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CWRU study examines family struggles with anger and forgiveness when relative is dying

Watching a loved one die tests some family members' relationships with God or the higher being of one's faith. And the spiritual anger and resentment grow with the level of pain and suffering their family member endures, according to researchers at Case Western Reserve University.

Psychologist Julie Exline and palliative care advanced practice nurse Maryjo Prince-Paul surveyed 147 family members with a hospice patient under home care.

More than four of every 10 respondents reported at least some level of anger with God, a major source of which was watching a loved one suffering great pain. Resentment was strongest among family members of cancer patients and weakest among family members of heart disease patients.

A family member's level of spirituality was also a factor. The less religious or spiritual family members said they were, the more anger they reported toward God. Family members also reported more anger toward God if they could not see any deeper meaning in the suffering that the patient and family were experiencing.

Exline, associate professor of psychological sciences in the College of Arts and Sciences, and Maryjo Prince-Paul, assistant professor at the Frances Payne Bolton School of Nursing at Case Western Reserve and research scientist at Hospice of the Western Reserve, published their findings in the current Journal of Palliative Medicine article, "The Spiritual Struggle of Anger Toward God: A Study with Family Members of Hospice Patients."

A related study by the researchers in a recent Journal of Palliative Medicine article (volume 15, issue 10, 2012), "Forgiveness, Depressive Symptoms, and Communication at the End of Life: A Study with Family Members of Hospice Patients," explored the importance of forgiveness-related communications between hospice patients and family members. Many family members reported that they saw seeking and granting forgiveness as very important in their relationships with loved ones who were dying.

The forgiveness study showed that if family members saw forgiveness issues as important but had not completed the process, these unresolved conflicts were linked with greater depressive symptoms. Building on these findings, the new study showed that anger toward God was also linked with higher levels of depressive symptoms among family members.

Respondents in the new study were asked about which coping strategies they would prefer if they were feeling angry toward God. The most popular strategy was prayer. Other common strategies included reading sacred texts, handling feelings on their own and discussions with friends, family, clergy or hospice team members. Self-help resources and therapies were less popular, respondents said.

Exline concludes that finding ways to overcome anger with Godand being able to seek and grant forgiveness in relationships with family members can be important for both families and patients in the dying process.

"People have difficulties when they struggle to find meaning in their lives during stressful events," explains Exline. "If people feel guilty about mistakes they have made, or if they feel alienated from God or a family member, these issues can make it more difficult for them to cope." Such issues may loom especially large in end-of-life contexts, when repair of close relationships can take on great importance.

In the forgiveness study, family members wrote about the significance of expressing love and gratitude, but also felt that clearing up unresolved issues was important before the patient died.

These two articles continue Exline's research on the many anger-related issues that people can experience when they are facing stressful life events. The research also adds to understanding of the many emotional, social and spiritual strains faced by family members of dying patients.


Contact: Susan Griffith
Case Western Reserve University

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