During one of my recent calls to a patient I have, Louise*, she quite literally began our conversation with, “you know Sam, I don’t think God loves me anymore.”

This was a rather remarkable statement and took me by surprise at the time. Louise and her husband live in an assisted living community in a local suburb. Both are strong Catholics and maintain a daily spiritual practice that is almost monastic in some ways. They both get up early to read their devotions together, pray and sing hymns. Throughout the day they will stop and pray together as well. She also is an avid reader of Christian literature from Protestant as well as Catholic traditions. She is tremendously warm and open, however she’s declined visits for now as she finds that her cancer wears her down so quickly that phone calls are more welcome than visits.

When Louise told me how she felt, I wasn’t so much taken aback as I was curious. I asked her to tell me more. Very matter-of-factly she told me of how much she had struggled with pain over the winter. Many days she was either in too much pain or physically sick to get out of bed. Several times I was only able to talk with her husband as she was too ill to talk. It was on the heels of a long episode of significant illness and pain that she told me that she wasn’t sure if God loved her.

We often think of faith as a kind of shield in difficult times, absorbing the arrows of the world’s distress and our own weakness. Yet I find that it’s not those with the weakest faith that struggle most with death and suffering, but those with the strongest. Dr Ken Pargament recently spoke at a CPSP regional conference I organized on the topic of working with those in spiritual struggles, taken from a recent publication (which I highly recommend). He stated that faith and spirituality can act as sort of an inoculation against some spiritual struggles and challenges, but that same faith can be beaten down and even shattered by others. The differences he found between cases was not a matter of magnitude, but rather in focus. Spiritual distress affects those with broad, liberal views of God as well as those with narrow, conservative ones. He found that when core personal beliefs about the world as well as how one relates to it are threatened, spiritual distress is heightened. Paradoxically, this happens more in those who may consider themselves strong in their faith as well as those who consider themselves agnostic.

Spiritual struggles are not just questions about God or one’s own faith. They are foundational challenges to core concepts about the world, how it operates and how one relates to it. Pargament calls this one’s “orienting system”. It encompasses more than the idea of “world view”, as it includes one’s notions of ultimate purpose and meaning. While religious systems and beliefs often are the source for orienting systems, non-theists also have orienting systems that are grounded with similar senses of ultimate importance and significance. Astronomer Carl Sagan for example approached the cosmos with a sense of awe and wonder that many would consider spiritual:

“The Cosmos is all that is or was or ever will be. Our feeblest contemplations of the Cosmos stir us — there is a tingling in the spine, a catch in the voice, a faint sensation, as if a distant memory, of falling from a height. We know we are approaching the greatest of mysteries.”

Carl Sagan, Cosmos

What Louise was experiencing was a dramatic blow to her orienting system. Her “north star”, the idea that God was good and loved her unconditionally, had been shaken by her ongoing illness and the feeling that her prayers were going unheard. She felt abandoned in her time of greatest need. Her pain – emotional, spiritual and physical – called other patients’ stories back to mind. I remembered the patient I had years ago who proclaimed with a feeling that was almost joy that she was ready to die and be with her Jesus, only to ask months later as her body withered and bled from cancer why God hadn’t taken her. I remembered the woman I had just seen who, confined to her bed, wonders every day through tears what God’s purpose is for her.

These same stories and struggles also take me back years to another patient I had who dealt with her own struggle of faith. Grace* was bed-bound, frail and emaciated, blind and almost deaf. Yet she transformed this suffering into purpose in the most wonderful way. She saw that even though physically she was completely dependent on others for care and could do almost nothing for herself, she could pray for others. She turned this into a calling. She told me she began to pray for the staff that would come in to see her and care for her. Soon, the facility staff as well as other residents started coming to her room to receive prayer. In my visits with her, after we prayed together, she always prayed for me with joy and enthusiasm. It was hard not to leave her room feeling in some way touched by God.

Grace’s story is one that I share often with patients who are struggling not because she is some pillar of strength or faith, but because it shows how one person dealt with the questions they themselves might be asking: what is my purpose? what can I do? where is God in my suffering? It encourages fellow sufferers to continue to press on with those questions rather than fall into a pit of despair. When one’s spiritual compass is no longer trustworthy, I ask “what gives you hope?”

I’ve spoken with Louise several times since that call I spoke of previously and thankfully she is feeling quite a bit better since then. She noted several reasons for this. Her pain and weakness, while still significant, are better controlled and managed than before. The celebration of Easter helped renew the sense that, as Christ overcame suffering and death, she may overcome it as well. She even commented, “you know, I don’t think about the resurrection enough!” I also see a renewed sense of hope for the future, something which had been shattered before by her spiritual struggles. Last we talked, she spoke of looking forward to her husband’s birthday and their anniversary, and also being outside with her beloved plants and nature. She told me about the white squirrel that shows up outside from time to time, as well as the many birds outside their patio home. She told me how much she looked forward to seeing the trees lit up by fireflies on summer nights “like pixie lights on Christmas trees.”

It can be tempting to give my own prescription for meaning in someone else’s life. It’s so hard to watch someone struggle spiritually and it’s hard not to try and take that pain away. Recognizing and affirming that struggle though is one of the most important things we can do for our fellow sufferers. Many feel the struggle itself is a problem, maybe the problem. However spiritual struggles are often simply part of the cost of having faith, whatever that faith may be in. We can help by pointing out strengths, including that the struggle itself is a sign of strength. We can focus attention on what one can do rather than what one can’t do. We can listen and bear witness, lending strength through the telling of our own struggles as well as those of others who came out on the other end of them, not in the sense of “go and do likewise” but to give hope that struggles are common and can be worked through.

In the same way that Grace’s story has helped others many years after her passing, I hope Louise’s can provide hope and healing as well.

*all names have been changed to preserve anonymity