to training and going on to complete that training and then to serve on active duty for their year group (2004), 100% of those records were included in the study. The Systems Administrator selected these records by the dates (12 months, January–December) for returning soldiers. Soldiers who terminated prior to December were not included.

These computerized records were the result of automating the Soldier Intake Form and process. Soldiers responded to several questions, nine of which the researcher had requested data access to. The researcher was granted exclusive and limited access to data files that contained the responses to the nine questions listed above. The researcher was assigned a personal ID and password to gain access to the files. His access was “Read Only” and he had to be physically located in the 120th Reception Battalion to use one of their stand-alone machines to access the files. None of this data was available via remote access or over the Internet. Every transaction made under the researcher’s user ID and password was visible and periodically reviewed by the systems manager. The researcher was not granted access to any other records. Personnel information was masked (not visible to the researcher) so that only the responses to the nine questions were available to the researcher. These records did not contain any personal identifiers, so that soldiers’ replies could not be connected back to an individual soldier. The records were in a spreadsheet format so that the information could be loaded into SPSS. The information will not be released outside of the 120th Battalion until the dissertation is published.

The review that the researcher conducted included reviewing the responses to the nine questions in a spreadsheet format extracted for “Read Only” reviewing. With the limited and

Religious Preference and Spirituality 131 controlled access, the “Read Only” capability, and the removal of personal identifiers, the study was in compliance with university standards for confidentiality and anonymity. Additionally, the absence of any personnel records or medical and health-related information deleted the requirement for any other safeguards.

For the two primary hypotheses, in comparing the data between the two groups (the group possessing a religious preference and the group not possessing one, and the group with low and high levels of spirituality), the degree of disparity between the groups on each evaluation was studied further to draw cautious conclusions about whether each factor (spirituality, lack of spirituality, or frequency of spiritual practice) affected the Army’s ability to retain injured soldiers. The statistical design for the two main hypotheses looked like this: Primary Hypothesis 1: DV1 (Retention) = IV1 (Spirituality, frequency of practice); Primary Hypothesis 2: DV2 (Attrition) = IV2 (Religious Preference). The statistical design equations for the secondary hypotheses looked like this: Secondary Hypothesis 1: DV1 (Retention) + V1+V2+V3+V4+V5+V6 = IV1 (Spirituality 1{S1} or Spirituality 2 {S2}). V1 equals service component; V2 equals gender; V3 equals race; V4 equals education; V5 equals marital status; and V6 equals grade. S1 equals a daily practice of religious preference, while S2 equals a weekly practice of the same. Simply stated, this hypothesis suggested that there were several variables, including the frequency of the soldiers’ practice of their religious preferences, which affected soldier retention. The more the soldier practiced his religious preference, along with the aspects of the other variables, the higher the likelihood of his retention. While the extent of each variable’s effects on retention remains unknown, or whether individual variables cause more or

Religious Preference and Spirituality 132 less of an effect than others, collectively, they impacted soldier retention. It was believed that the higher the level of spirituality (frequency of the practice), the higher the retention rate.

Secondary Hypothesis 2: DV2 (Attrition) + V1+V2+V3+V4+V5+ V6 = IV2. The only difference here was Religious Preference 1 {RP1} or Religious Preference 2 {RP2}), which suggested simply whether a soldier indicated a religious preference or not. The variables were the same as those reflected in Hypothesis 1. RP1 indicated a positive religious preference (a “yes” reply), while RP2 indicated a negative religious preference response ( a “no” reply).

Similarly, the secondary hypotheses suggested that the presence of a number of variables ranging from component to grade, including religious preference, impacted soldier retention.

While it is also not clear here which specific variable made the most or least amount of impact, or whether that impact was positive or negative, on retention, collectively they affected retention.

An affirmative religious preference resulted in a lower attrition rate among initial-entry soldiers.

Both formulas resulted from a group comparison and conclusions were drawn based on the differences reflected in the data collected from each group. Note: The presence or absence of a religious preference or spirituality were also determined from the soldiers’ replies to these questions; therefore, the researcher placed the responses in one of the two groups (based on soldier responses to these two questions) and made the causal-comparison based on this placement. The other variables (demographics and military experience) were added to the equation after the initial comparison between the groups was accomplished as reflected in the formulas for the two main hypothesis. Only then was the secondary causal relationships explored.

Religious Preference and Spirituality 133 The null hypotheses then for both primary hypotheses stated that there was no impact resulting from the independent variables upon the two dependent variables of religious preference and spirituality. Similarly, for the secondary hypotheses, the null hypotheses suggested that none of these variables had any causal relationship upon the independent variables of religious preference and spirituality. The data did not support either null hypothesis.

Data collection focused on identifying the effects being investigated between both the retention and attrition rates for injured soldiers. The research analysis identified potential causes and defined more clearly the cause-and-effect relationships among the data collected. These variables were the basis of all analyses. The existing confounding variables were the higher-thannormal attrition rates among the female population as opposed to those among the male population. To adequately address this disparity, the participantsâ&#x20AC;&#x2122; sample size was distributed along the same percentages as was represented in those results. It is unknown at this time as to why this data reflects such a high attrition rate among female members, but since it was a matter of record, the researcher selected a sample size consistent with the high percentage of females in the overall percent of soldiers attrited in 2004.

After determining group disparity, an accurate depiction of the group was required so that the results of the study could be understood in a meaningful way (Christensen, 2001). For this causal-comparative study, the researcher gathered data on two groups of soldiers who recovered from their injuries and returned to training. At the onset of this study, one population of Army trainees was entering the initial training program. They arrived on station either possessing a religious preference or not. By virtue of that difference, the researcher then separated them into two groups for research purposes. The first group was those injured soldiers who identified no or

Religious Preference and Spirituality 134 some type of religious preference; this information also determined if those identifying a religious preference also had a lower attrition rate. The second group derived from the results of the first group based on those who identified a religious preference and frequent practices of that preference, which we are calling spirituality. Data was then compared between these groups to determine whether an increase in spiritual level also resulted in an increase in retention, or if the existence of a religious preference also resulted in reduced attrition rates.

Spirituality as related to a soldier’s religious preference was recorded during the soldier’s initial entry into the Army and again while he or she was enrolled in PTRP. During both times, a military processor asked the soldier certain military and religious preference questions and the responses were entered into a central computer. Utilizing the intake forms and applications, the specific questions concerning frequency of practicing religious preference (spirituality) were asked during the PTRP intake and exit interview process. This allowed a unit and the Army to determine the soldier’s basic religious preference and frequency of practicing those spirituality requirements. The religious preference was entered on the soldier’s “dog tags,” used to identify military members killed in combat. This computerized information enabled the researcher to determine if the injured soldier who ultimately recovered, graduated from PTRP, and returned to initial entry training had no or some type of religious preference. This information was then recorded as his/her baseline. If the soldier indicated that he had a religious preference, how often he or she practiced that preference determined his or her level of spirituality.

Once the religious preference and frequency of spirituality was determined for each soldier, and the information was recorded in the automated computer software, the researcher reviewed the file of each injured soldier with an indicated religious preference to determine if

Religious Preference and Spirituality 135 injured soldiers specified how they practiced their religious preferences. This answered the question of whether soldiers who actually practiced their religious preference more often than others were more likely to be retained in the Army. This data was collected from the universe of soldiers who answered affirmatively regarding possession of a religious preference.

All soldiers who identified a religious preference/spirituality were studied further and their responses compared against each others to determine their level of spirituality based on the frequency of their practices. The frequency of practices was determined if the injured soldiers indicated that they practiced their spirituality daily (S1) or weekly (S2). For the purpose of this study, “daily” indicated a high level of spirituality and “weekly” indicated a low level of spirituality. This comparative analysis answered the question of whether soldiers who practiced their religious preference/spirituality daily, along with other demographics and military experience, were more likely to be retained in the Army (Zikmund, 2000). This information was also scaled to investigate whether degrees of practice yielded certain results.

In other words, the hypothesis that considered whether soldiers who frequently practice their spirituality have a greater chance of being retained in the Army was determined from those injured soldiers who identified a religious preference. The first question asked about the soldier’s religious preference and the second question asked about the frequency with which they practiced their religious preferences (spirituality).

Once the soldier answered the questions, the interviewer entered the data into the computer. If the soldier indicated no religious preference/spirituality, then the soldier had completed the religious section of the interview. If the soldier indicated a religious preference,

Religious Preference and Spirituality 136 that soldier was asked whether his or her religious preference was practiced daily (a personal living faith) or weekly (church attendance). For example: Interviewer: As a result of your religious preference/spirituality, do you practice your faith daily (a personal living faith) or weekly (church attendance)?

Soldier: Indicated how he or she practices his or her religious preference/spirituality.

Again, the injured soldiers were provided two choices, daily (a personal living faith) or weekly (church attendance). As previously mentioned, for research purposes “daily” was determined to be a high level of practice and “weekly” was determined to be a low level of practice. The injured soldiers had no knowledge of what represents a high level or a low level of practice as it related to their spirituality when responding to the questions, since the definition was only assigned for this research project. The assigning of meaning to the frequency of practicing one’s religious preference (high or low levels) was for the purpose of doing a comparative analysis to determine if soldiers who frequently practiced were more likely to be retained in the Army (Hayden, 2000).

This data was then analyzed using the Statistical Package of the Social Sciences (SPSS).

SPSS is the industry leader in analytics technology and has been in use at more than 120,000 corporations, academic institutions, and a host of other businesses for the last 37 years. It is an automated software program designed to provide predictive analysis of data by quantifiably interpreting all types of data input by the researcher. It assists with the conversion of raw data to that collected via surveys, questionnaires, interviews, etc., interprets it in numerical quantities, and then allows quantitative interpretation and data analysis. For example, “some religious preference” responses will be converted to a numerical value (i.e., 1 for some; 2 for none )

Religious Preference and Spirituality 137 Whether the data is behavioral, social, attitudinal, or simple demographics, SPSS can convert that information into meaningful, measurable data that can be interpreted with accuracy. An industry leader, SPSS has comprehensive technology that can calculate all data in terms of everything from the descriptive analyses and scaling data to the standard deviation. (What Makes SPSS Unique, 2005) Data Analysis In order to analyze causal-comparative information, the researcher performed data analysis and computed explanatory statistics for each group in the study. Generally, these numbers included the group mean, which indicated the average performance of a group on measurable variables; the mode, the attribute that occurred most often in respondentsâ&#x20AC;&#x2122; replies; the median, or responses that typically occurred in the middle of the scores having an even number of responses above and below it; the variance and the standard deviation, which indicated the size of the range on a set of scores and their relationship to the mean, that is, whether the scores were relatively homogeneous or heterogeneous around the mean (Martella, Nelson, & MarchindMartella, 1999); frequency distributions on the raw data, reflecting how often respondents selected a particular response and how those responses appear when charted on frequency curves; the variance between data points particularly between dependent and independent variables; and finally, hypothesis testing to quantify data collection as it related to the two hypotheses in the study. A more detailed description of how the researcher developed each statistic and the statistical equations related to each will follow.

For example, to calculate the mean on age (Secondary hypothesis #3), education levels (Secondary hypothesis #5) and grades (Secondary hypothesis #7), the only variables where an

Religious Preference and Spirituality 138 average would be meaningful, the researcher added the total number of respondents in each category and divided the total by the number of respondents in that category for the average number of respondents. For example, an age category of 1–4 would equate to: (1) Less than 20; (2) 21–25; (3) 25–30; and (4) 30–35. Further analysis of the mean included calculating an average age in each category as well.

A similar analysis was done for education levels 1–5 that equated to: (1) high school/some college; (2) associate’s degree; (3) bachelor’s degree; (4) master’s degree; and (5) post-graduate degree. The mean would told the researcher the categories where the majority of respondents were identified. The formula for the mean would be Sum of (age category)f x/N).

To calculate the mode for all variables, the researcher developed a table of respondent replies and charted them as raw data for each of the variables. The variables were listed separately on tables with their frequencies of replies identified from 1 to 100 (total number of records) in the left column, and categories listed as column headings across the top. The researcher totaled those replies by category, noting the replies that occurred the most primarily through visual observation as the mode was not calculated. The researcher simply recorded the response that appeared the most and identified the mode of the data from that observation. The mode was calculated for all variables.

For the median, the researcher grouped the data for age and education, and identified the median age and education levels for the respondents by counting the numbers of responses (N = 100). Because of the even number, the researcher would add 1 (N/2 +1) or identify the midpoint between the two middle responses. A median was calculated when it had statistical relevance.

Religious Preference and Spirituality 139 The standard deviation was more complicated. In order for the data to be drawn out on the normal distribution curve, the standard deviation was calculated. The standard deviation told the researcher how much each respondents’ replies deviated from the average responses. It included the variances between responses and provided the researcher with an idea about how homogenous or heterogeneous the data was. Standard deviations were meaningful for the following data: age, education levels, and grades. Frequency distributions were developed using bar and pie charts.

Finally, for hypothesis testing, the researcher compiled data on the responses to the religious preference questions (N = 72 for “yes” replies; N = 28 for “no” replies) and compared these to the results from each variable. A similar comparative analysis was done on the responses to the frequency of the practice of the religious preference (for this study, this is the level of spirituality). Each was compared to the results from the other variables. The causal comparison will always occur between the two homogenous groups (those with religious preferences and those without one, and those who practice their spiritually/religious preference weekly or daily) regardless of which variable is being considered. The data then either supported or negated the validity of each hypothesis or did the same with the null hypothesis.

Following the initial data analysis, the researcher performed a test of statistical significance. The selection of a statistical significance test was based in part on whether the researcher was interested in comparing groups with respect to each group’s mean score, variance, or median, or with respect to rank scores or category frequencies (Creswell, 2003).

Choosing a suitable test also depended on whether the assumptions essential to the test being considered were fulfilled, or at least not grossly violated (Martella, Nelson, & Marchind-

Religious Preference and Spirituality 140 Martella, 1999). Specific questions and their related hypotheses are listed in this chapter under the section entitled â&#x20AC;&#x153;The Design of This Study.â&#x20AC;? The researcher conducted appropriate statistical analysis for each variable.

Tests of Statistical Significance Causal-comparative research produces data about the measured phenomenon. The researcher determines if the distribution of scores or data has enough value or statistical significance to be used in further studies or for other purposes. To test the significance of the findings, the researcher applies various tests to the data to see if variances or differences in scores are significant. Generally, researchers conducting causal comparative research use a parametric test or a nonparametric test. Parametric tests make certain assumptions about the distribution and form of the scores on the measured variable; nonparametric tests do not. This study used a parametric test to determine statistical significance. According to Gay (1996), parametric tests create distributional assumptions that samples are normally dispersed. When these assumptions are met, parametric tests provide a powerful tool that the researcher can use to test for statistical significance (Creswell, 2003). These tests were the primary method of interpreting data collected in this study.

For this study, the t test was used for independent means (scores). The t test in causalcomparative studies relied on three suppositions about the acquired scores. The first supposition is that the scores form an interval or ratio scale of measurement. The second belief is that scores in the populace being studied are generally dispersed. The third supposition is that score variances for the populations being studied are equal. Statisticians have concluded that t tests

Religious Preference and Spirituality 141 supply precise estimates of statistical significance even when there is a considerable breach of these suppositions (Creswell, 2003). Every individual comparison required a separate t test.

The second or other hypothesis comparing injured soldiersâ&#x20AC;&#x2122; level of spirituality was analyzed using the t test as well. This increased the chances of finding a significant difference between groups on measured variables.

The following sequence of actions were taken in this order: (a) Soldiers completed the initial intake applications and surveys, (b) Military interviewers entered the data into the computerized data software system, (c) Researcher retrieved 100 records that met the criteria (soldiers being returned to training), (d) Data was entered into SPSS from all 100 records, (e) Researcher produced measures of central tendency for all applicable variables, (f) Researcher conducted SPSS sort on religious preferences and selects those records with 1 (Yes) responses; (g) Researcher built a separate record for this subset in SPSS; (h) Researcher sorted on the frequency of the religious practice, 1 for daily and 2 for weekly and built a subset in SPSS for this population; (i) Researcher directed SPSS to perform a variety of analysis on these subsets of data; (j) Researcher utilized â&#x20AC;&#x153;Cross tabâ&#x20AC;? command for each variable against the two independent variables; (k) Researcher directed SPSS to create frequency and t test statistics for all applicable variables, creating bar or pie charts for each variable; (l) Researcher quantified results of the hypotheses; and (m) Researcher drew conclusions and made inferences based on quantifiable support for (or against) the hypotheses.

Religious Preference and Spirituality 142 Reliability and Validity The methodology as described herein resulted in a reliable assessment and a valid study, notwithstanding its limitations as described in Chapter 1. The researcher used extreme selectivity in the types of responses to be included in this study (Christensen, 2001). The survey materials contained a host of other unrelated questions that helped to deter attention to the ones this study included in its data collection. These questions included responses related to the information the researcher required of each participant and therefore had content validity. They were designed to measure the required information. The files contained general in-processing data which was computerized using an automated personnel management system. Instruments were administered upon entry and again as soldiers successfully completed the rehabilitation portion of PTRP. The data instruments were neither unique to, nor designed by, the researcher. Their purposes were not data collection, but were maintained as part of the standard personnel records of each member.

Similarly, the instrument had predictive validity; its results could be used to predict the soldier’s future achievement with a degree of accuracy, when combined with the other variables.

For these reasons, the instruments were valid for the study and yielded meaningful, measurable, and unbiased results.

The majority of questions asked on the instruments were “closed” questions and would therefore solicit the same response from the same individual responding regardless of when or how asked (Christensen, 2001); this increased the reliability of the responses. Additionally, the Army reminded all applicants that if they made false statements on any of these documents, they could be prosecuted. Since they were part of the applicants’ official files, these documents generally contained true or proven responses. The only exception to the closed questions was

Religious Preference and Spirituality 143 during the exit interview, where members were allowed to offer more personal responses to open-ended questions. Even then, these responses were standardized before being entered into the centralized, automated data bank. Reliability was also expected under these conditions.

Challenges to the validity of these results were based primarily on the covariance between related data points (Yin, 2000). For example, if a soldier indicated that he had a religious preference, but then indicated elsewhere that he did not know what that religious preference was, then the variables would not have covariance. Similarly, because of the difficulty in drawing meaningful cause-and-effect conclusions from this data, and the stringent definitions for valid data upon which these conclusions were drawn, the validity of the findings will be subjected to criticism and challenges. Among these are the same ones associated with using standard test scores to determine a student’s academic potential. As there is no precise measurement for intelligence, measuring spirituality is equally difficult, as there is no precise measurement for spirituality. This study defined spirituality in limited terms and therefore might be subject to challenges regarding its validity.

Secondly, because these questions were collected in a “controlled” environment (i.e., completing them was not optional), the responses may have been affected by the environment.

The replies may be subjected to a “halo effect” where one characteristic may overshadow the evaluation of others and thus affect responses and results. Thirdly, expectations (perceived or real) regarding the Army and the Army’s training may affect responses as well (called a stereotype threat). Here a soldier will answer based on what he thinks is the “right” response instead of how he really feels (Brannon, 2004). All of these challenges threaten the validity of the instrument and cause some concern for the researcher as they are uncontrollable in this study.

Religious Preference and Spirituality 144 To adequately assess validity, the researcher reviewed this instrument from the perspectives of four validity tests: criterion, construct, content, and face validity.

Criterion validity is measured primarily through two techniques: the “known group comparison” technique and predictive validity (discussed above). Since both spirituality and religious preference are considered complex constructs for measurement purposes, the “known group comparison” would compare the instrument’s use among two varied groups to judge its validity. Validity would result in similar scores from respective groups when the instrument is used more than once with different groups of the same two persuasions. One example discussed using a measurement scale for political ideologies and administering that scale among two extreme political right and left groups. If the instrument is valid, the researcher should gain similar, consistent results each time it is administered.

For the purpose of this study, the instrument in use by the Army now has been relatively the same since 1993 and has yielded consistent results over the years among the various demographic differences among soldiers (GAO, 2005). For this reason, it would be considered valid by this technique.

Secondly, the predictive validity, whether the instrument also provides accurate data to make predictive assessments on other factors, appears to be present as the results of the instrument will also be used to predict a soldier’s ability to successfully complete training after an injury as well as whether that ability is impacted by his level of spirituality.

Construct validity refers to whether the instrument measures highly complex constructs and produces other data that support the predictions of theory. For example, the spirituality theory purports that there is a relationship between one’s spirituality and their psychotherapeutic

Religious Preference and Spirituality 145 recovery. If the instrument the researcher uses in this study can provide some other complex data points related to this theory, and most importantly, in support of the theory, then the tool is considered to have construct validity. In this study, the other variables (gender, race, age, marital status, military experience, service component, and grade) had the potential to provide such related results and produced those highly complex results present in construct validity.

Content validity is the measurement of whether an instrument asked the appropriate content questions to gain the desired results. As discussed earlier, the range and type of questions on this instrument address the level of depth of information needed from participants to draw the related conclusions. It, therefore, has content validity.

Lastly, face validity deals with whether, on the surface, the instrument appears to contain the right indicators for what the researcher is attempting to measure. When the researcher reviewed this data form initially, there was no question that the completed personnel file contained more than enough data to gain the information the researcher needed, and certainly contained the contents of what the researcher needed for this study. The researcher concluded that the instrument has face validity.

Reliability is based upon whether the instrument can yield similar results when used several times. Based on the type of questions asked, the long-term use of the instrument for unrelated purposes, and the inclusion of specific closed-ended questions relating specifically to spirituality and religious preference, the instrument has a high level of reliability. Its continued use by the Army to collect its own personnel data and recruiting goals makes it a reliable measurement tool for this study.

Religious Preference and Spirituality 146 In regards to both precision and accuracy, this studyâ&#x20AC;&#x2122;s results will not require a level of accuracy below whole number percentages.

Limitations of Methodology Causal-comparative studies are good for recognizing relationships, but they are less robust on ruling out alternative explanations. Researchers involved in looking at causality in causal-comparative research must decide whether a practical association (that is presumed to be causal) fades away after controlling important antecedents or concurrent unrelated variables. The evidence of causality becomes stronger with each test the hypothesis survives (Gay, 1996). By testing and comparing religious preference/spirituality and the levels of spirituality at the 120th Adjutant General Reception Battalion PTRP, the researcher was able to get only a snapshot of how spirituality affects retention. This snapshot alone is not sufficient to support an undisputable causal relationship. It will, however, reflect a positive or negative trend for that particular variable at that point in time.

The results were not totally conclusive, but paved the way for additional studies and identified avenues for improving retention. Although the findings were not totally conclusive, this researcher found that a high level of spirituality improved the attrition rate of injured soldiers matriculating through Physical Training Rehabilitation Programs in the Army. When supported by the data, this information will help the Army to refocus planning and resources to augment this expected phenomenon and insert programs and policies that directly address the importance of spiritual fitness and spirituality as they relate to soldier retention and attrition.

The processes to statistically prove the impact of the nine variables in a causal relationship faced several challenges. First, although the study sought to draw causal

Religious Preference and Spirituality 147 conclusions, it was also understood that these nine variables were not all inclusive of variables that could affect either the soldier’s rehabilitation or his ultimate completion of the training.

There were numerous other variables that could and did affect each soldier’s results, variables too numerous for this study to consider. Among these were the soldier’s existing physical condition, his desire to succeed, his family background, his history of peer pressure and influence, and others. At best, this study concluded on the results of the limited nine variables with the understanding that they do not contain all of the impacting variables that contributed to a soldier’s failure or success in this program.

Secondly, the variables were primarily qualitative (nominal) and not quantitative as required for ordinal and interval variables, and required to support causal relationships.

Consequently, the employment of more sophisticated statistics did not apply. Basic frequencies provided the answers to all of the questions present in the primary and secondary hypotheses.

Even when the attempt was made, the nominal variables prevented the application and logic of these statistics. As a result, conclusions were made on frequency data alone, while denoting or inferring causal relationships.

Thirdly, the records review was limited to the records from the 2004 year group. That year, over 1,100 soldiers entered training, but only 100 successfully completed it. Without the data from previous years, it could not be determined whether this year was representative of past years, or an anomaly. A trend or baseline could have been established had there been data from past years and this data could have driven the requirement to re-examine 2004 and its related conditions in more detail. As it was, the results were drawn from a very limited perspective, and one that has not been statistically proven to be representative of the years preceding 2004.

Religious Preference and Spirituality 148 Further, if the Army uses this information for future classes, it should be understood from this perspective.

Lastly, the data was limited to the results from the nine questions only. As the study progressed and the data was recorded, it was evident that more detailed information would have aided in making the causal relationships more supportable. For example, none of the questions addressed how long it took soldiers to return to training. A quantitative reply here would have provided more detailed analysis and possibly led the researcher towards other causes. A simple go/no-go position does not provide any such details. If it took one soldier a month to return to training, and another soldier returned to training in a week, the study could have focused on the reasons why and drawn more conclusive causal relationships. Without that data, all completions were recorded as successes when, in fact, one completion may have been quite different from another one.

Ethical Issues and Timeline for the Study There are no potential risks to soldiers since the researcher is using existing data and the researcher makes no personal contact with the soldiers. In addition, no personally identifiable information was collected from the records, thus assuring anonymity and confidentiality. For ethical considerations it should be noted that the researcher in this case is also a former employee of the organization and the records to be reviewed are those of soldiers assigned to the 120th Reception Battalion. The researcher is not, however, in a supervisory capacity in this organization and can in no way affect decisions regarding the outcomes of the soldiers whose records were reviewed. From this perspective, the researcher will in no way make recommendations regarding personnel actions or employment decisions on any of the soldiers

Religious Preference and Spirituality 149 whose records were used in the study. Further, the researcher has never made, and will not make, any personal contact with these soldiers. Information contained in this report will be made available to military leaders only when officially published. Regardless of the outcome, the studyâ&#x20AC;&#x2122;s contents will not affect any of the soldiers whose records were used for data collection.

The subsequent reassignment of the researcher to a higher level position removes any potential for direct soldier impact as a result of this study. Finally, the records are from the 2004 group only, all of whom have completed their rehabilitation training and gone on to other assignments outside of South Carolina.

The timeline for this study was approximately 30 to 45 days based on access to the appropriate military computers.

CHAPTER 4: RESULTS Overview This chapter includes results relative to the data acquired, and their relationship to the studyâ&#x20AC;&#x2122;s purpose. The explanation of the statistical data analysis is presented in narrative form, along with bar graphs and/or pie charts for applicable variables. In analyzing the data for each of the hypotheses, the researcher included descriptive statistics (frequencies, measures of central tendency, standard deviations, t tests, and chi squares) to the extent that were meaningful and appropriate. The analysis of the variance (ANOVA) was employed only when it had statistical application and as it applied to all of the data. With the large number of nominal variables in this study, not all of the data results lend themselves to this type of extensive analysis. The majority of these variables are nominal (qualitative) and were reflected using the qualitative statistics listed above. For example, an average number would not apply or have any meaning for the gender, religious preference, or spirituality variables as these variables only have two responses.

An average would equate to one of these, and would not be statistically meaningful.

The researcher analyzed those variables that contain scales or that are ordinal (race, education level, and grade) and these were reflected using the appropriate statistics. Three of the variables were interval variables; there was some significance in the distance between the data points, and these differences appear to be meaningful. The interval variables were age, education level, and grade. The researcher conducted more sophisticated statistical analyses on these variables. A complete summary of the frequency data is in Appendix A. This chapter will include all relevant statistics and the appropriate data tables and charts that reflect the results of statistical data collected for both the two primary hypotheses and the

Religious Preference and Spirituality 151 seven secondary hypotheses. The researcher will draw conclusions regarding conclude on either the data results support or nullify the original hypotheses.

Summary of the Data Once the 100 records were secured from the Computerized Data Information System (CDIS), the researcher converted the responses into numerical values as reflected in the Code Sheet. (See Table 9.) These records were “sanitized” in that they contained no personal identifiers, medical, or health information, and allowed only the results of the nine questions to be included in the records released for this purpose. The researcher was assigned a temporary user name and password and could gain access to these records only when physically present in the building where the CDIS was maintained. The administrator checked the researcher’s picture identification before releasing the records. All other required security measures were exercised while the researcher was in the facility.

A brief summary of the frequency data reflected the following: (a) All 100 respondents answered all nine questions; there were no omitted responses; (b) There were 64 active duty, 20 Army National Guard and 16 Army Reserve soldiers in the total; (c) There were 27 males and 73 females; (d) There were 47 White, 32 Black, 3 Hispanic, 4 Asian and 5 other; (e) There were 49 below the age of 20, 36 between 21–25, 11 between 26–30, and 4 between 31–35; 6) 71 were high school or equivalent graduates, 22 had associate’s degrees, 4 had bachelor’s degrees, 2 had master’s degrees and 1 had a post-graduate degree; (f) There were 69 single soldiers, 23 married, 6 divorced and 2 listed as other; (g) 41 had the rank of private (E-1), 30 were privates (E-2), 24 were Private First Class (E-3), and 5 were Specialists (E-4); (h) Seventy-two soldiers answered affirmatively to the religious preference question; 28 soldiers responded negatively. They were

Religious Preference and Spirituality 152 eliminated in the final question on spirituality; (i) The total responses for the question on spirituality were 72 (balance of responses after the 28 negatives; 46 answered daily and 26 answered weekly).

Religious Preference and Spirituality 153

Table 9 Code sheet to provide a summary of the instructions to be used to convert the information into SPSS Independent variable & SPSS variable code Dependent variable: (I) Retention (II) Attrition Component (COMPONENT)

Description Retention: Rate of soldiers retained in the Army after injury; Attrition: Rate of soldiers discharged after injury Active duty/regular Army (AD); Army National Guard (ANG); Army Reserves (RES)

SPSS data codes N = 100 soldiers

Gender (GENDER)

Subject’s gender

1 = Male 2 = Female

Race (RACE)

White, Black, Hispanic, Asian, other

1 = White 2 = Black 3 = Hispanic 4 = Asian 5 = Other

Age (AGE)

Age in years by category

1 = n < 20, 2 = 21 - 25 3 = 26 - 30 4 = 31 - 35

Education (EDUCATION)

Years of formal education completed

1 = High school/GED 2 = Associate’s degree 3 = Bachelor’s degree 4 = Master’s degree 5 = Post-graduate degree

Marital status (MARSTAT)

Subject’s marital status

1 = Single 2 = Married 3 = Divorced 4 = Other

Grade category (GRADE)

Enlisted soldier’s military rank

1 = E-1 2 = E-2 3 = E-3 4 = E-4 5 = Other

Religious preference (RELPREF)

Soldier’s religious preference

1 = Yes 2 = No

Spirituality (SPIRIT)

Soldier’s frequency of practice of religious preference

1 = Daily 2 = Weekly 3=N/A

1 = Active duty 2 = Army National Guard 3 = Army Reserves

Religious Preference and Spirituality 154 Analysis of the Primary Hypotheses The study included two primary hypotheses and seven secondary hypotheses. For clarity, the results will also be reported in that same order. Because the data results for the two primary hypotheses are extracted from the same data supporting all seven of the secondary hypotheses, this data will be reflected only once immediately following each of the primary hypotheses, and then each secondary hypothesis will be discussed as the data relative to that particular variable is reflected per statistic in the tables.

The first primary hypothesis stated that a high level of spirituality combined with the impacts of the other variables affects an increase in retention. To statistically evaluate this hypothesis, the researcher compared data from all other variables with the results of the spirituality question. Including the cumulative data from all variables, and comparing that to the responses for the question on spirituality, of the 100 soldier surveys that represent successful completion of the program, 46 percent indicated a high level of spirituality by practicing their religious preference on a daily basis. (See Table 10.) These results support the primary hypothesis as this large percentage of successful completions, nearly 50% of the whole, increased the retention rate for this year group and represents those who also practiced a high level of spirituality. It can be inferred that the high level of spirituality contributed to this high percent of soldiers who were successfully rehabilitated.

The second primary hypothesis stated that the existence of a religious preference combined with the impacts of other variables can cause a decrease in the attrition rate. Again, including the cumulative data from all other variables, and comparing that to the responses for the religious preference question, of the 100 soldier surveys, 72% indicated that they had a

Religious Preference and Spirituality 155 religious preference. Overwhelmingly, this statistic suggests that the presence of a religious preference contributed to the success of the large majority of soldiers who successfully completed training and thereby reduced the attrition rate for this year group. (See Table 10.)

Table 10 Spirituality and Religious Preference (Crosstabulation)

Spirituality and religious preference

Spirit

Yes

No

Daily

46

0

46

Weekly

26

0

26

0

28

28

72

28

100

N/A Total

Total

Collective Analysis of the Primary and Secondary Hypotheses In order to draw statistical conclusions on the primary hypotheses, and support a causal relationship, the researcher had to look more closely at each variable in relationship to the soldiersâ&#x20AC;&#x2122; responses for the seven variables related to the secondary hypotheses. This section will provide the raw data for the statistical equations as described in Chapter 3. It will attempt to analyze the results individually first, variable by variable, and then collectively in order to make

Religious Preference and Spirituality 156 causal comparisons using the results from all of the variables, including the religious preference and spirituality, the two primary hypotheses. The researcher will present the results for specific variables related to the seven secondary hypotheses and add further analysis of these results as they relate to the two primary hypotheses in the following order: (a) Component, (b ) Gender, (c) Race; (d) Age, (e) Education, (f) Marital Status, and (g) Grade or Rank. The two variables for the primary hypotheses will be discussed in conjunction with each one of these variables, spirituality first and religious preference second.

When evaluating the data results in relationship to the first primary hypothesis and spirituality, the researcher found the following: Component: When reviewing the results for the component (Active Army, Army National Guard, and Army Reserves), 46% indicated that they had a high level of spirituality (practiced their religious preference daily). An additional 26% practiced their religious preference weekly. Based on the primary hypotheses, that suggested the higher spirituality level would affect an increase in retention; the results support that hypotheses.

The secondary hypothesis related to the soldierâ&#x20AC;&#x2122;s component suggested that active duty soldiers would return to training in larger numbers than those assigned to the Army National Guard and Army Reserves. The results reflect that 64% of the successfully rehabilitated soldiers were active duty Army, as opposed to 20% for the Army National Guard and 16 percent for the Army Reserves. The data supports the original hypothesis. (See Table 11.)

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Table 11 Spirituality and Component (Crosstabulation)

Spirituality and component Active duty

Spirit

Total

Army National Guard

Army Reserves

Total

Daily

29

8

9

46

Weekly

18

6

2

26

N/A

17

6

5

28

64

20

16

100

Gender: By far, the females had a higher percentage of daily practice (high spiritual level) when compared to the males (35% versus 11%), but they also had the larger number of â&#x20AC;&#x153;noâ&#x20AC;? responses (22) and of the lower spiritual level (weekly = 16, versus the malesâ&#x20AC;&#x2122; 10). This may have been caused by the large representation of females in this sample size. This is discussed further below.

The secondary hypothesis related to gender stated that male soldiers would return to training in larger numbers than female soldiers. Comparing the raw data, this initially appears not to be supportable from the results as there were 73 females and only 27 males who successfully completed the training. With a more in-depth review, however, the percentage of males returning to training was much higher than that of the females. Historically, the number of females

Religious Preference and Spirituality 158 sustaining injuries in training and requiring rehabilitation has been higher than their male counterparts; however, a comparison by percentage renders a different picture. For example, the standard ratio for males to females entering training each year is 60:40. Multiplying these numbers by the original population entering the rehabilitation program (1,130), the result is 678 males and 452 females. When comparing these numbers to the total who successfully completed the program (678/27 for males and 452/73 for females), 25% of males were rehabilitated successfully, while only 6.1% of females were rehabilitated successfully. The percentage that considers the total population is a more realistic picture of the whole, and more aptly addresses the male/female results. Consequently, the data, when considered from the standard gender ratio, supports the hypothesis. (See Table 12.)

Table 12 Spirituality and Gender (Crosstabulation)

Spirituality and gender Males Spirit

Total

Daily

11

35

46

Weekly

10

16

26

6

22

28

27

73

100

N/A Total

Females

Religious Preference and Spirituality 159 Race: From the perspective of the primary hypothesis, high spirituality positively affects retention. From a purely numerical standpoint, the soldier’s race would not matter. It is simply interesting to note that of the 46 positives for high spirituality, 22 were White, 15 were Black, 3 were Hispanic, 3 were Asian, and 3 were other. It should also be noted that 11 of the 28 “no religious preference” responses came from White soldiers, who also represent the largest number of high spirituality levels. This suggests that no real conclusions can be drawn regarding race and spirituality without additional information.

The secondary hypothesis with race as the variable suggested that White soldiers would return to training in larger numbers than other ethnic groups. Conclusively, when comparing the raw data, 47% of the successfully rehabilitated soldiers were White soldiers, as compared to 32% Black, 10% Hispanic, 6% Asian, and 5% other. Note: If the other ethnic groups’ numbers are combined (53), the hypothesis would not be supported by the data. Because the original hypothesis did not state specifically that the results for all other ethnic groups would be combined and then compared to the results for White soldiers, the hypothesis is supportable as originally stated in the hypothesis. (See Table 13.)

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Table 13 Spirituality and Race (Crosstabulation)

Spirituality and race

Spirit

White

Black

Hispanic

Asian

Other

Total

Daily

22

15

3

3

3

46

Weekly

14

10

0

0

2

26

N/A

11

7

7

3

0

28

47

32

10

6

5

100

Total

Age: When analyzing this data as it relates to the primary hypothesis for spirituality, the age of the soldier is not as important as his or her level of spirituality. It is interesting to note that the larger number of high spirituality levels are found among the younger soldiers (42 versus 4).

Since this same group is represented in the high spirituality numbers, it suggests that the younger soldiers with higher spiritual levels positively affect the retention rate.

The secondary hypothesis with the variable for age suggested that the younger the soldier, the more likely they are to return to training. A full 49% of the soldiers who successfully rehabilitated were under the age of 20. Conclusively, the data supports the secondary hypothesis.

(See Table 14.)

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Table 14 Spirituality and Age (Crosstabulation)

Spirituality and age

Spirit

Total

<20

21 - 25

26 - 30

31 - 35

Total

Daily

26

16

2

2

46

Weekly

10

8

6

2

26

N/A

13

12

3

0

28

49

36

11

4

100

Education: The frequency of higher spiritual levels increases among the lower education grades. The number of high school or equivalent responses was 37 as compared to a total of 9 for all remaining levels (associates through post-graduate). This could also have been the cause for their high level of success in the training programs. Though no supportive causal relationship can be supported by this data, it does support the hypothesis regarding the positive effects of spirituality on retention.

The secondary hypothesis related to education levels stated that the higher the soldierâ&#x20AC;&#x2122;s educational level, the more likely that he/she will be returned to training. Of the 100 soldier surveys, 29% had an education level above the high school or equivalent level, while 71% had an education level equal to high school or equivalent. Based on these results, the larger percentage

Religious Preference and Spirituality 162 of successful trainees were at the lower educational level and does not support the original hypothesis. Additional data reflective of the overall percentage of soldiers with higher education levels would be needed in order to compare these numbers to the overall percentage (similar to the gender results above); however, that information is not available for this study. (See Table 15.)

Table 15 Spirituality and Education (Crosstabulation)

Spirituality and education High school Spirit

Total

Associateâ&#x20AC;&#x2122;s Bachelorâ&#x20AC;&#x2122;s degree degree

Masterâ&#x20AC;&#x2122;s Post-graduate degree degree

Total

Daily

37

6

1

1

1

46

Weekly

16

7

2

1

0

26

N/A

18

9

1

0

0

28

71

22

4

2

1

100

Marital Status: Of the total 46 soldiers indicating a high spiritual level, 29 were single, 11 were married, 5 were divorced, and 1 was listed as other. The single percentage represents 63% of the total. Since the significance of this data does not impact the results for the primary hypothesis (as the raw number does regardless of status), no causal relationship can be inferred from these results alone.

Religious Preference and Spirituality 163 The secondary hypothesis for the marital status variable stated that single soldiers will return to training in larger numbers than their married counterparts. The results overwhelmingly supported this hypothesis. Single soldiers successfully completed the training at a ratio of 3:1 over married soldiers (69% versus 23%). (See Table 16.)

Table 16 Spirituality and Marital Status (Crosstabulation)

Spirituality and marital status

Spirit

Total

Single

Married

Divorced

Other

Total

Daily

29

11

5

1

46

Weekly

21

4

1

0

26

N/A

19

8

0

1

28

69

23

6

2

100

Grade or Rank: The two lower grades (E-1 and E-2) overwhelmingly have the larger number of high spiritual levels (32 of 46 or 69%). This percentage is also represented in the secondary hypothesis. Consequently, the causal relationship is supported by the data.

The secondary hypothesis for grade (military rank) stated that the higher the soldierâ&#x20AC;&#x2122;s military rank, the more likely they are to return to training. When comparing the numbers for the two highest grades (E-3 and E-4) to the numbers for the two lower grades (E-1 and E-2), the

Religious Preference and Spirituality 164 lower grades had the highest number of successful soldiers (71 versus 29). Consequently, these results do not support the original hypothesis. (See Table 17.)

Table 17 Spirituality and Grade (Crosstabulation)

Spirituality and grade

Spirit

Total

E-1

E-2

E-3

E-4

Total

Daily

18

14

11

3

46

Weekly

13

9

4

0

26

N/A

10

7

9

2

28

41

30

24

5

100

When evaluating the data results in relationship to the second primary hypothesis and religious preference, the researcher found the following: Religious Preference and Component: The majority of soldiers replied affirmatively to the religious preference question; 72% answered yes. Clearly, the existence of a religious preference aided in the soldiersâ&#x20AC;&#x2122; successful completion of the program and consequently, could have contributed to the increased retention. Accordingly, the data supports the original hypothesis. (See Table 18.)

Religious Preference and Spirituality 165

Table 18 Religious Preference and Component (Crosstabulation)

Religious preference and component

Relpref

Total

Active Duty

Army National Guard

Army Reserves

Total

Yes

47

14

11

72

No

17

6

5

28

64

20

16

100

Religious Preference and Gender: When comparing the number of males to females, 51 of the total 72 yes replies came from female soldiers, while 21 came from male soldiers. The balance of 28 soldiers (6 males and 22 females) replied negatively. Based on the percentage of males and females (as discussed above), and contrary to the raw numbers, the overall percentage of males is higher than that of females. Because the primary hypothesis simply stated that the presence of these variables, along with a religious preference, can cause a decrease in the attrition rate, the large percentage of yes responses alone (72%) support the hypothesis, regardless of gender. (See Table 19.)

Religious Preference and Spirituality 166

Table 19 Religious Preference and Gender (Crosstabulation)

Religious preference and gender Males Relpref

Total

Females

Total

Yes

21

51

72

No

6

22

28

27

73

100

Religious preference and Race: Of the 72 positive replies, 36 came from White soldiers, 25 from Black soldiers, 3 each from Hispanic and Asian soldiers, and 5 from other soldiers.

Clearly, the largest number of positive replies came from White soldiers, but the largest number of negative replies also came from this same group and represented the largest pool of negative responses. Race does not appear to be a factor on its own, but the total numbers without regard to race support the original hypothesis. (See Table 20.)

Religious Preference and Spirituality 167

Table 20 Religious Preference and Race (Crosstabulation)

Religious preference and race

Relpref Yes No Total

White

Black

Hispanic

Asian

Other

Total

36

25

3

3

5

72

11

7

7

3

0

28

47

32

10

6

5

100

Religious Preference and Age: Clearly, the larger number of yes responses occurred in the lower age groups (60%). Though statistically significant, the numbers alone do not suggest a causal relationship. Collectively, the total positive responses constitute significance, but this data, separated by age, does not result in any meaningful significance. The total, as stated before, is significant and suggests a causal relationship relating positively to attrition. (See Table 21.)

Religious Preference and Spirituality 168

Table 21 Religious Preference and Age (Crosstabulation)

Religious preference and age

Relpref Yes No Total

<20

21 - 25

26 - 30

31 - 35

Total

36

24

8

4

72

13

12

3

0

28

49

36

11

4

100

Religious Preference and Education: Of the 72 positive responses, 64% resulted from those in the lower grades. This suggests that, contrary to the initial secondary hypothesis relating to education level, the large number of soldiers with lower education levels but who also had a religious preference identified made up the larger number of rehabilitated soldiers, and thus contributed the most to the reduced attrition rate. (See Table 22.)

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Table 22 Religious Preference and Education (Crosstabulation)

Religious preference and education High school Relpref Yes No Total

Associateâ&#x20AC;&#x2122;s Bachelorâ&#x20AC;&#x2122;s degree degree

Masterâ&#x20AC;&#x2122;s Post-graduate degree degree

Total

53

13

3

2

1

72

18

9

1

0

0

28

71

22

4

2

1

100

Religious Preference and Marital Status: The total number of married soldiers who answered positively to a religious preference outnumber the other three categories combined (50 versus 21). This supports the original hypothesis that single soldiers would return to training in larger numbers than the married soldiers. Consequently, it also supports the positive impact of the presence of a religious preference upon the attrition rate. (See Table 23.) Note: Although the single soldier represented the largest percentage of soldiers who did not have a religious preference, when the numbers for those with a religious preference (practicing both daily, 26, and weekly, 10) are combined, they also comprise the largest percentage of those possessing a level of spirituality.

Religious Preference and Spirituality 170

Table 23 Religious Preference and Marital Status (Crosstabulation)

Religious preference and marital status

Relpref Yes No Total

Single

Married

Divorced

Other

Total

50

15

6

1

72

19

8

0

1

28

69

23

6

2

100

Religious Preference and Grade: Of the 72 positive responses, 54 of them came from the two lowest grades (E-1 and E-2). This disputes the original hypothesis that would suggest that the higher grades would return in larger numbers. Instead this reflects the larger numbers among the lower grades. Based on their large numbers, they certainly impact the results in favor of reducing the attrition rate. (See Table 24.)

Religious Preference and Spirituality 171 Table 24 Religious Preference and Grade (Crosstabulation)

Religious preference and grade

Relpref Yes No Total

E-1

E-2

E-3

E-4

Total

31

23

15

3

72

10

7

9

2

28

41

30

24

5

100

Religious Preference and Spirituality: Looking at these results again with a focus on religious preference, 46 of the 72 positive responses practiced their religious preferences daily (high level of spirituality) and 26 practiced them weekly (low level of spirituality). Regardless of the level of spirituality, the numbers collectively support the original hypothesis that stated the presence of a religious preference would in fact reduce attrition. (See Table 25.)

Religious Preference and Spirituality 172

Table 25 Religious Preference and Spirituality (Crosstabulation)

Religious preference and spirituality

Relpref

Total

Daily

Weekly

N/A

Total

Yes

46

26

0

72

No

0

0

28

28

46

26

28

100

Other Descriptive Statistics As indicated by the contents of the results review thus far, most of our variables were categorical, analyzed best by using frequencies. Opposite of the categorical variables are the continuous variables. Here the researcher produced more descriptive statistics (mean, mode, median and standard deviation) on the three variables to which they would most effectively apply: Age, Grade, and Education Level. These analyses include parametric statistics such as the independent samples t test, analysis of variance, and nonparametric variables such as the chi square. Together, these results provide another angle from which to analyze this data. Though not as statistically significant and readily apparent as the frequencies, these results are consistent with the results from the frequencies and complement those findings. A summary of the data for the three aforementioned variables is in Table 26. (See Table 26.)

Religious Preference and Spirituality 173

Table 26 Descriptive Statistics equation is to compare information regarding Age, Education and Grade.

N

Minimum

Maximum

Mean

Std. deviation

Age

100

1

4

1.70

.823

Education

100

1

5

1.40

.752

Grade

100

1

4

1.93

.924

Valid N (listwise)

100

Looking first at age, and recalling the interpretation of the responses as reflected on the Code Sheet (See Table 9), the data shows that the response “1” (less than 20 years old) was the most common response. Quantitatively, that resulted in 49% of the total group falling into this category. The mean was 1.70 or those soldiers under the age of 25. The median is 2.0 or category 21–25. The standard deviation is .823 (less than 1.0) and suggests that the responses were not dispersed significantly away from the mean and that the researcher can have confidence in the results. The minimum and maximums correspond to the categories as well: “1” as the less than 20-year-olds, or the youngest, and “4” representing the 31–35-year-olds, or the older soldiers.

(See Table 27.)

Religious Preference and Spirituality 174

Table 27 Age (Descriptive)

N

Valid Missing

100 0

Mean

1.70

Median

2.00

Mode

1

Std. deviation

.823

Minimum

1

Maximum

4

For education, there were five ranges starting with “1” as high school and going up to “5” as post-graduate. Reflected below is a median of 1.00 (high school), a mode of 1 and a standard deviation of .752. The mean is 1.40 (between high school and associate’s degree); it includes the large numbers between the first two categories and the unusually small numbers at the higher end, both contribute to the skewness of this data. It can still be identified as meaningful though, as it contains a simple measure of the same data reflected in the frequencies and supports the conclusions drawn there. (See Table 28.)

Religious Preference and Spirituality 175

Table 28 Education (Descriptive)

N

Valid Missing

100 0

Mean

1.40

Median

1.00

Mode

1

Std. deviation

.752

Minimum

1

Maximum

5

The Grade variable also had five ranges in its responses, each reflective of the rank structure (1 for E-1, 2 for E-2, etc.). This data correlates with the coding of this variable on the code sheet and reflects minimum deviation from the mean. The researcher can have confidence in these results as well. (See Table 29.)

Religious Preference and Spirituality 176

Table 29 Grade (Descriptive)

N

Valid Missing

100 0

Mean

1.93

Median

2.00

Mode

1

Std. deviation

.924

Minimum

1

Maximum

4

Unlike the two previous variables, the marital status variable has its kurtosis and skewness calculated as part of the measures of central tendency. As discusses above, these each reflect the level of symmetry and peakedness and contribute to the confidence that the researcher can place in the data. In this case, with a kurtosis value greater than zero (2.935), this indicates that a large number of the responses were in the middle of the distribution. This could cause an underestimation of the variance since the sample size here is only 100, a small amount statistically. Similarly, with a standard error of kurtosis of .478, this suggests that the extreme responses (69 for single and 4 for other) also affected the results. (See Table 30.)

Religious Preference and Spirituality 177

Table 30 Marital Status (Descriptive)

N

Valid Missing

100 0

Mean

1.41

Median

1.00

Mode

1

Std. deviation Kurtosis Std. error of Kurtosis

.698 2.935 .478

Minimum

1

Maximum

4

For the t test, the researcher focused on spirituality from the male and female responses.

The results of the t tests revealed that the significance level was less than .05, indicating that the variances are not the same. Consequently, the second line of data should be used when recording the t test results. This line does not assume equal variances. Reading the second lineâ&#x20AC;&#x2122;s quantity under Sig. (2-tailed), it equates to .969, which is less than .05. It suggests that there is a statistically significant difference between the two groups on this variable. This is consistent with the data results using the frequencies. (See Table 31.)

Religious Preference and Spirituality 178 Table 31 Spirituality (T Test)

Leveneâ&#x20AC;&#x2122;s test for equality of variances

t test for equality of means 95% confidence interval of the difference

F Spirit Equal variances assumed 2.206

t

.141

-.037

98

.970

-.007

.191

-.387

.373

-.039

51.180

.969

-.007

.182

-.373

.359

Spirit Equal variances not assumed

Spirit

df

Sig. (2- Mean Std. error tailed) differencedifference Lower Upper

Sig

Gen

N

Mean

Std. deviation Std. error mean

Males

27

1.81

.786

.151

Females

73

1.82

.872

.102

Finally, to compare the data between two groups, focusing on the relationshipâ&#x20AC;&#x2122;s strength, the researcher looked at three variables: race, religious preference, and spirituality. A positive correlation would suggest that as one variable increases, the other variable would correspond

Religious Preference and Spirituality 179 accordingly. Because the correlations are all less than the significant level (0.01), this suggests no significant correlation between these variables. This is to be expected as each variable was reviewed in relationship to the two variables associated with the two primary hypotheses (religious preference and spirituality) and not necessarily in relationship to each other. Each of the variables associated with the secondary hypotheses was evaluated independently. The absence of this correlation does not indicate that there were no significance or collective impacts to the overall results, but suggests that these were evaluated more independently than collectively and further support the conclusion that this categorical data lends itself more easily to frequencies. (See Table 32.)

Religious Preference and Spirituality 180

Table 32 Correlations (Race, Religious Preference, and Spirituality)

Race Race

Pearson correlation

1

Sig. (2-tailed)

Relpref

Spirit

a

Relpref

Spirit

.096

.045

.344

.659

N

100

100

100

Pearson correlation

.096

1

.875a

Sig. (2-tailed)

.344

N

100

100

100

Pearson correlation

.045

.875a

1

Sig. (2-tailed)

.659

.000

N

100

100

.000

100

Correlation is significant at the 0.01 level (2-tailed).

To address whether the results of a particular variable are statistically supportable or whether the results occurred purely by chance, the researcher used results from the chi-square.

Since the frequency data was overwhelming for education level and religious preference, it would be assumed that these numbers would have equivalent representation when analyzed for their relationship to each other. From the results of the chi-square, the count and expected count

Religious Preference and Spirituality 181 for each category were very close in number. This suggested no real significant differences between these two. Additionally, when looking only at the rare numbers produced for the Pearson chi-square, the associated significance level is .0517, which is larger than the minimum significance level of .05. However, the note below the table states that this calculation does not have the adequate number of expected counts. Only 60% of the cells have the minimum value of 5 when 80% is required. Accordingly, no conclusions can be drawn from this data. None of the variables in this study will meet the requirements for the chi-square as depicted above. (See Table 33.)

Table 33 Chi Square (Religious Preference and Education)

Relpref Yes Education

No

Total

High school

Count 53 Expected count 51.1 % within educ 74.6% % within relpref73.6% % of total 53.0%

18 19.9 25.4% 64.3% 18.0%

71 71.0 100.0% 71.0% 71.0%

Associateâ&#x20AC;&#x2122;s degree

Count 13 Expected count 15.8 % within educ 59.1% % within relpref18.1% % of total 13.0%

9 6.2 40.9% 32.1% 9.0%

22 22.0 100.0% 22.0% 22.0%

Bachelorâ&#x20AC;&#x2122;s degree

Count 3 Expected count 2.9 % within educ 75.0%

1 1.1 25.0%

4 4.0 100.0%

Religious Preference and Spirituality 182

% within relpref 4.2% % of total 3.0%

3.6% 1.0%

4.0% 4.0%

Masterâ&#x20AC;&#x2122;s degree

Count 2 Expected count 1.4 % within educ 100.0% % within relpref 2.8% % of total 2.0%

0 .6 .0% .0% .0%

2 2.0 100.0% 2.0% 2.0%

Post-graduate degree

Count 1 Expected count .7 % within educ 100.0% % within relpref 1.4% % of total 1.0%

0 .3 .0% .0% .0%

1 1.0 100.0% 1.0% 1.0%

Count 72 28 Expected count 72.0 28.0 % within educ 72.0% 28.0% % within relpref100.0% 100.0% % of total 72.0% 28.0%

100 100.0 100.0% 100.0% 100.0%

Total

Chi-Square Tests

Value

df

Asymp. sig (2-sided)

Pearson Chi-square

3.250a

4

.517

Likelihood ratio

3.929

4

.416

Linear-by-linear association

.004

1

.953

N of Valid Cases

100

Note. 6 cells (60.0%) have expected count less than 5. The minimum expected count is .28.

Religious Preference and Spirituality 183

Summary of Findings To summarize the findings in this chapter, of the nine variables included in the analyses, and comparing the results as they relate to the two primary hypotheses and seven secondary hypotheses, seven of the nine original hypotheses were supportable by the data results, including both primary hypotheses. The two hypotheses that were not supportable were the education level and grade. In both, the researcher expected the higher levels to return to training in larger numbers than the lower levels. The opposite was reflected in the data results. The lower levels had higher representation among those who had successfully returned to training; thus the null hypothesis for each of these two variables is more supportable by the data. The null hypotheses suggest that the higher grades would not impact the results (or have more representation among the numbers succeeding). Based on the results, the null hypotheses are more supportable from the data.

Looking at the two primary hypotheses and five other secondary hypotheses being supportable by data, the majority of the data supports the original hypotheses and statistically supports the original hypotheses. Therefore, it is the conclusion of this study that the two primary hypotheses as stated are in fact proven with the studyâ&#x20AC;&#x2122;s data results. Additionally, seven of nine secondary hypotheses are also proven in the studyâ&#x20AC;&#x2122;s results.

CHAPTER 5: CONCLUSION Summary of the Dissertation This study originated out of a need to improve the Army’s retention and attrition rates at one of its largest training posts, Fort Jackson, South Carolina. After determining that a large number of these soldiers were being prematurely separated after sustaining physical injuries during the training, the study focused on a program that was designed to assist injured soldiers in their rehabilitation efforts, with the ultimate goal of returning them to training. This program incorporated spirituality and religion as part of the rehabilitative process. It was originally believed that incorporating these elements would assist the soldier mentally, physically, emotionally, and spiritually and that they would result in a larger number of soldiers successfully completing their training and going on to complete their obligation to serve in the active Army.

There were two primary hypotheses that emphatically stated that spirituality and the existence of a religious preference aided in the soldier’s recovery and rehabilitation, ultimately reducing the attrition rates and improving the retention rates. These two hypotheses specifically concerned with the Army’s retention and attrition rates predicted a causal relationship between spirituality (defined in this study as the frequency of the practice of a religious preference) and the existence of a religious preference. Because it was recognized from the initiation of the study that other variables could affect the soldier’s ability and willingness to rehabilitate, seven other demographic and military experience variables were added. The other seven secondary hypotheses addressed certain demographics (race, age, education level, marital status, and gender) and military experience (component and grade) and evaluated these in conjunction with the two primary hypotheses.

Religious Preference and Spirituality 185 The data collection involved a review of 100 records resident on the Army’s Computer Data Information System and represented the 100 cases from 2004 of successful completion of the rehabilitation program and successful return and completion of the initial-entry training.

Their data was entered into SPSS and used as a sample set for training injured soldiers Armywide. The two primary questions became the basis upon which all seven other variables were analyzed. The results were then analyzed using primarily frequency data, but also with other parametric and nonparametric statistics. The methodology employed included a causalcomparative analysis that is primarily quantitative by nature; however, the majority of the study’s variables were nominal (qualitative in nature). Therefore, the causal relationship could not be unequivocally supported. Inferences were made based on the results and the direction of those results, but the fully developed theoretical framework was not supportable.

The literature review focused on alternative forms of healing, primarily those associated with spirituality and religious preference. It highlighted the uniqueness of the training environment, and the similarities between soldiers’ and athletes’ injuries, to include the psychology of their rehabilitations. Additionally, it focused on the spiritual or religious part of psychotherapy, an aspect oftentimes overlooked when it comes to the basic premises of psychotherapy.

Implications This study has implications for the Army’s training program at Fort Jackson and for other similar military training activities as well. The results suggested that in order to improve retention and attrition among initial-entry soldiers, the Army must focus on more than the injuries themselves and the rehabilitation of them. To prevent a reoccurrence of the problem,

Religious Preference and Spirituality 186 they must create and enhance programs that offer opportunities to address and include the spiritual and psychological aspects of the injury and the person who has sustained the injury. As spiritual beings, humans have an immaterial portion of their being that, when neglected or ignored, can result in unresolved symptoms. Solutions focused solely on the symptoms alone can not adequately address the entire need. Wholistic rehabilitation containing some aspects that address the spiritual part of man appears to be more effective in the treatment of these injuries.

The results of this study can serve as a foundation for other training programs. If the contents of the study are to be seriously considered, additional research is needed. That research should consider the limitations and challenges listed in this study.

Contributions Despite its challenges and limitations, this study made three major contributions. First, it was the first of its kind conducted at an Army training facility with a focus beyond physical rehabilitation. Although the training environment has always included a chapel service and access to an Army chaplain, the dimension of spirituality and religious preference, as defined in this study, has never been the focus of a study with the aim of suggesting significant contributions to the overall success of the training. From this point, it opens the door for religious programming Army-wide to reconsider its overall contribution to the total success of any program and not to remain as just another program. If the results are consistent with other studies, programs could be developed to incorporate the spiritual and religious elements in anticipation of positive effects. The study gave Army leadership another angle by which to gauge its own success.

Religious Preference and Spirituality 187 Secondly, it established a close connection between the rehabilitation process for athletes and that for Army soldiers. Including both the nature of the injury itself and rehabilitation processes that have accomplished quick results, this study reflected the similarities in the psychology of recovery and healing. The literature review alone supported the existence of similarities between the injuries and the rehabilitation processes for both the soldier and the athlete and suggested that both could benefit from a spiritual dimension as well. With additional supporting data as discussed above, it could be used to establish joint ventures between local athletic and sports medicine organizations and military units conducting this type of training. To the researcherâ&#x20AC;&#x2122;s knowledge, there is no other military study of this nature in any other location.

This one could open the door to several other collective options, once the results are explored further and analyzed more closely for these types of organizations.

Lastly, it defined a relationship between spirituality and psychotherapy and its effective use in similar military settings. The study accepted psychotherapy as an effective form of rehabilitation, but went on to highlight that its effectiveness is tied to the spiritual or religious dimension as well, an aspect of psychotherapy that is often overlooked. This study not only included that aspect, but went on to suggest that it was a key to the soldierâ&#x20AC;&#x2122;s ultimate recovery and return to training. Its value will be multiplied as other studies consider its merits and embark upon similar studies at their own locations.

Recommendations If a study of this nature is attempted in the future, the researcher should attempt to collect data over a longer period of time and from other training units. As mentioned before, this study was limited to the data from the 120th Battalion at Fort Jackson for the year of 2004 only.

Religious Preference and Spirituality 188 Although Fort Jackson is the largest training post in the Army, it is not the only one. Specific characteristics of its location, the longevity of its staff members, and other characteristics could have played a huge role in the results. Without any data by which to compare it, it is impossible to conclude the sample size is representative of the whole.

Collecting data over a longer period of time would have allowed for comparisons between training classes and identification of any trends or abnormalities associated with the class in the study. For example, this class had a high number of female recruits (approximately 60%). Without statistics from other classes, it is impossible to determine whether this high number was consistent or an abnormality. This recommendation carries more impact as service lines are crossed (Air Force, Navy, Marines, Coast Guard, etc.) Additionally, collecting data over time would have given the study more validity.

Further, the researcher recommends that a similar study include more quantifiable variables. One concern with the variables is that many of them were more qualitative than quantitative, as required in a strong causal relationship; however, the two primary variables were quantitative. As a result, the researcher used these quantitative variables more consistently with all of the other variables. Each variable was then compared based on its relationship to the two primary variables. According to the conditions for a valid causal relationship (covariance, spuriousness, logical time order, and a theory), when these are evaluated, some variables will have stronger correlations, meaning a more clear-cut causal relationship exists. While other variables may make lesser contributions, they are still considered causal at a lesser degree, but causal nonetheless. The inclusion of more qualitative variables would eliminate this concern and make the causal relationship stronger.

Religious Preference and Spirituality 189 Finally, the researcher recommends that any future study consider conducting personal interviews as opposed to a records review. Conducting interviews with subjects provides the opportunity to follow up on questions and gain more information for analysis. This study was limited in that it only included a records review of existing data.

Future Research Any future study of this nature should consider the challenges listed above, as well as the limitations listed in Chapter 1, and solicit more quantifiable data upon which to conclude.

Based on the limitations of this study, any effort by personnel to incorporate the results found here into an actual program should first involve conducting an additional study of this nature in their own training environment. The additional study should make attempts to address the limitations identified here, as well as develop a theoretical basis more prone to a clear causal relationship. Additional variables and more detailed data are needed in order to establish a causal basis and to address the many other variables that could impact the retention and attrition rates.

Additionally, any future research should include a longitudinal aspect and incorporate data from several years before drawing conclusions from the results, and should also include a larger sample size as well.

Final Summary The study’s focus on the Army’s declining retention rate and increasing attrition rate was unique in that historically, most of the suggestions to improve these statistics have been standard management techniques. Increasing the budget to pay a higher enlistment bonus or allowance, granting soldiers a “choice” of specialties, extending or shortening enlistment, free education, or other benefits have all been used in the past to address this problem. From time to time, they

Religious Preference and Spirituality 190 have all been effective; however, none of them have totally eliminated the peaks and valleys in the Armyâ&#x20AC;&#x2122;s end strength numbers. Maybe there is something more enduring that could permanently change this fluctuating pattern. For injured soldiers, who make up the large majority of this statistic, all enter the Army anticipating that they will complete training and go on to serve on active duty. But something interrupts their plans. It is at this moment that they are in need of something more than the usual rehabilitation program. This study suggests that spirituality and the presence of a religious preference in the rehabilitation process may aid in the retention and attrition rates.

A review of the hypotheses reflects that the data supported seven of the nine original hypotheses affirmatively: (a) A high level of spirituality combined with the impacts of other variables, affects an increase in retention; (Supportable), (b) The existence of a religious preference combined with the impacts of other variables can cause a decrease in the attrition rate; (Supportable), (c) Active duty soldiers will return to training in larger numbers than those assigned to the Army National Guard and Army Reserve; (Supportable), (d) Male soldiers will return to training in larger numbers than female soldiers; (Supportable), (e) The younger the soldiers are, the more likely they will be rehabilitated and returned to training; (Supportable), (f) White soldiers return to training in larger numbers than soldiers of other ethnic groups; (Supportable), (g) The higher the soldierâ&#x20AC;&#x2122;s educational level, the more likely that he/she will be rehabilitated and returned to training; (Unsupportable), (h) Single soldiers will return to training in larger numbers than their married counterparts; (Supportable), and (i) The higher a soldierâ&#x20AC;&#x2122;s military rank, the more likely he/she will be rehabilitated and returned to training, (Unsupportable).

Religious Preference and Spirituality 191 While an unquestionable causal relationship can not be concluded upon from this data, a causal effect exists in that the two primary hypotheses originally suggested that the presence of other variables could combine impacts and influence the results of the causal relationship. In five of the seven demographics, this relationship is evident. Only the two nonsupportable variables do not reflect this trend. Because of the large number of nominal variables, the causal relationship can be questioned.

Several limitations were applicable to the study. First, the causal relationship that required a clearly supportable statistical basis proven best with quantitative statistics relied solely upon qualitative statistics in this study. These statistics and the limited scope of data which they provide did not allow for ruling out any alternative solutions. As a result, the causal relationship was inferred using qualitative data, making the inference of a causal relationship of any degree to be based solely on this limited qualitative data.

The data in this study was limited to responses on the nine variables, which were initially understood not to include all of the potential causes. Other variables certainly could have affected the results, but there was no data collected on these variables. Additionally, none of the variables included the more extensive data relating to how soon or when (at what point) did the soldier return to training. It simply answered the question of whether or not he returned to training. Knowing how long the process took from one soldier to another could have yielded more quantifiable data related to the extent of the injury and the amount of time in rehabilitation.

In the absence of this and other related data, the conclusions drawn must be viewed from this extremely limited perspective.

Religious Preference and Spirituality 192 As a condition of gaining approval for the study, the records were limited to the 2004 year group. There was no historical data on any prior years to which to compare these results.

Since the results are recommended for the Armyâ&#x20AC;&#x2122;s consideration in future training programs, it would have been helpful to be able to compare this particular year to previous years and then perhaps establish a baseline. Without the historical data, the researcher was unable to indicate if the data from this particular year group was representative of the previous years, or whether they were higher or lower than previous years. Accepting this data as representative without that historical comparison is an assumption, and as such, requires an assessment of the risk associated with that assumption.

As discussed before, the statistics were primarily qualitative (nominal) and not quantitative (ordinal) as required for the causal analysis. This data did not lend itself to more sophisticated statistics and could not independently conclude on a causal relationship. Inferences made from this data should be viewed as those based on qualitative data and therefore not strictly and emphatically causal in nature.

Finally, the study included only nine variables when there clearly were many more that could have and did contribute to the soldierâ&#x20AC;&#x2122;s success or failure in the program. Although these nine questions correlated with the original hypothesis, they were limited in scope and produced only qualitative results for a small pool of potential causes. In reality, there were numerous other variables that affected the results.

In spite of the challenges listed above as well as the limitations listed in Chapter 1 (limited variables, probable forecasts, limited population, limited definitions, causal relationships, theoretical model, Army leadership impacts, generalizations, restricted questions,

Religious Preference and Spirituality 193 and statistical equations and techniques), and particularly the limited theoretical basis for a causal-comparative analysis, the study overwhelmingly concludes affirmatively on the two primary hypotheses and seven of the nine secondary hypotheses. From this standpoint, it has validity and its conclusions should be considered in the development of future programs. The presence of a spiritual component and the existence of a religious preference were both present in high percentages among the successful trainees for that year. Though more research is still required in order to conclusively support the causal relationship, there is ample support for the positive contention of religious preference and spirituality overall. It is apparent that these variables impacted the results and ultimately contributed to the Armyâ&#x20AC;&#x2122;s reduced attrition rate and improved retention rate among initial-entry soldiers.

The variety among the demographic variables provided a wider range from which to gauge the causal relationship. With both religious preference and spirituality being compared to the other seven variables, the records reflected a consistent pattern of impacts on the total training experience. Whether it was gender, race, or education level, a large percentage of trainees consistently indicated that their religious preference and the practice of it (spirituality) aided in their recovery and return to training. This has wide application as it was approached from a nontraditional standpoint. Healing and rehabilitation can have mental and spiritual effects.

The Army training environment offers its own unique nuances, complete with the boasting of physical prowess and competition. The emphasis on physical performance and the stigma associated with injuries can make the challenge of rehabilitating and returning to training that much more difficult. To add the need for a spiritual or religious aspect can be viewed by some as weakness. Even in spite of these circumstances, overwhelmingly, the soldiers indicated that their

Religious Preference and Spirituality 194 high level of spirituality assisted them in their efforts to rehabilitate. That alone suggests that more comprehensive research should be accomplished, which perhaps looks into that social and psychological, and yes, spiritual, aspect of rehabilitation.

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APPENDIX A Basic Frequency of the Variables Table A1 Component (Frequency)

Component Valid

Frequency

Percent

Active duty

64

64.0

64.0

64.0

Army National Guard

20

20.0

20.0

84.0

Army Reserves

16

16.0

16.0

100.00

100

100.0

100.0

Total

Valid Percent

Cumulative Percent

Religious Preference and Spirituality 242 Table A2 Gender (Frequency)

Gender Valid

Frequency

Percent

Male

27

27.0

27.0

27.0

Female

73

73.0

73.0

100.0

100

100.0

100.0

Total

Valid Percent

Cumulative Percent

Table A3 Race (Frequency)

Race Valid

Valid Percent

Cumulative Percent

Frequency

Percent

White

47

47.0

47.0

47.0

Black

32

32.0

32.0

79.0

Hispanic

10

10.0

10.0

89.0

Asian

6

6.0

6.0

95.0

Other

5

5.0

5.0

100.0

Total

100

100.0

100.0

Religious Preference and Spirituality 243

Table A4 Age (Frequency)

Age Valid

Percent

<20

49

49.0

49.0

49.0

21 â&#x20AC;&#x201C; 25

36

36.0

36.0

85.0

26 â&#x20AC;&#x201C; 30

11

11.0

11.0

96.0

31 - 35

4

4.0

4.0

100.0

100

100.0

100.0

Total Statistics N

Valid Missing

100 0

Mean

1.70

Median

2.00

Mode Std. deviation

1 .823

Minimum

1

Maximum

4

Valid Percent

Cumulative Percent

Frequency

Religious Preference and Spirituality 244 Table A5 Education (Frequency)

Education

Valid

Frequency

71.0

71.0

71.0

Associate’s degree

22

22.0

22.0

93.0

Bachelor’s degree

4

4.0

4.0

97.0

Master’s degree

2

2.0

2.0

99.0

Post-graduate degree

1

1.0

1.0

100.0

100

100.0

100.0

Valid Missing

100 0

Mean

1.40

Median

1.00

Std. deviation

Cumulative Percent

71

Statistics

Mode

Valid Percent

High school

Total

N

Percent

1 .752

Minimum

1

Maximum

5

Religious Preference and Spirituality 245 Table A6 Marital Status (Frequency)

Marital status Valid

Frequency

Valid Percent

Cumulative Percent

Single

69

69.0

69.0

69.0

Married

23

23.0

23.0

92.0

Divorced

6

6.0

6.0

98.0

Other

2

2.0

2.0

100.00

Total

100

100.0

100.0

Statistics N

Percent

Valid Missing

100 0

Mean

1.41

Median

1.00

Mode Std. deviation Kurtosis Std. error of Kurtosis

1 .698 2.935 .478

Minimum

1

Maximum

4

Religious Preference and Spirituality 246 Table A7 Grade (Frequency)

Grade Valid

Frequency

Percent

E1

41

41.0

41.0

41.0

E2

30

30.0

30.0

71.0

E3

24

24.0

24.0

95.0

E4

5

5.0

5.0

100.0

100

100.0

100.0

Total Statistics N

Valid Missing

100 0

Mean

1.93

Median

2.00

Mode Std. deviation

1 .924

Minimum

1

Maximum

4

Valid Percent

Cumulative Percent

Religious Preference and Spirituality 247