Date of Award


Document Type


Degree Name


Organizational Unit

Joint Ph.D. Program in Study of Religion

First Advisor

Carrie Doehring, Ph.D.

Second Advisor

Frank Seeburger

Third Advisor

Deborah Creamer


Autoimmune disease, Disenfranchised loss, Intercultural care, Meaning making, Spiritual direction, Theology


Rheumatoid arthritis (RA), multiple sclerosis (MS), and systemic lupus erythematosus (lupus) are incurable autoimmune diseases affecting a growing number of people in the U.S. Women typically receive medical care for the physical effects of these diseases, but psychospiritual dimensions of illness experiences are often neglected. Common autoimmune illness experiences include delayed diagnosis; chronic pain, fatigue, depression; and liminality (being neither healthy nor sick). Women with RA, MS, and lupus also experience ongoing losses (which may be disenfranchised), such as losses of identity, relationships, self-agency, and spiritual beliefs and practices. As a result of ongoing experiences of suffering and loss, women can "get stuck" in spiritual struggles that negatively affect her overall health and well-being. Provisional theological claims about the psychospiritual needs of women with RA, MS, and lupus assert that they would benefit from ongoing (over the course of years) acknowledgment of losses and complex, contextual theological meaning making, tested through coping strategies and spiritual practices that help them establish and/or sustain well-integrated spiritualities and life-enhancing relationships with God/the transcendent (a naming convention that reflects diverse spiritualities and spiritual direction practices). Evaluation of medical, psychological, and pastoral caregiving approaches finds contemporary intercultural spiritual direction, grounded in the Christian tradition, to be an optimal context for long-term care that addresses these needs. A model of spiritual direction for women with autoimmune disorders calls for (1) spiritual directors informed by women's experiences of autoimmune disease and prepared to balance a woman's need to engage in transformative spiritual struggle with the risks posed by getting stuck in chronic struggles, (2) an intercultural and feminist approach that privileges women's experiences and understandings of illness and God/the transcendent, (3) ongoing complex and contextual theological meaning making through narrative and ritual practices that address the shifting perspectives of chronic illness (recurrent vacillation between illness-in-the-foreground and wellness-in-the-foreground), (4) attention to coping strategies and spiritual practices that enact life-enhancing understandings of illness and God/the transcendent, and (5) co-construction and performance of rituals that acknowledge losses and facilitate transitions between illness-in-the-foreground and wellness-in-the-foreground perspectives. This model of spiritual direction can be used in one-on-one or group settings.

Publication Statement

Copyright is held by the author. User is responsible for all copyright compliance.

Rights Holder

Kelly Renee Arora


Received from ProQuest

File Format




File Size

229 p.


Spirituality, Psychology, Alternative medicine