Profiles of Resilience: Interviews with Atheistic Spinal Cord Injury Survivors

Karen Hwang

It has long been accepted as an article of faith that religion/spirituality (hereafter “R/S”) has a beneficial effect on both physical and mental health. Popular U.S. survey data appears to indicate a positive association between R/S and various indices of mental and physical well-being. However, this research is not without methodological controversies. Primary among them is a lack of agreement among researchers regarding how best to define and measure such nebulous terms as religion and spirituality; without universally standardized definitions, we can only investigate thoughts and behaviors such as frequency of church attendance or experiences of prayer or meditation that we typically think of as associated with R/S.

However, there may be no reason that qualities typically characterized as “spiritual“ need to fall exclusively within the experience of R/S individuals or that affirmatively non-spiritual (that is, secular) persons are incapable of experiencing “deep and meaningful connections” or “a feeling of inner peace,” to name just two of the items often encountered in many R/S measures. Secularists may also hold different interpretations of items related to meaning or purpose in life, or they may dispute the need for a meaning or purpose at all. Moreover, studies comparing health and well-being in persons reporting high to low R/S are based on the assumption that lower spirituality must translate to higher secularity. Therefore, they fail to differentiate between affirmative secularists and people whose beliefs are vague or conflicted. The few studies that do examine differences within nonreligious participant samples have found no differences between strong believers and committed atheists in measures of neuroticism, emotional disturbance, or other psychological risk factors (for more on this, see Hunsberger, Pratt, and Pancer 2001).

Few things might threaten an individual’s health and well-being as severely as a permanent and significant disability. Religious individuals who become disabled may find comfort in their beliefs. They may see their experience as a sign from God or an opportunity to turn their lives around. They may also find peace in personal prayer or religious rituals or receive social support from their churches. On the other hand, they may be at risk for anger or depression if they feel that their deity is punishing or abandoning them. Religious responses to disability have been the focus of many empirical investigations published in clinical literature. However, there has been virtually no systematic research into the ways that atheistic individuals adjust to traumatic disability.

Spinal Cord Injuries

Specifically, this project focused on individuals who had suffered traumatic spinal cord injuries. According to the National Spinal Cord Injury Database, spinal cord injury (SCI) affects approximately 11,000 new individuals each year, mostly young people, as a result of such diverse causes as motor vehicle accidents, sports injuries, violence, and falls. Fifty-five percent of SCIs occur among persons in the 16- to 30-year age group, and the average age at injury is 32.1 years. The number of SCI survivors in the United States today has been estimated to be between 183,000 and 230,000. The great majority of SCI survivors (about 80 percent) are male. Considering the youthful age of most persons with SCI, it is perhaps not surprising that most (53.4 percent) are single when injured. Among those who were married at the time of injury, as well as those who marry after injury, the likelihood of their marriage remaining intact is slightly lower when compared to the uninjured population. The likelihood of getting married after injury is also reduced.

The Study

In a 2008 study published in SCI Psychosocial Process, we contacted twenty SCI survivors who described themselves as nontheists and invited them to complete a series of semi-structured interviews by e-mail. The format of the study was chosen for two reasons: first, because the relative scarcity of eligible participants would present difficulty recruiting for a large-scale quantitative study; and second, because the use of open-ended questions would allow respondents to express themselves in greater depth. The interview covered three major areas:

  • development of secular identity (At what age did participants first reject religious belief? How did early experiences affect their development as secular individuals?);
  • impact of secularity on adjustment to SCI; and
  • meaning, purpose, and spirituality.

Participants were volunteers recruited from a general notice posted on online SCI-community message boards. After providing informed consent, participants received a detailed project description along with the survey questions, as well as an additional questionnaire seeking injury and demographic data.


Self-assessment of secularity. Unfortunately, there are no standardized assessment measures focused specifically on atheism or secularism. Therefore, secularity was assessed by presenting participants with three statements about the existence of God and asking them to select the one that best corresponded to their personal philosophy. The three choices were:

  • “I see convincing evidence that god does not exist.” (strong atheist)
  • “I do not find convincing evidence that god exists.” (weak atheist)
  • “The existence of gods is an impossible question to answer.” (agnostic).

An “atheist” was defined as one who does not believe in a god due to the lack of evidence. A “strong atheist” was defined as one who claims a positive assertion that God does not exist. An “agnostic” was defined as one who claims that there is no knowledge of a god and there never will be. (The definitions were developed by George H. Smith.)

Participant responses were organized into separate, discrete domains conforming to the format of the original survey: history and development of atheistic identity; the impact of SCI on atheism, including any changes in spiritual beliefs; and questions related to meaning and spirituality. Common themes were defined as responses reported by at least three participants.


Of the twenty individuals who responded to the initial advertisement, fifteen (eight men and seven women) completed the entire interview. Their ages ranged from 20 to 62 years old, with a mean age of 40.3 years. Ten of the participants identified themselves as students; seven were employed; one was a homemaker; another was seeking work. The rest were either retired or not actively seeking work, perhaps due to complications from their disability. Occupationally, these figures are largely reflective of statistics within the entire SCI population. Educationally, all but three had at least some college.

Self-assessment of secularity. Seven individuals (out of the fifteen) identified themselves as “strongly atheistic” and three were “weakly atheistic.” The remaining five were “agnostic.” Intercorrelations revealed that the men were more likely to be strongly atheistic (six out of eight men), while the women were more likely to be weakly atheistic (n = 2) or agnostic (n = 4).

Most of the interviewees had consciously embraced secularism sometime in their adolescent years. The most common factors associated with active apostasy were an increased interest in science and an exposure to other religions, which then triggered a critical reexamination of existing faith and the eventual shedding of theistic beliefs. Other contributing factors associated with atheist/agnostic identification were support from significant others (most commonly parents or teachers) and a sense of increasing disconnection between religious teachings and the behavior of their adherents:

I don’t really know exactly at what age this started. I would guess probably around junior high school. Science class was more detailed than grade school and I had an atheist as a teacher for one of those classes. Though the teacher didn’t go into any atheist vs. god debates they did offer scientific explanations for different events. Being the son of a minister in the Nazarene church I would take their explanations in class and ask my father about them. Instead of flat out denial of the scientific explanation he would simply state “well that is how god did it.” Though I didn’t completely convert to atheism it did start me down that path.

—Roger, age 33

I was raised Catholic but rarely attended Church. My parents were non-practicing Catholics. Although my siblings went to private Catholic schools, I did not. I grew up in a diverse town with all denominations. I attended Temple more than Church with my closest friend and through Bar and Bat Mitzvahs. I remember distinctly discussing religion with some friends when I was around 13–14 and one newer friend told us she and her parents did not believe in a “God” and that they were Atheist. This surprised me but intrigued me because I had never met anyone who believed so. From then on I questioned the belief of a “God,” was very interested in Mythology, teetered between being an Agnostic and Atheist.

—Marilyn, age 38

When I was between 3rd and 4th grade I was attending Baptist Bible summer camp and I realize that I disagreed with the fundamental reason for believing in God—that I was born sinful and needed to be saved. I did not believe I was sinful at birth nor then. I believed we were all inherently good people. I was a closeted agnostic until college. Ironically, I helped teach Sunday school classes to preschoolers to avoid having to go to church with my family from the age of about 11–18.

—Phil, age 51

Impact on adjustment to SCI. Contrary to what might be expected, none of the individuals interviewed had shed religious belief as a result of their injury. However, about half of them felt that their SCI experiences had strengthened their already held beliefs. In addition, many participants felt that being secular actually helped them to adjust psychologically and existentially to their disabilities.

I think [SCI has] strengthened (my atheism). Naturally, I have more time on my hands, thus more time to think about things like religion. And the more I think about it, the more it doesn’t make sense.

—Robin, age 28

After giving a lot of thought to the how and why this happened to me, I came to the conclusion that it was just an accident. God had nothing to do with it. I fell and broke my neck. Accidents happen.

—Adam, age 20

Post-SCI is when I embraced Atheism. Things I was going through made sense to me. I was no longer frustrated with waiting on this purpose god must have for me. I started getting better; I wasn’t stressed out all the time and frustrated with why this happened. Why has there been no revelation from god as to what my purpose should be now that I was SCI.


I did at one time want to be a believer in a god and heaven because I think some people use their beliefs or hopes as a coping skill when things are not going their way. I also think it would be nice if I had a fairy god mother to call to when times are tough or wish I was a Genie. . . . My thought process just does not operate that way and or I was not conditioned to think in fantasy terms.


Three participants reported being approached by aggressively religious people after injury:

I kept thinking about this purpose everyone said god had for me. I was so sick during those years I would beg god to let me die. I tried many times to end my life to no avail. After an arrogant hospital minister visited my room I started taking a different view of my situation. By removing god completely from all that had been happening and still happening to this day it made clear just why I was going through the hell I was. Put god back into the equation and it got all muddy again. This was the defining moment in which I accepted there is no god in control.

—Alec, age 43

When I was first injured, people kept preaching to me. Telling me to pray so I could walk again. I tried doing that and nothing happened. Society kept telling me that if I believed in god I would miraculously get up again. I found myself stuck in rehab with people surrounding my bed saying their prayers for me. I just went along with it. I was on too many pain meds to think straight. After giving a lot of thought to the how and why this happened to me, I came to the conclusion that it was a just an accident.

—Lynne, age 36

The efforts of well-meaning but intrusive proselytizers only served to further entrench our participants’ already held secular worldviews.

Meaning, purpose, and spirituality. Despite their nontheistic outlook, almost half of the participants described themselves as “spiritual.” For them spirituality was a source of meaning and strength that helped them cope with the daily experiences of living with their disabilities. These individuals typically defined spirituality as an appreciation for the interconnectedness to nature, humanity, and the universe: “being in touch with their heart and mind” or “a higher consciousness of one’s self and surroundings.” These aspects were generally identified as a source of meaning and strength. Another common source of meaning and purpose was significant others, family, and children: “I live and do everything for (my kids), they are my purpose.”

I find my source of meaning and purpose in today, one day at a time, the things and people I love such as my animals, family and friends. I am needed and loved. When I’m feeling weak and need mental strength I toughen up by thinking about all I love. When someone does me wrong I hold on to a more of a cosmic belief rather than Buddhist belief in karma. I think every person has an effect in some way on every other person or creature they encounter which gives them meaning and purpose.

—Sarah, age 28

I feel like everyone individually has the responsibility to do their very best to make this world the best it can possibly be. I think when there is a crisis, you just need to bear down and find resources within yourself. I think everyone is far more capable of doing great things than most people imagine. When I am at my lowest of low I look around and see that there are others who struggle with more than I do and that I can make it through this time stronger than I am now.

—Hazel, age 52

By contrast, more than half of the participants did not consider themselves spiritual, indicating that the idea of “spirituality,” with its basis in the word spirit, was by definition indicative of a “higher power” or consciousness beyond the objectively proven. Definitions offered by these nine participants included “how some people define their personal relationship with their chosen savior” and “a belief in a non-physical universe/dimension, in other words there are spirits, ghost, karma, etc.”

I find my source within myself. I figure a human trying to figure out a meaning and purpose to their life is about as pointless as a duck trying to figure out basic chemistry.


(I)n times of crisis, I look inward to try and figure out how to get out of said crisis (instead of turning it over to “God”).


“I’ve always connected spirituality and religion, although I realize most people don’t,” admitted another respondent. These individuals tended to be extremely self-reliant and did not consider a lack of spirituality to be detrimental to their overall sense of well-being.


The results of this investigation indicate that despite their lack of religious or spiritual beliefs, the fifteen individuals interviewed were generally happy and dealing well with their injuries. This supports the idea that a strongly secular orientation can be just as meaningful as a strongly religious one.

All of the individuals interviewed had been confirmed nonbelievers prior to injury. The reasons for their initial atheism/agnosticism are largely reflective of those found in other research. There was no evidence that a loss of faith was triggered by negative emotional experiences after injury or that a lack of religious belief had negative effects on post-injury well-being and no evidence that the trauma of a spinal cord injury had triggered any anger, with God or otherwise. It was clear that the shift from agnosticism to atheism—or from weak to strong atheism—reported by some individuals was a result not of any significant shifts in worldview but rather an increased confidence in an already held worldview.

One hypothesis for the resilience of secularity is that a sudden loss of faith following a traumatic incident is likely to be reactive, emotional, and internally incoherent and therefore less likely to be self-sustaining in the long-term. By contrast, de-conversion as a result of careful thought is more likely to result in a worldview that is both intellectually and emotionally coherent. In short, the adolescent de-conversions described by participants occurred not out of rebellion or negative experiences with family or with religion but as a natural part of identity formation.

What about spirituality? Previous studies have reported that spirituality, in particular, is related to improved health outcomes in adjustment to disability. However, the results of this present study did not reveal any difference between self-identified spiritual and non-spiritual participants with regard to happiness with life or dealing with injury. Of course, many atheists disdain the word spiritual because of its supernatural connotations. Nevertheless, many elements of “spirituality”—particularly those dealing with human connections or highly emotional experiences—are equally important to affirmatively non-spiritual individuals. This confusion in terms can lead to misunderstandings by others, who may wrongly assume that non-spiritual individuals reject any activity that could in any way be interpreted as “spiritual,” even those having to do with basic human contact, including, as Tom Flynn wrote in a previous issue of FREE INQUIRY, “having a quiet conversation with a patient, holding a patient’s hand, evaluating a patient or family member’s emotional state, even giving a comforting alcohol rub.”

General discussion. Despite these intriguing findings, this study has its limitations. Its principal limitation was its small sample size. This was not unexpected, given the relative infrequency of nonbelievers in U.S. society in general and among SCI survivors in particular. In addition, all the participants were Caucasian or Asian. This was also to be expected, given that African American and Hispanics are much less likely to be nonbelievers. It is hoped that further investigations will attract larger participant sample sizes sufficient for more objective assessment methods; however, subject recruitment difficulties may hamper such future research efforts. These findings, therefore, remain highly exploratory.

Despite these limitations, the results of this investigation support the idea that a lack of religion and/or spirituality does not necessarily constitute a detrimental effect on adjustment to spinal cord injury in affirmatively atheistic and agnostic individuals. That is, it is the strength and consistency of one’s belief, rather than the nature of the belief itself, that promotes healthy adjustment and general happiness. We hope that the results of these interviews can help to provide some insight into the ways in which a consistent, committed secular worldview can also help individuals deal with difficult periods and move on to happy lives.


Selected References and Further Reading

  • Buggle, F., D. Bister, G. Nohe, W. Schneider, and K. Uhmann. “Are Atheists More Depressed than Religious People?” FREE INQUIRY, Fall 2000.
  • Exline, J. J., and A. M. Martin. “Anger toward God: A New Frontier In Forgiveness Research.” In Handbook of Forgiveness, edited by E. L. Worthington. New York: Routledge, 2005.
  • Flynn, Tom. “Taken in the Wrong Spirit.” FREE INQUIRY, April/May 2009.
  • Glaser, B. G., and A. L. Strauss. The Discovery of Grounded Theory: Strategies for Qualitative Research. New Brunswick: Aldine Transaction, a division of Transaction Publishers, 1967.
  • Hall, D. E., H. G. Koenig, and K. G. Meador. “Hitting the Target: Why Existing Measures of ‘Religiousness’ are Really Reverse-scored Measures of ‘Secularism.’” Explore 4 (2008).
  • Hunsberger, B., and B. Hunsberger. “Religious Socialization, Apostasy, and the Impact of Family Background.” Journal for the Scientific Study of Religion 23, No. 3 (1984).
  • Hunsberger, B., M. Pratt, and S. M. Pancer. “Religious versus Nonreligious Socialization: Does Religious Background Have Implications for Adjustment?” International Journal for the Psychology of Religion 11, No. 2 (2001).
  • Hwang, K. “Experiences of Atheists with Spinal Cord Injury: Results of an Internet-Based Exploratory Survey.” SCI Psychosocial Process 20 (2008).
  • Hwang, K., J. H. Hammer, and R. T. Cragun. “Extending Religion-Health Research to Nonreligious Minorities.” Journal of Religion and Health, October 28, 2009. Epub ahead of print.
  • Riley, J., S. Best, and B. G. Charlton. “Religious Believers and Strong Atheists May Both Be Less Depressed than Existentially-uncertain People.” QJM: Monthly Journal of the Association of Physicians, 98 (2005).
  • Smith, George H. Atheism: The Case Against God. Los Angeles: Nash, 1974.


Karen Hwang

Karen Hwang is adjunct assistant professor of medical rehabilitation at University of Medicine &, Dentistry of New Jersey. She is on the staff of the Center for Atheist Research.

It has long been accepted as an article of faith that religion/spirituality (hereafter “R/S”) has a beneficial effect on both physical and mental health. Popular U.S. survey data appears to indicate a positive association between R/S and various indices of mental and physical well-being. However, this research is not without methodological controversies. Primary among them …

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