Watching a loved one die tests some family members’ relationships with God. This spiritual anger and resentment increases 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, primarily caused by having to watch 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 also was 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 Prince-Paul, assistant professor at the Frances Payne Bolton School of Nursing 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, titled “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. In the 2012 study, many family members reported they saw seeking and granting forgiveness as very important in their relationships with loved ones who were dying.

The 2012 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 also was 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 God—and 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,” Exline explained. “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 face stressful life events. The research also adds to understanding of the many emotional, social and spiritual strains faced by family members of dying patients.

Staff members of the Hospice of the Western Reserve in Cleveland were instrumental in the conduct of the study and also contributed to the article. The Fetzer Institute funded the research.

  • Dan

    Yes, I would say that believing in God is un-heathy and causes and anger resentment.

    • Alex


      Except the article clearly states that the least religious had the most anger towards God. Way to show that reading comprehension.

  • Lisa

    Interesting concepts, however I think that the article is a little unclear, as evidenced by the above comment. It seems that the study found that unresolved conflicts give rise to lingering anger and resentment on the death of a loved one, and that belief in God can be a factor in resolving a sense of conflict through forgiveness. However, that is my *interpretation* of the article, and my interpretation is colored by my own beliefs.

    • Eileen

      To the first response: Then if they stop believing in the relatives they feel alienated form, they also will be more healthy?

  • carolyn

    Uncomplicated anid complicated grief are interesting topics to study. By understanding the differences between survivors we may gain a deeper level of insight on how to help the grieving family.

  • Greg class of “77”

    I think the distinction is made quite clear, the mitigating variable was the family members “level of spirituality”. “Baby Christians” new to God’s word are fed milk as sustenance (the basics of Bible knowledge). As one begins to grow in Christ, more faith, trust, knowledge, understanding, and ultimately spiritual wisdom is garnered.The “baby Christian” can now feast on the spiritual meat(or more hearty/vigorous) principles of the Bible. If I have just accepted Christ, one might not expect me to be as spiritually mature as one who has been saved for a significantly longer amount of time. Certainly there are always exceptions to the rules where a new Christian might posses an awesome burning desire for comprehension of things of God and for service to his people and who might take a death much better than a more mature Christian who has been long in the Lord, but who is now inactive in Christian service.

  • Greg class of 77

    i do not see my comment posted

    • thedaily

      Sorry, Greg! We moderate comments so sometimes it takes a little time for them to he reviewed. It appears now!