A Global Perspective on the Relation between Compassion, Spirituality, and Psychopathology
There has been a growing interest in the link between spirituality and psychopathology, including increasing evidence that spirituality may be protective against various aspects of mental illness, such as depression, anxiety, substance abuse, addiction, and suicidality. Some research out of our lab at Columbia University has shown that people who report spirituality to be highly important to them have lower rates of depression, even if they are from families at high risk for depression.1 We have shown these protective effects, not only clinically (psychologically) across ten and twenty-year spans, but also biologically. That is, we have found that individuals who placed great importance on spirituality had biological differences in the brain when compared to people who did not place great value on personal spirituality. For example, using resting state functional magnetic imaging (rs-fMRI), we found reduced connectivity in the default mode network of the brain in individuals at high-risk for depression who reported spirituality to be highly important to them as compared to those who reported it was not that important.2 We have also shown protective effects in brain structures using magnetic resonance imaging (MRI) techniques. Here, we found that the very same regions of the brain that showed vulnerability for depression through cortical thinning showed cortical thickening in the individuals who reported high spiritual importance.3 We further replicated this finding longitudinally over 5 years.4 We also used another neurophysiological measure, electroencephalography (EEG), that measures brain waves. The greater the Alpha waves, the greater the association with protection against depression. Greater Alpha waves have been observed previously in clinical responses to anti-depressants and in experienced meditators. In our studies, we found greater Alpha in people who reported high spiritual importance.5 Moreover, this protective effect extended over twenty years.6 We also ran a study that examined potential genetic markers of spirituality and found that there may be a genetic component to the protective effects of spirituality that is transmitted within families.7
Dimensions of Spirituality
These findings raise some important questions: (a) what are the components of spiritual importance, and (b) are these components culturally specific, or are they stable across cultures? (c) How do the spiritual components relate to psychopathology? And, (d) what role might compassion play in these associations?
Members of our research team, McClintock et al. (2016) ran a study that examined these questions.8 First, they sought to establish various dimensions of spirituality. They defined spirituality as an innate capacity through which people experience transcendence, which may also extend to lived practices and values. They differentiated spirituality from religion by defining religion as the composite beliefs, sacred language and rituals, holy texts, traditions, and institutions that are inextricably contextualized by culture and that hold and cultivate a natural capacity for spirituality. In the study, they asked over 5,500 people (20% Buddhist, 21% Christian, 11% Hindu, 2% Muslim, 26% Non-religious, and 9% Other) from China, India, and the United States to complete an array of validated questionnaires from the psychological science literature. Participants completed two-hour online surveys containing measures of lived spiritual experience, as well as various clinical assessments related to mental health outcomes. The results of the survey were subjected to rigorous statistical analyses. This was to reduce potential bias in the findings by ensuring the results met stringent mathematical criteria. Out of forty self-report scales and questionnaires, five stable components of spiritual experience emerged across all three cultures and across all religions:
- Unifying Interconnectedness
- Contemplative Practice
- Religious and Spiritual Reflection and Commitment
The experience of Love was strongly correlated with measures of forgiveness and loving connections with others. It comprised three aspects of love: the psychological experience of being loved, the social aspect of loving others, and the ontological sense of love as an ultimate force and reality.
Altruism was the dimension of spirituality that specifically entailed compassion for others. It included humanistic engagement – a desire to help others. It also included existential engagement – a desire to help the world as whole, to relieve suffering, and to promote kindness and happiness for all. The altruism dimension also contained gratitude and a sense of awe.
Unifying Interconnectedness related to a more esoteric experience of spirituality, one that may be the basis of some mystical experiences. It included a sense of interconnectedness with all living things, including the sense that nature is imbued with spiritual significance. It promoted eco-awareness – viewing the environment and the world through a spiritual lens and assuming responsibility for its well-being and ability to flourish. As such, this aspect of spirituality was intricately related to a sense of unity with all living things. It supported a positive moral imperative to act justly and to promote the good. It further related to a personal spiritual quest, spiritual self-discovery, and a sense of connection with others.
The Contemplative Practice component of spirituality comprised both sitting and moving prayerful practices, such as prayer, meditation, mindfulness, yoga, qigong, and Tai Chi. It included various spiritual and religious practices, including constructs of mindfulness and relaxation observed in mental health practices and interventions – specifically, those that find their origin in spiritual traditions.
Finally, the spiritual dimension of Religious and Spiritual Reflection and Commitment reflected personal devotion and general religiosity. It included private religious/spiritual practice, intrinsically motivated and meaningful religiosity, employing religion to help one cope with life’s stresses, and commitment to religious beliefs lived out throughout one’s daily life and relationships. This dimension of spirituality correlated with measures of how important religion and spirituality are to a person, as well as how frequently a person attends religious services.
The fact that all five dimensions emerged as statistically stable and invariant factors of spirituality across all three cultural groups (China, India, USA) is remarkable given the diversity of religions and cultural norms represented. This suggests that the experience of human spirituality is universal across national and religious cultures.
Cross-Cultural Considerations of Spirituality
The cross-cultural and multi-dimensional structure of spirituality observed in this study does not imply that real differences in the particularities of both traditional and non-traditional spiritual expressions and experiences do not exist. Rather, the consistent structure of spirituality that has emerged provides a framework by which potential components of a universal spirituality may be understood. That is, members of different religious groups may weigh the importance of the five spirituality factors in vastly different ways. In the present study, the reported religious affiliations of the community samples in China, India, and the United States were as follows. In China, nearly half (45%) identified as non-religious and about a third (33.7%) identified as Buddhist. In India, the vast majority identified as Hindu (70.7%), followed by Christian (17%). And, in the United States, the predominant religious affiliation was Christianity (48.8%), followed by a non-religious affiliation (39.4%).
The five spiritual dimensions were examined in relation to sociodemographic variables and revealed some interesting cross-cultural similarities and differences. Most of the spiritual dimensions were positively associated with age in each of the three countries. This is consistent with numerous other studies that have found older age to predict higher levels of spirituality and religiosity. That is, spiritual beliefs and practices appear to intensify as people get older.
Females were also more likely than males to report greater degrees of spirituality in each country. Previous studies have observed the same finding – women are, on average, consistently more spiritually and religiously inclined than men. The explanations for this vary widely, but are beyond the scope of the present paper.
The most notable and, perhaps, interesting cross-cultural difference was observed for correlations between education levels and spirituality. Education had a positive association with spirituality in China and India. An inverse association of education was observed, however in the United States for Love and Unifying Interconnectedness. This suggests that people who are more spiritual are also better educated in China and India, whereas people who are more spiritual in the United States tend to be less educated. The positive association between education and spirituality in China and India may suggest greater social integration of religious and spiritual practices within Eastern cultures. In the United States, the inverse association between education and spirituality may reflect evidence that suggests spirituality and religion provide resources for dealing with socially and materially disadvantaged life circumstances that are, often, associated with lower education and socio-economic status.
Indeed, previous studies have shown an association between lower levels of spirituality in affluent youth in the United States and have observed an increase in materialistic cultural values toward acquiring wealth that have risen since the 1970s. McClintock et al. suggest that a culture of privilege in more highly educated circles in the United States may overvalue extrinsic, materialistic goals and undervalue intrinsic, spiritual ones. Based on current evidence, this phenomenon may not (yet) extend to China or India.
Spirituality and Psychopathology
I now turn to the associations between the spiritual dimensions and mental health. The strongest and most consistent aspects of spirituality to be associated with positive mental health outcomes were Love and Altruism. The top 25% of people who engaged in altruistic behavior across all countries (China, India, USA), as compared to the lower 75% of people, had 37 – 72% lower odds of having major depressive disorder, 47 – 62% lower odds of having suicidal thoughts, 30% – 72% lower odds of having generalized anxiety disorder, and 47% – 79% lower odds of alcohol abuse. Those in the top quartile of scores on Love showed a similar trend: 10 – 60% less likelihood of having depression, 35 – 49% less likelihood of having suicidal thoughts, and a 23 – 62% reduction in anxiety. Given the fact that the data were collected at a single point in time, whether the spiritual component led to the positive mental health outcome, or vice versa, cannot be determined. Nonetheless, previous research on similar topics has suggested that altruism, compassion, and prosocial behavior can have a positive impact on mental health and clinical (psychological) symptoms.
In all three countries, Unifying Interconnectedness was also associated with a lower risk for depression and suicidal thoughts. Experiencing a connection with others, and particularly with nature, is what defines this aspect of spirituality. Previous studies have also found that exposure to nature and experiencing a sense of connection with it can decrease stress levels and improve one’s mood. It has also been shown to reduce neural activity specifically in regions of the brain that promote behavioral withdrawal and obsessive self-referential thinking. Studies on social networks and connectivity have also shown that positive social relationships and connections promote better mental health outcomes. Taken together, these findings suggest that overcoming self-focus and absorption by establishing connections with other people, nature, and even animals may help to elevate overall mood and decrease psychopathology.
Contemplative Practice in India, and to a lesser extent in the United States, was, associated with better mental health outcomes. Previous research has shown that contemplative practices, such as meditation – in particular, mindfulness meditation – can reduce depressive symptoms, anxiety, and psychological distress. In China, however, contemplative practice was associated with higher rates of psychopathology.
Religious and Spiritual Reflection and Commitment also had a consistent protective effect against psychopathology in India and the United States. In both countries, those with scores in the top quartile, compared to all others, had approximately half the likelihood of having major depressive disorder, suicidal thoughts, and generalized anxiety disorder. This dimension of spirituality had the highest overlap with traditional and orthodox religiosity, including frequency of attending religious services, religious affiliations, and personal religious importance. Several other studies have also found protective effects of religiosity against various psychopathologies, including depression, suicidality, and anxiety.
Religious and Spiritual Reflection and Commitment also involved an orientation of one’s lived life toward a divine other or a transcendental power. Such a commitment imbues a sense of meaning beyond one’s own life experience, which may in itself reduce the risk of psychopathology and aid people in coping with adverse life circumstances. Religious and spiritual worldviews tend to nurture a fundamental sense of hope and provide a range of strategies for confronting suffering and hardship. Furthermore, people who participate in religious or spiritual communities tend to receive positive social support through the relationships and connections with others, regardless of economic or social resources.
Dimensions of Spirituality Associated with Greater Risk of Psychopathology in China
A notable exception to the protective effects of spirituality against psychopathalogy was found in China, as compared to India and the United States. In particular, Contemplative Practice and Religious and Spiritual Reflection and Commitment in China were associated with a greater, rather than a lower, risk of psychopathology. Other studies on spirituality and mental health in China have found similar effects. For example, as McClintock et al. describe, one study found personal religious/spiritual importance and religious service attendance in a community in China to correlate with increased incidence of psychopathology, namely, anxiety. Another study found that, among Chinese rural women, those who were religiously affiliated were also more likely to suffer from suicidal thoughts and attempts.
McClintock et al. speculate that it could be that the differential effects of spirituality in China, as compared to India and the United States, are related to differences in national policy surrounding religious freedom of expression. Research in China in this area is sparse, but suggests that the religious climate of the larger society over decades may play a moderating role in the mental health outcomes for its people. At times in its history, the Chinese government has dissuaded the religious practices of various traditions. This may help explain the observed association between spirituality and psychopathology. Indeed, the two spirituality factors, out of five, associated with negative mental health outcomes were also the factors that were most overtly expressive – contemplative practice and religious and spiritual reflection and commitment. It may be that stifling natural spiritual and religious expression results in depressive symptoms.
McClintock et al. also note that China, in comparison to India and the United States, has a larger proportion of non-religious residents who constitute the majority of the population. Those who adhere to religious or spiritual beliefs and practices remain outside of the mainstream culture as minorities. This may also contribute to feelings of isolation, despair, and alienation. China’s Confucian-based culture also strongly promotes social harmony, encouraging individual subordination to this end. Taken together, the psychological strain of religious believers in China may outweigh the protective effects of spirituality observed in other cultures.
To end, I would like to consider, specifically, the role of compassion in the research I’ve outlined. The studies outlined do not use the term ‘compassion’ explicitly, but they do discuss two closely related phenomena, Altruism and Love. Insofar as compassion comprises both altruism and love, data on the relation of the latter to psychopathology will apply to compassion, as well. Notably, lLove and aAltruism were the strongest predictors of mental and psychological health across all three cultures. People who reported the highest degrees of lLove and aAltruism, on average, had an over 50% reduction in the odds of having major depressive disorder, generalized anxiety disorder, suicidal thinking, and alcohol abuse. This suggests that compassion is associated with overall mental health and well-being.
The key to the positive relationship between compassion and mental health appears to be that being compassionate draws focus away from oneself and directs it, rather, to another. This phenomenon is observed in the other spirituality factors, as well. For example, Unifying Interconnectedness raises attention away from oneself and focuses it on nature and other living things. This aspect of spirituality is defined by a person’s awareness of, and willingness to enter into, relationships with other living creatures. Contemplative Practice also tends to elevate one’s attention away from one’s own perspective by adopting either detached awareness of oneself as an outside observer or directing positive intentions to others. Finally, Religious and Spiritual Reflection and Commitment has the power to direct one’s attention to divine beings and a transcendent power through various spiritual beliefs and practices. The crucial ability to connect with another through compassion appears to be the heart of spirituality.
McClintock et al. outline several psychological studies that support this notion. For example, it has been shown that directing attention away from oneself decreases rumination and obsessive self-referential thinking in the default mode network of the brain, which is otherwise generally associated with depression, excessive worry, and feelings of victimization and helplessness. Another study found that training in compassion, as well as, altruistic behavior, enhanced neural pathways that support critical thinking, feelings of pleasure and reward, second-person relatedness, and empathy. The capacity to provide support to others in need has also been shown to activate self-compassion, which, in turn, was also positively related to mental health outcomes. That is, serving others may draw upon the same inner resources needed to help oneself through difficult circumstances.
There have also been several studies that support the positive correlations between Love and mental health outcomes. Positive emotions associated with love have been shown to support long-term dispositional states, mental health, and resilience. The experience of love has been related to the brain’s reward system – the system in the brain that activates positive, pleasant feelings and decreases negative ones. This, in turn, confers health benefits and decreases psychopathology. There has also been research that suggests deficits in loving attachments and feelings of belongingness are risk factors for psychopathology. Feelings of love and belonging may be experienced within familial relationships and friendships, but they may also extend to a relational bond with a ‘higher power’. Having a loving relationship with the divine and a sense of belonging in an ordered universe may confer similar protective effects. Vaillant (2008), as cited in McClintock et al., has posited a fundamental role for love within spiritual experiences to “free the self from self.” Taken together, the findings suggest that compassion decreases one’s own suffering (psychological distress) and enhances happiness and overall well-being. Because compassion generally involves entering willfully into the suffering of another, this conclusion may appear somewhat paradoxical.Further research is needed to investigate this seeming paradox.
Limitations and Clinical Implications of Study
It should be noted that the associations between spirituality and psychopathology reported in this paper should be interpreted with caution. First, all of the findings are based on self-report responses, which are vulnerable to various other influences that could bias the results. The large sample (of over 5,000 people), fortunately, helps to mitigate this concern. Also, as previously mentioned, because the questionnaire responses were collected at a single time point, it is empirically impossible to determine causal pathways between spirituality and psychopathology. Nonetheless, as outlined throughout the paper, several other lines of research support the notion that cultivating an innate sense of spirituality can indeed have protective effects against psychopathology. Lastly, the three countries represented in the paper do not represent all countries, cultures, or spiritual traditions. As such, the extension of these results should be carried out with sensitivity, and in light of, other cultural and environmental contexts.
Taken together, the results of the study have implications, not only for spiritually-inclined individuals and people at risk for various psychopathologies, but for clinical psychologists, as well. The findings underline the need for further clinical research on the interplay between spirituality and psychopathology. For example, the five aspects of spirituality discovered in the present study appear to have differential effects clinically and culturally. More refined investigation is needed on the interplay between spirituality, culture, and psychology. Moreover, there may be an additive protective effects of the spirituality factors in clinical and therapeutic treatments. More research is needed on this. Finally, compassion appears to be a crucial component of the protective effects observed between spirituality and mental health. More research is needed to understand its cross-cultural dimensions and manifestations, its protective effects against psychiatric symptoms and disorders, and its potential role in clinical interventions and treatments. This paper supports the thesis that compassion is intricately related to psychological well-being – perhaps, specifically, through entering into relationship with another (person, animal, nature, or transcendent power). Taken together, the practice and potential healing power of compassion warrants further use and research.
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