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House Calls Podcast
How Does Spirituality Protect Our Mental Health?
With guest Dr. Lisa Miller,
Psychologist

Description

Can spirituality enhance our mental health?

That is the question that psychologist and researcher Dr. Lisa Miller has pursued through her career. During her clinical internship after graduate school, she observed how while some of her patients had symptoms of major depression that required medication, other patients carried a sadness that carried life’s big questions: What is the purpose of life? Is there a larger meaning to existence? Decades later, Lisa has found that each of us has an “awakened brain,” neural circuitry that enables a human’s natural capacity for spiritual awareness.

In this conversation, Lisa and the Surgeon General delve into the science that explains spirituality’s protective effects on mental health. They also discuss the universal human need for an inner life that connects us to something greater than ourselves, and offer a few meditation practices to support the awakened brain. 

We’d love to hear from you! Send us a note at housecalls@hhs.gov with your feedback & ideas. For more episodes, visit www.surgeongeneral.gov/housecalls.   

 

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Transcript

Dr. Vivek Murthy

Hello and welcome to House Calls. I'm Vivek Murthy and I have the honor of serving as U.S. Surgeon General. I'd like to introduce you to Dr. Lisa Miller, psychologist and professor, who studies the science of spirituality. Today we'll be talking about the relationship between spirituality and our mental health. What is spiritual health? How does it differ from religion? And what does spirituality have to do with our mental health? These are questions Dr. Lisa Miller has been studying for decades, and they're at the heart of our discussion today. Dr. Miller's research tells us that we all have a biological capacity for spirituality. And just like food, exercise, sleep and social connection, our spiritual health is an essential component of our wellbeing. Through our pursuit of spiritual health, we all face those deeper existential questions. What is our life's purpose? What gives us meaning? Dr. Miller's work shows that we are biologically wired to explore these questions. Her breakthrough research also shows how spirituality is a powerful buffer against mental health challenges, including depression. Her work has shown that adolescents are less likely to experience depression if they have strong personal spirituality. With our innate capacity to lead a spiritual life, the question becomes, how do we awaken and cultivate it? This is particularly important now in the face of our loneliness epidemic and our youth mental health crisis. Some key takeaways for me from our conversation, the importance of connecting with something greater than ourselves, knowing that we're not alone in our spiritual quest, and recognizing that our spiritual health is an essential component of our overall health. We start this episode with a guided meditation.

Dr. Lisa Miller

Okay, so Vivek, I invite you to close your eyes, clear out your inner space, take five breaths. This is your inner space, and this is an invitation. I invite you to locate a time where you wanted something so badly. It was that job, that internship, that promotion, it was him, her, or them, to say yes. A place to live. That red door, it was yours, and you did everything right to get there. A + B + C. You researched it, strategized. You go for that red door, you grab the handle, it is yours, but the door's stuck and you can't believe it stuck because you've done everything right. A + B + C. You might be in shock, angry, kick the door. In time, perhaps depressed. You did not get what you wanted, but only because that red door is stuck. You have no choice. You pivot 20, 50, 100 degrees. And over there, over there is a wide open shining yellow door. You might've said yellow doors don't exist. You've never seen yellow doors, heard of them. But on the other side of the yellow door, was someone more right for you that made you feel alive, was a mentor, a job where you found something in yourself you didn't even know you had. The other side of that yellow door was not what you had wanted. It was better and better for you and has so much to do with who you are and where you are today. So if you sit back now and you think at the stuck red door and the hair pin turn leading to the wide open yellow door, was there anyone there at that hairpin turn? A mentor, a grandparent, a good friend who for the first time told you a story or from their own life and pointed you to the yellow door? Or was it someone in your community, someone you met for two minutes on the bus, an elder? Someone a few years older who you admired, who gave you information? At that hairpin turn, there was a trail angel pointing you to the wide open yellow door that has so much to do with where you are and who you are today. And now sitting even further back, stuck red door, hairpin turn, trail angel, and wide open yellow door, how are the most important parts of our lives found? Sure, we need research and strategy and tactic, but is it really through control alone that we find our path? Or are we less makers of our journey and more discoverers of a quest? Are we less in radical control and perhaps in a dialogue with life and showing up for one another to betrayal angels pointing the way? And now finally sitting way back, stuck red door, hairpin turn, trail angel and wide open yellow door, where in your road of life is your higher power? Whether it is the force of nature, other people, God, HaShem, Allah, source, whatever your understanding is, is your higher power in the wide open yellow door? And perhaps the stuck red door? Is your higher power in the trail angel and who we really are for one another and your openness, your ability to be an open system in dialogue with the deeper nature of life. Are you perhaps loved and guided? Are you never alone? Is it possible that you have been on a spiritual path all along in your walk? And when you're ready, I invite you back.

Dr. Vivek Murthy

Wow, that was very powerful, Lisa.

Dr. Lisa Miller

So that's an entree to the notion that we do need to prepare and build our lives, but we don't have total control. We don't have radical control. And there's really a dialogue with life and we all play a role for one another, and we have in our own understanding a higher power. Some people say it's Mount Rainier, the force of nature. Some people say it's goodness in humanity, and some people say it's transcendent, it's God, it's HaShem, Allah, spirit, Jesus, whatever their word is. But we're not alone in this life. There's a deeper nature. We're loved and held, guided, and never alone.

Dr. Vivek Murthy

Well, that's beautiful, Lisa. And I think especially at a time where people are feeling alone and feeling lost and I'm thinking about many of the college campuses I just visited over the last couple of months as part of our Made to Connect college campus tour about loneliness and connection and how many students were feeling that sense of, it's not just lack of clarity, but that sense of, I think about that their journey is a solitary one, that they're on their own somehow, and that the road isn't bright, but that it's dark. So I appreciate you sharing this, and Lisa, this is one of the reasons I really wanted to talk to you was to have a chance to think about a dimension of health that I think we don't often see as connected to our health, and that is our spiritual health. I think 50 years ago, if you asked people what health was, they would've said it's physical health. And then a couple of decades ago, people started to, more so in the public realized that wait, mental health, that's a component too. I think recently our office has certainly been working hard to make sure people also know that social health matters, our connections with others. I think this fourth dimension, spiritual health is vital too. And I'll just say that I have been having conversations with university chaplains who have been telling me that while religious affiliation among college students has been going down, their spiritual hunger as registered on surveys of incoming freshmen, has in fact been going up. And so, I'm excited to have you on the podcast today to talk about these topics and I'd love to start by building on what you were just saying and defining what spiritual health is. I think many people assume that spiritual, the word spiritual just means religious or that they're the same thing. You clearly, I think, have articulated so beautifully that they are actually not the same thing, but how do you think about spiritual health?

Dr. Lisa Miller

So Vivek, I think there's a very important point you're raising, which is for a very long time people thought that over here on the right is spirituality with or without religion, and over here on the left is science. And you know, on one camp, people would say, "I am a deeply spiritual, perhaps spiritual and religious person. I know this in my heart to be true, and I don't care if science can show it or not." And on the other hand, people would say, "I am a hard-boiled, rigorous scientist. I only take to be true that which can be shown with certainty by science. What is this spirituality stuff," right? But it turns out that spirituality and science can go hand in hand. And from the view of clinical science, we can take our lens whether that is an MRI study, a genotyping study, just like a telescope or a microscope. Every method is a lens and point that at a broad host of questions, including the impact of lived human spiritual life onto the rest of our lives, including the origin or the development of lived human spiritual life across the lifespan. And that now finally, is what a strong, relatively new body of science, as you suggest, now offers both mental health and physical health. Our understanding now can expand to include the spiritual core of the whole person. Vivek, also to your point, there's been a sense of we are physical beings, we are emotional beings, cognitive beings, we are social beings. Well, it turns out that we also are innately, naturally spiritual beings. Every single one of us from day one is born a naturally spiritual being. Now that's a big claim, if that sounds perhaps new to someone. And the question is, hey, how do you know that? And the way we know that, the first way is using the lens of a twin study. We can look at twins raised together, twins raised apart, and factor out as a function of genes and shared environment, the extent to which any human capacity is inborn versus environmentally formed. So, I know your parents must be very proud of you. You're a brilliant doctor. Now, the doctor of doctors. Well, you were actually born smart, Vivek (laughs). 60% of IQ is hardwired. - Hm. - 40% environmentally formed. And our temperament, whether we're introverted, extroverted, whether we are tightly wound or laid back, that is 50% innate. That's quite a inborn capacity. Well, the interesting new information for society is that we are also innately spiritual beings. The capacity through which we experience our spiritual awareness is one third innate, two thirds environmentally formed, which means that when someone raises their hand and they say, "Am I spiritual?" Or if someone says, "I don't know if I'm so spiritual," you are spiritual. You were born a spiritual being. Two thirds molded by our parents and grandparents. Our 10,000 exchanges by the high school locker, our pastor, priest, Imam or rabbi, all this weighs into shape the spiritual core. And the reason that as you go from campus to campus, hearing from the chaplains that there's a hunger, and yet not always a place to meet that hunger is that our natural spirituality will be there. Whether we are held by our community, held by our family, held by our school or not, it is there, the longing, the hunger, the hunger of the spiritual heart in every single one of us. 40 years ago, in the good attempt, in the effort to be inclusive, we threw all religion out of the public square. And actually threw the spiritual baby out with the bath water, we became a spiritually non-conversant society. And we now for years, it's long enough for someone to grow up, have a baby who's now on the campus that you just visited. And for the first time, while some young adults do have a strong spiritual core, never have so many not, and it's no fault of their own. They have never meditated or prayed or gone on some form of transcendent nature quest with a parent or a grandparent. They may have never read any sacred text from any faith tradition or the arts with an eye towards ultimate reality. These are opportunities that were baked into the lineage of our beautiful, multicultural country, beautiful pluralistic religious traditions of our country, and are pretty silent right now. The second thing we lost when we silenced spiritual and religious life in the public square was we lost our greatest American, I think, greatest American asset, which is pluralism. And now as society has grown up and we've worked so hard to develop pluralism, inclusivity around race and gender and orientation, the next step forward is to embrace pluralism around spiritual diversity so that we can know each other and connect in the deepest way. Where in this is spiritual health. Well, the old argument, right? Would've been, "Hey, what is spiritual health?" The body is physical. Oo, and then we found out emotions are physical, and then we found out that social connection is also physical. Body, mind and soul are one. The mono-ist point of view. And yes, our spiritual life has a neuro docking station, has an inborn biologically based capacity through which we experience the sacred and the transcendent.

Dr. Vivek Murthy

I also want just ask you, Lisa, when I think about spirituality in a broad context, I think about the forces and moments that help us feel deeply connected to something greater than ourselves. Those sort of moments could be when you're in nature, they could be when you're potentially in a house of worship, practicing a traditional faith. They could be when you're engaged with a cause or an activity that you deeply believe in and feel deeply connected to. Does that sync with how you're defining spirituality, how you think about it?

Dr. Lisa Miller

That is indeed the most important dimension of lived human spiritual life. We are hardwired to be in a sustained relationship with our higher power. What you're calling “something more.” It is inherently loving good and guiding for the good, right? So this natural capacity with which we are all endowed to be in a sustained relationship with our higher power turns out to be foundational to mental health in a way that is unseen in the peer review published science by any other dimension of human life. So, to be a little bit more specific, a capacity to turn to our higher power for guidance in times of difficulty. Or if we say, "I have a tough decision to make. I wanna turn to the guidance of my higher power," whether that's through meditation or prayer, whether that's a walk in nature or turning to an elder. The capacity to be in a sustained relationship with our higher power is 80% protective against addiction. There's nothing in the clinical or social sciences as profoundly protective against addiction. And as we look further into more and more, now hundreds of peer review articles, our capacity to be in a sustained relationship with our higher power is protective against depression, anxiety, and suicide. - A meta-analysis, as you know, a study of studies rounding up all good studies to yield 2,000 plus tragically completed suicides, and 5,000 plus matched controls showed a 62% decrease in completed suicide when there's a strong spiritual life. And that goes up, Vivek, to 82% less likely to take our life when spiritual life is shared. Shared in the Sangha, the Mingin, the fellowship shared in the community. It could be shared in a squad in the army. I've done a lot of work with the Pentagon on this exact point. And when the army supported the spiritual core of the whole young adult, in three years we saw a 36% decrease in the rate of suicide, which as you know, was not found nationally nor in the other branches because the army took this on with the spiritual readiness initiative.

Dr. Vivek Murthy

Yes, and I think it's worth pointing out for people who may not be familiar with it that this notion of spiritual health is actually something that has been incorporated into military health. And that's also reflected in how the VA, the Veterans Administration, also approaches health. And so, I do think that this is incredibly powerful and it's nice to see more and more recognition of that. I do want to dig into the mental health connection though, which you have just brought up, which I think is so powerful. Some of the data points that you were citing indicate that spirituality is protective when it comes to our mental health and wellbeing. Can you talk a little bit about why that might be? That having a healthy spiritual life may help reduce the risk of depression?

Dr. Lisa Miller

You know, Vivek, the most effective treatment for addiction right now is AA. And what are the two components of AA? Learning to hand it over to our higher power We use our awakened brain. And the second dimension in AA is that we might feel the presence of our higher power in a radical love for one another, fellow human beings. And by radical love, I mean unconditional. I mean, I love you equally, whether you are on the front page of the paper for making $50,000,000 or going to jail. I love you equally. So, AA has been a place where a great number of people awaken. They awaken both in terms of their capacity to feel the presence of their higher power and hand it over and to show up for one another in an unconditionally accepting way. As we know, most faith communities have those same two dimensions of relational spirituality as the DNA. You walk into any house of worship and it has come as you are. And while you're there, there's many ways to assemble and connect socially. Well, this isn't any form of social support. This is social support where in us, through us, and among us is this sacred presence, the higher power. So, the form of relational spirituality that's found in a faith community, that's found in AA is a realization. It is effectively the cultivation of our innate awakened brain, our own awakened spiritual awareness. Now, spiritual health is there, it's within reach for each and every one of us. Can we cultivate these two core dimensions of who we really are? And the answer is yes, we can do that in every second of every day. It's a shift in how we look at each other and how we treat each other. So, we can move outside this sort of chronic world of performance and measurement and who we are on some type of grid. "What do you do and where do you live? And what's your partner doing?" To, "Hey," at the next dinner party, at the next parent meeting, "Tell me something really beautiful from the past week. I'd love to hear a really good one."

Dr. Vivek Murthy

Those are some very powerful, practical tips for how we can engage with one another. And I'm thinking, Lisa, building on this if you're, let's say a young person or an older person listening to this conversation and you recognize that, okay, there's an innate element to my spirituality here, but you wanna cultivate a spiritual life in your spiritual health, what sort of practices would you recommend to people to help build their spiritual health?

Dr. Lisa Miller

I share some of this in "The Awakened Brain," in my book, "The Awakened Brain." The practices that I share in "The Awakened Brain" are written in the language of life. So someone can be a complete skeptic or they could be devout within their faith tradition and still engage in these practices that strengthen our natural awakened brain. Would you like to do one?

Dr. Vivek Murthy

Sure. Yeah, let's do one together. - Okay, thank you. So Vivek, I invite you to close your eyes and clear out your inner space. Open up your inner chamber. And here I invite you to set before you a table. This is your table. And to your table you may invite anyone, living or deceased, who truly has your best interest in mind. And with them all sitting there, ask them if they love you. And now you may invite your higher self, the part of you that is so much more than anything you may have or not have, anything you may have done or not done, your true, eternal, higher self. And ask you if you love you. And now finally, you may invite your higher power, whatever word is yours, however you know your higher power. And ask if they love you. And now, with all of these people sitting here right now, what do you need to know? What do they need to share? What do they need to tell you now? And when you're ready, I invite you back. This is your council and they're always there for you.

Dr. Vivek Murthy

Oh my gosh, that was incredible, Lisa. Especially that moment when you had guided me to ask the council if they loved me. That was just a very powerful moment. - And what's also striking to me about it is it was relatively short. I'm thinking for anyone who may be listening to this, this is the kind of exercise you could do in between meetings, the beginning of the day before you go to sleep, or just in a few minutes if you're having a hard day, when you step aside and say, "I just need a moment to myself." But a very simple, a powerful practice. Thank you.

Dr. Lisa Miller

I think, Vivek, that's very important that we can bring to our counsel what's on our heart. And if someone at work is weighing on us, or if we feel bad or guilty about something we've done, if I feel badly, I was short-tempered with my child on the way to work. If I feel that I am not living up to the person I wanna be, and I did something that I don't feel good about, I can take that to council. And the type of direction and love and renewal opens up a direction that I haven't even thought of. - Mm hm. - And that's why our spiritual awareness is different than the other forms of thinking and being. There's a very deep way of connecting to whether we call the spirit in life, our higher power, that is redirecting, that opens up a avenue that we hadn't even considered, the yellow door.

Dr. Vivek Murthy

Mm hm.

Dr. Lisa Miller

And that's a form of transcendent awareness, that is our awakened brain.

Dr. Vivek Murthy

And can you, Lisa, I know you've obviously written an entire book on this and eloquently described what the awakened brain is. But for our listeners today, could you talk a little bit more about what the awakened brain is and how we can harness its power?

Dr. Lisa Miller

As we were sitting together just now sharing the council practice, there was an authentic transcendent connection between those who truly love us, whether alive or crossed over to our deepest truest self and to our higher power, however we may know, and whatever word may be ours. That is a transcendent relationship. It is a lived, felt, dynamic relationship. It's not merely a belief, right? It's not a theory or a theology. It is a directly held and known personal relationship. Our awakened brain is the neuro docking station for that transcendent relationship which we just shared in the council practice. The awakened brain is a series of circuits that run during that level of awareness, the transcendent relationship. So whether I am religious or not religious, I have the same awakened brain. And within a faith tradition, whether I am Hindu, Muslim, Catholic, Christian, Jewish, I have the same awakened brain. There's one awakened brain and we all have it. Now, of course, practice strengthens the awakened brain, and we see that in MRI studies and there's human variability. But just as we can all listen to music and feel the rhythm, there is a capacity to perceive and know the transcendent relationship.

Dr. Vivek Murthy

No, that's incredibly powerful and I hope people may see in this conversation that there's a tool in our toolbox that we didn't know perhaps we had, but that is extraordinarily powerful. And this, I wanna come back to college campuses for a moment. You're a professor at a college campus, at a university. You're interacting with students and engaging with them often. I wanted to ask this seeking that we are seeing, and I'm hearing about from university chaplains is spiritual seeking, if you will, is this to be expected at this particular stage of life? And are there other life stages where we find that our spiritual seeking spikes?

Dr. Lisa Miller

Any human capacity that's hardwired has developmental chapters. And I like to think about the fact that after sophomore year in high school, we all went home for summer break, played outside, came back as juniors, and half the class had grown four inches over the summer. (laughs) That's a hardwired growth spurt. Late high school, physical growth. Well, tracking physical growth, there's actually also spiritual growth. We are hardwired for phases of accelerated spiritual growth, a surge from the inside out. We track this in science through a longitudinal twin study. We come back when the participants are 15, 18, 20, 24. There is a surge, there's a biological clock. The experience of the developmental growth spurt spiritually is often a very strong hunger of the heart to feel and know the sacred connection with our higher power. To hunger for deep love and purpose and meaning. And so too, there's a nagging of the head. What is true? What is real? This process is the most important work we do as adolescents and emerging adults. But it is not easy because with the expansion of our spiritual capacity across adolescence and into emerging adulthood, the college campus, it can feel like a half empty glass of spirituality, an existential longing. And this process of seeking is really a quest. It used to be that on day one, college students showed up with a little bit more in their spiritual backpack. From home they'd learned some method of prayer or meditation or had a holy text to turn to, or some felt, lived, inner spiritual guidance. Now we have young people showing up who again, have never had support for their innate spiritual core and left to lay fallow it’s somewhat atrophied. And there's no language of transcendence or roadmap of the deeper reality or sacred text to which to turn or community of fellowship, Mingin, Sangha, nothing. So the spiritual quest becomes quite individual. We've been working for a couple years on Awakened Campus, where college deans and counselors and mental health providers were showing up and saying, "We've done everything in our playbook. The crisis is not only about more providers, of course we need more providers, but we've gotta get upstream of this from treatment, prevention, wellness, all the way up to formation." And what in our culture and climate could be more supportive here on campus of the spiritual core? What can we do to support awakening?

Dr. Vivek Murthy

So actually I'd love for you to dig into that. Like, what does an Awakened Campus look like if by that you mean a campus that supports the spiritual health and wellbeing and exploration of students? Like, what would that look like?

Dr. Lisa Miller

So Vivek, we formed the Collaborative for Spirituality and Education at Columbia Teachers College together with Frank Peabody and Steven Rockefeller, who you know was the dean at Middlebury and the chair of World Religions. And we spent three years together looking at many spiritually supportive educational settings. And what we found was that despite a beautiful range of cultural differences across campuses and also K-12 schools, differences in mission. Some schools were religious, some were not religious. There was a core DNA in the relational culture that was consistent both in college and in K-12 schools. And I could share with you some of the core drivers that were really universal. One was that there was a language for the transcendent reality. And oftentimes there was a pluralistic language where here we're speaking in the universal language of science, but everyone's voice and everyone's language is welcomed in a way that's inclusive and student-centered. And in that way, full of free expression. Quite constitutional, right? - Mm hm. - We wanna hear your free expression of your spiritual heart. Well, the language of transcendence was taken with respect, with interest, and as pointing to something real. A language of transcendence means that on that campus, there has been a liberation from the past 40 years of a very quiet but insidious radical materialism. There has been an evisceration of meaning held in many college campuses that any notion of God, the higher power, "Oh, prove that to me," you know? Any practice of transcendence, "Oh, that's just quieting your mind," as opposed to connecting to something real, to someone real, your higher power. So, a campus that welcomes a language of transcendence is a campus that more deeply welcomes the possibility of a sacred reality, or in academia we would say multiple ontologies. The structure of reality is not necessarily a dead inert random universe. We could very well be living in a meaningful, purposeful, sacred universe where there's a force of God or spirit in us through us and among us.

Dr. Vivek Murthy

Lisa, this makes sense, but I mean, I'm curious, why do you think this isn't happening right now on college campuses? In terms of support for a spiritual dialogue and community? Do you think it's because it's not seen as a priority? Or is it that it is, but people aren't quite sure how to do it? Or are people worried about pushback if they focus on the concept of spiritual health and wellbeing?

Dr. Lisa Miller

So, leadership on a campus needs to make clear that yes, we welcome spiritual diversity, we welcome free expression, and we support you physically, emotionally, socially, and at the deepest level of the spiritual core. Real leadership says yes, we talk about that here. The way that right now, Vivek, you are holding that torch for our country, a college president, a dean needs to take a stand and explicitly say, yes, we care about spiritual health, the spiritual core of the whole student. That's the first piece. The second piece is equally true that I've met a great number of deans and administrators who want to help, but they don't know what it looks like because there has been so little discussion in mental health and education as they were coming up both in their education and in their professional life. And here is where I think a whole new burgeoning body of science is very helpful. Because we have peer review science in top journals, "JAMA," "American Journal of Psychiatry" that says, "Yes, the spiritual core is essential to health and wellness." - Hm. - So, you're not taking a risk by supporting the spiritual core. You're actually taking a risk by silencing the spiritual core.

Dr. Vivek Murthy

Yeah, and I think that's a very powerful paradigm shift. And that research that you mentioned, I think is very helpful for people to feel that there is a scientific foundation for them to move forward in supporting spiritual dialogue. I'm also just curious on a personal level, Lisa, like how did this come to be important to you and how did you come to do research in this space?

Dr. Lisa Miller

Well, if we dial back to college campuses, I was once 19. And like every other emerging adult, I went through what I now know to be this spiritual emergence that kicks off as a developmental depression. - Hm. - And you know, Vivek, college counselors tell me, two thirds of my caseload is really not classic diagnostic mental illness. What I'm looking at is developmental depression, the coming of age, the struggle, the existential pain of knowing what is true and who are we really? And what is a meaningful life so that I can go live one? And it's to the great credit of young adults that there's deep, authentic care about how they spend their lives. So, I was no different than anyone else. I was having developmental depression. It's usually ignited by some type of life event. And in my case, well, I had my first love, my first boyfriend, and he was perfect. And I was in love. - Mm hm. - And that was at three months we'd been boyfriend and girlfriend for three months, the longest relationship I'd had at 19. And then at five months he broke up with me. - Mm, oh. - And I said, "Oh, but you said you loved me." And he said, "No, I did." I said, "But you don't love me now?" He's like, "No, but I did. I don't love you anymore." And I thought, "Well, how can that be? Love isn't permanent?" That was a horrifying thought because my mom loved me and she still loved me and my grandparents loved me and they still loved me. So I dealt for the first time with a breach of love. And it was devastating. And it set me thinking more deeply because we are primed at this point, I now know to delve existentially, well, wait a minute. If Jason loved me and now he doesn't, is Jason permanent, or is Jason impermanent? And are any of us permanent? And what really are we as a humanity? And this downward spiral was a very authentic quest to understand the nature of our human journey, the nature of our human reality. It was very, very painful because if we take seriously that everything we've ever felt might not be true, that everything you've ever told me, grandma, grandpa, mom, dad, pastor, priest, Imam, rabbi, what if that's not true? What if the universe really has no meaning? That's a very chilly, scary place to be. So I went to a mental health provider and I went to the school counseling center and I said, "Listen, I'm really depressed. I don't know if God exists and I don't know if life has any meaning and I feel really alone." And the very well-intentioned counselor said, "Well, you feel alone. Were your parents absent when you were a kid?" And I said, "No, no. My parents were very attentive." The notion that that concern was real, that it was developmentally the most important work before us as emerging adults to figure out the nature of reality and what is ultimately true was viewed as simply as downstream symptom of a biological depression. But we now know that the spiritual emergence in the young adult that boots up as developmental depression, where the longing and pain and loneliness is actually a knock at the door for an awakening, has biological correlates. We see the surge across longitudinal twin studies and the heritable contribution. We can track in MRI studies the difference between a developmental depression and real psychopathology of a diagnostic type. So, this has really been a breakthrough in honoring the importance of the formation and strengthening of spiritual health in the young adult. It's really shifted our understanding of treating all forms of longing and depression the same way to having a more nuanced ear and thinking, well, maybe this is actually the existential longing of emerging adulthood through which the spiritual foundation is built for the rest of their life. Now, what's so interesting is that as every biological capacity has a developmental arc hardwired in, we don't only go through this once. Emerging adulthood is the first of three bridges where we are hardwired to have an existential search. - Hm. - Just as we ask, what is my meaning, what is my purpose at 19, 22, at midlife, we are again, body, mind, and spirit hardwired to this time ask, have I lived my meaning? Have I followed the ultimate purpose of life? What is my spiritual footprint? We have a nickname both for what happens in emerging adulthood and at midlife. One is sophomore slump and the other is midlife crisis. - Hm. - Both of those terms are sort of colloquial, and I'm afraid trivializing of what's really going on, which is the formation of our awakened awareness so that we can inherit the next phase of our life. Just as the emerging adult needs to figure out what's ultimately true and meaningful in life so that they might go live one, at midlife, we are shifting from building our world to care for the world. And this shift requires an augmented capacity, a real deeper connection with our higher power, the sustained relationship with our higher power and the profound unconditional love towards one another that comes of relational spirituality. The third bridge is elderhood. And here as many psychologists and mental health providers have said, we wanna leave things well, we wanna clean up our mess, and we wanna also live a living legacy that is a spiritual legacy. These are profound moments of existential longing of un-clarity. And for many people, everything felt fine yesterday. I'm 48, I'm 54, and yesterday everything felt fine and today everything feels not good enough. That I'm not good enough, that this life I've built isn't good enough. Well, the not good enough feeling, the not enough feeling, we often interpret as, "Hey, my job just isn't good enough." I haven't been successful enough. Or you know what? I just don't really know if I love my spouse, if my marriage is good enough, but actually the question is deeper than that. It's an existential question that we're being called to feel, hey, how can I shift in my deep heart to be ever more? More, more loving, more present? It's a shift in our deep seat of being. It's not a shift in our outward world that we're being beckoned to address.

Dr. Vivek Murthy

Yeah. These three bridges you're talking about, these three phases of life where we are inclined to experience an acceleration and perhaps spiritual questioning, these really resonate with me personally. You're making me think about my own time in college. Perhaps it wasn't my after my freshman year, so I guess it's not sophomore slump, maybe, I dunno, freshman flop, whatever we're gonna call it. But it was a time when I had just transitioned from home to being in college. I was feeling a little bit overwhelmed with what I was doing academically in college. I was slow to build friendships and relationships. And it was a time where I found myself questioning a lot about my role, my purpose, my worth. And it was an incredibly painful, difficult time. And it came to actually mark the rest of my college experience. It became a quest for searching for a sense of purpose, a way of making sense of the world and my role in it. And it's interesting, I'm now 46 years old. I've been blessed to have a few different experiences in life and I find myself also at a place these days of just reflecting again on what my purpose is and what would feel deeply meaningful as I think about the next chapter of my life. So these really do resonate at a deep level. In the earlier part of this conversation, I think you raised some interesting points about whether or not this kind of searching and some of the pain and distress that may accompany these difficult moments in life, whether it's a breakup or a major transition, whether we're thinking about those in the right way. I think certainly these experiences in particular circumstances and without adequate support can sometimes predispose us to diagnosable mental illness, whether it's depression or anxiety or other conditions. But they also require us, I think, to think as you are saying more deeply about the origins of that and to wonder, to ask ourselves, is this part of a develop developmental process that needs to actually be met with support, with guidance, with a spiritual foundation, with the kind of social connection that can help people feel like they're not alone in their quest for purpose and meaning, but they're part of a community. And it does strike me that, as you said, many young people are coming to college with a lighter backpack, I think is how you put it, in terms of spiritual resources. The question that I have found from administrators on college campuses has often been, whose job is it to address this deeper gap, whether it's the social gap or the spiritual gap? And many of them say, shouldn't this have been addressed earlier in a child's life course? I think the answer is yes, it likely should have. We, I think we need to do a better job as a society in creating the space for these kind of conversations about one's spiritual health and wellbeing and about creating the kind of resources for people to be able to build and develop their own spirituality, starting with just acknowledging it. But I think when you fail to do that, it ends up being a challenge that colleges have to take on or the workplace has to, and ends up sort of burying the consequences of, and most importantly, the people themselves end up experiencing the form of more suffering. So I really appreciate how you're talking about this and I wanna actually delve into one other piece of this, which is, I think of a sort of spiritual phenotypes, if you will. I think one of the most challenging things I've found in talking to people about this notion of spirituality is making it concrete enough for them to understand like what constitutes their spiritual life if it isn't 100% overlap perhaps with religion or religious life. And you have, I think sort of talked about five common spiritual phenotypes, altruism, a love of neighbor, a sense of sort of oneness or community. You've talked about the practice of sacred transcendence as well as adherence to a moral code as all being like five key components of how we can start to think about our own spiritual life and development. And I was wondering if you wanted to comment a little bit on those core elements of spirituality?

Dr. Lisa Miller

Vivek, we looked all around the world. We looked in India, we looked in China, we looked of course in our beautiful United States. We looked everywhere. And in, quite by design we looked where the most, And quite by design we looked where the most, the high frequency, most highly populated faith traditions were. So, we were able to see the most highly represented faith traditions around the world as intersecting with culture and all the beautiful ways in which we are diverse. And because there is a universal spiritual brain, because there is a inborn natural spirituality, there were universal phenotypes, expressions, experiences of our natural spirituality. There is a capacity in all of us to know and feel that love is a real presence in and through life and through the universe. Just like magnetism or gravity, there's a force that is real, that is love and it is mutative. It's not just a feeling like happiness.

Dr. Vivek Murthy

I just wanna pause you there. - Yeah.

Dr. Vivek Murthy

I think what you said is really important and bears repeating. You said, "Love is not just a feeling, but it's a force in our lives that's within us, that's all around us." I mean, I think that's in incredibly powerful to think about love in that way and not just as a reflexive emotion.

Dr. Lisa Miller

And when we choose to open our heart to love, we are literally conduits of a powerful force. - And everyone around the world knows this equally. Of course there's human variability everywhere, but it doesn't matter what country you're from and it doesn't matter what faith tradition you're from, you are equally likely to know and feel that love is real and a mutative powerful force. - Hm. - The second universal phenotype is that just as we are distinct and diverse, we are also part of one family of life. White caps on one ocean. The unitive reality is every bit as much as real as the world of distinction. I tell my students at Columbia, you are a point and you are a wave. You are both. And what that means is that we are never alone. Even when I'm sitting alone in my apartment and I can't go out and maybe there's a physical reason I can't go out, or maybe I'm feeling trapped by my own anxiety or despair, there is a seat of knowing that we can tap into that is real, that at that very moment we are still part of the great unitive family of life. And that's everybody. That's everybody. And that includes fellow living beings. It is the great force in us, through us, and around us, and through us. So, we are loved and we are never alone. That is our capacity to perceive all around the world inborn, natural spiritual awareness. Now, those two are perceptual. Those two phenotypes are perceptual. The other three were found all around the world, which is an on-ramp to the perception of unitive love, which is a practice, whether it's prayer, meditation, mind, body, a process of awakening that is within our control. We can choose to engage. We control our inner environment, if you will inside our head. We can choose to shift our seat of perception. And many of us do that through prayer. Many of us do that through walk in nature or reading sacred text or beautiful poetry. We can awaken. That's a choice. And for instance, I can, Vivek, I could be in a meeting and feel really surly and frustrated and not my best self and step out for three minutes, take a moment. They don't know where I am. I could be in the restroom, at the water cooler, step outside for three minutes, and for me it's make a prayer. And my prayer is I talk to God and I say, "Dear God, please open my heart that I might be present to you in love and treat every one of your children at this table with love." And then I go back and it's a whole different meeting.

Dr. Vivek Murthy

That's a beautiful practice. I love that. Hm.

Dr. Lisa Miller

It's there for all of us. Whatever our prayer or meditation may be to choose to tap back in to the reality of this sacred love. There is also an off ramp of our awareness of unitive love, which is a moral code. It's a moral code that really rides on the back of knowing that there is a loving force in us, through us, and around us. That means it's very easy in this day and age to focus on how we're different, and then once we realize how we're different among us, we're even more different. We can splinter even further. And then we're more different and we're more different and finally, it's hard to connect, but there's actually a deep reality in which we also have one heart. And we're also about 98% identical. So, there's an on-ramp to transcendent reality, there's an off-ramp, which is knowing every single person, whether you agree or disagree, no matter what we look like as being part of this unitive reality. It's a deep yes function in the heart that we wouldn't dream of harming someone because we feel in our heart they're part of this deep love. And we wouldn't harm ourselves because there's a real sanctification, a yes in our heart of who we are. So, final fifth phenotype, which speaks so squarely to the work you've done for our country, which is altruism. Love of neighbor, service is a universal spiritual phenotype. Now, of those five natural phenotypes of our inborn spirituality, all five are important, all five are associated with cortical thickening, which is a strengthening of our brain across regions of perception and reflection and orientation. All five phenotypes change our life. But of the five, which one might you imagine which one really deepens our ability to love and connect and care?

Dr. Vivek Murthy

I think probably altruism.

Dr. Lisa Miller

Yes, yes indeed.

Dr. Vivek Murthy

Yeah.

Dr. Lisa Miller

And you might call that prayer in action when we treat one another as sacred, when we know one another in our heart, being one family of life. I love you, my sister. I love you, my brother. I totally disagree with what you just said, but I love you more deeply than what you just said. Radical love.

Dr. Vivek Murthy

Yes, and you've illustrated also that altruism hence, helps not only the person we are helping, helps us as well. And it is mutually beneficial, which I think is extraordinarily powerful. Yeah, and I think these are some great nuggets for people who are thinking about how to also build their spiritual life and contribute to their spiritual health. The notion of engaging in acts of altruism actually I think is a powerful on-ramp as you put it. And a great way again, to benefit others and benefit oneself. And just to come back to your story though, from college when you were heartbroken and you sought out some help and were asked about sort I wanted to ask you, where did you ultimately find the kind of support that you needed to do this spiritual exploration that has now benefited you for, in powerful ways for years and years? Like, what was that family members who kind of helped you in that reflection? Was that you reading on your own? Like, did you find a community that helped you dig into some of these deeper spiritual questions? Where did the help come from?

Dr. Lisa Miller

Vivek, I think when we are searching, when we are on a quest, we find that suddenly help comes from left, right, and center. So, suddenly I started meeting friends who wanted to talk about the spiritual paths and the longing of the heart and what they had figured out to be true of the sacred presence, of their higher powers as they understood the higher power. And suddenly I met teachers. There's this notion, I'm sure you know well of dharma, that on our journey we might learn something from Catholicism and learn something from Hinduism that suddenly on my road there were teachers and no one was my single teacher. I actually think the ultimate teachers within that's God, or your higher power in you. But there were many humans who showed up that were generous and taught me. And I'm very grateful that my parents, both of them, particularly my mother, raised me with a strong connection to our higher power that I watched my mother pray in a very authentic way. I mean, Vivek, she'd get tears in her eyes and she'd say, "Thank you, God for the children. Thank you God for the sunset." And when there was a problem, she would both deal with that problem directly, interpersonally, talk to us, talk to our teachers, talk, but also broaden the spiritual dimension. How do we make a spiritually grounded decision here? We can feel so trapped in our limited view of I don't know how to get out of this box and what's my next move? Do I wanna change jobs, do I wanna get back to school? Well, spinning round and round, rumination doesn't need to be the only way through that question. We can turn to our higher power for guidance. And that is a type of breakthrough that is much bigger. It reshuffles reality beyond what we might've planned.

Dr. Vivek Murthy

I'm glad that you were led to those extraordinary resources and I suspect you call them to yourself as well as part of your spiritual quest. When I was going through that, my own challenge in college of trying to make sense of the world and my place in it, I was genuinely not sure of what to do. Like there was a part of me actually, which wanted to, which had been thinking for years of becoming a monk and I was thinking about going down that pathway and leading a very different life. And then there were other parts of me, which I had dreams of what I wanted to do in the world and wondered if I should pursue that. But it was actually also people who came up in my life over the months and the subsequent years in college. Like people who ended up forming a bit of a spiritual community for me. And these turned out to be people who were asking similar questions. And we would have long conversations in the dining hall, one-on-one sometimes talking about them. We would meet on Sundays in our own sort of spiritual community, if you will, to talk about some of these issues, to read from different sacred texts and to reflect on them together. But I found that these challenges are, they're difficult to navigate on our own. And I think I say that because I think… Somehow I think we have created this expectation for people and for young people in particular, that you gotta be able to figure out all these questions on your own about purpose, about life direction, about… You gotta do everything on your own. But I think back on it, and I don't think I could have gotten through those moments alone. I think we need each other. one of the greatest amplifiers of pain is to feel like you're experiencing pain alone. And I think to know that there are others who may have similar questions or may be on a quest, if you will, for meaning and purpose, I think that's incredibly powerful. Which is why I think the kind of dialogue that you and I are talking about having in college campuses when kids are younger in society more broadly about meaning and purpose, about the spiritual life, I think these are vital to do 'cause I think if we had them, we would realize that hey, a lot of us are actually asking these questions and maybe some of this deeper yearning, maybe at the root of some of the despair that we're experiencing.

Dr. Lisa Miller

And on this quest, as you say so beautifully, we do not need to go at it alone. I called what you created back in college, a journey group. You were seekers together, a band of brothers and sisters. And this can be made on a college campus. We've done this at Columbia and Barnard. We create awakened awareness groups and we've actually, Vivek, created a multi-site study where this is now going on at Swarthmore and other, and Lewis & Clark and many colleges where young people in journey groups share from their heart their spiritual struggles, their questions, and together they treat the spiritual quest as an adventure. It can hurt. It's not always easy, but it is splendid and jaw dropping and takes you where you never dreamed you'd go. They also go at it together, And we share, for instance, the council practice that you and I just shared in our awakened awareness groups on campuses. And students will very often for the first time say, "I don't know what my higher power looks like." And they'll spend time really being with that, locating their own authentic experience. Sometimes they're sort of frustrated at the beginning 'cause they don't like the image or the word that they picked up from their family of origin, so they need to do this deep personal individuation work. And spiritual individuation is profoundly important. It's the foundation on which everything else is built. I mean, yes, you became an active monk. Look, right? I think that every campus can do this in a way that's inclusive and pluralistic and completely constitutional that nourishes the natural spiritual core of the student. And given what we now know in science that there is nothing as protective as a strong spiritual core against suicide, depression and addiction, to omit what we now know to be the foundational core of whole student development, to silence spiritual growth is really disintegrating the student. It's a form of un-health, disintegration.

Dr. Vivek Murthy

Actually, so as we come to a close, Lisa, I wanna ask you maybe last few questions on that last point, which is that for parents out there who are thinking about their own kids and maybe worried about them, who might be thinking, how can I help my child build that spiritual foundation that you're talking about, what advice for would you give to parents? And I'm asking this not just as Surgeon General, but as a dad myself of a five and 7-year-old who's thinking along with my wife, Alice, about how we raise them to have the right spiritual foundation that will serve them for life.

Dr. Lisa Miller

Your children, as you're well aware, watch you like a hawk. (chuckles) So, the ultimate statement of what's true and important is held in your being as their father or as their mother. When we walk the walk and talk the walk of our spiritual truth, they are listening and it becomes a roadmap of reality. I'll give you an example. Walk the walk means live out our spiritual values, and talk the walk means provide transparency into our own spiritual life. Pray out loud, invite them to meditate by your side, explain your own struggles, and tell your own stories of spiritual struggle and then breakthrough and realization. They will remember that the rest of their life. - Hm. - So I can share with you a a little story. When my three children were pretty young, after many prayers and tears, we were so grateful that three children came in three years and there they were, our little posse. I hadn't slept, Vivek, in two years. (Dr. Lisa laughs) (Dr. Vivek laughs) I was pretty tired and one morning, a particularly tired morning, we're at the coffee shop and I trip over a baby chair, hit the ground, and I cracked my elbow and I wasn't very pleasant, I'll have to confess, about that. And I felt badly that I'd been unpleasant to the barista. So, I stepped out. I had all three kids, we got back into my car and I just couldn't live with it. I couldn't live with the fact that I'd left this young guy, this barista with my not being very pleasant and that my kids saw it. So I said, "Oh, you know what guys, we gotta go back." (chuckles) We pull a U-turn, we go back to the coffee shop. With all three kids in tow I said, "You gotta stick with me, guys." We go up to the barista and I said, "Listen, I'm really sorry. I slipped, I broke my arm and I feel like I took it out on you and I apologize." - Hm. - And he said, He said, "Oh, you didn't have to come back. Thank you, I really appreciate it, and actually, you're one of the real nicest ladies around here." And now we're friends.

Dr. Vivek Murthy

Oh my gosh, really?

Dr. Lisa Miller

They saw that we can fix things, we can apologize, right? Then we pile back in the car and I don't turn the key yet, I whip around to the three car seats in the middle row and I say, "I'm really glad I apologize to that young man. Now, would you join me in a prayer?" And again, every family does this their own way. And for me, the prayer was, "Dear God, I'm so sorry I was unkind to that young man, your child. Please forgive me and please open my heart so that I might ever more be more loving to everyone I meet on your road. Amen.

Dr. Vivek Murthy

Ah, beautiful prayer. - What the children learn by our transparency, is that bumps in the road can be fixed both relationally and spiritually. On the Columbia campus, we have a great number of students who are very well therapized and who have fixed traumas relationally, but who we have found through very careful assessments still carry spiritual injury. - Hm. - Spiritual injury is the fixing the renewal of the deepest level. And this takes a direct targeted effort. The child can learn that through us, whatever language or truth is our own, when we open the window and let them see us apologize to God, renew ourselves, reconnect to the force in through life, nourish our spiritual heart. They know that's real, there's a way to get in, and they can do the same. It is not by picking up a book at 20 that most people cultivate the spiritual core. It is actually through the passing of the torch from parent to child, lived spiritual life, walking the walk and talking the walk.

Dr. Vivek Murthy

Oh gosh, I love that. And I think the advice that you just gave there is not only good for parents, it's good for everyone, that even if you didn't have three kids with you, that practice of re-engaging that young man, the barista, that practice of saying that prayer, and reaffirming to yourself who you wanted to be, I suspect that would've had great power even if there was nobody in the backseat, power in your own life. So I appreciate you sharing those nuggets, which I hope everyone can take away as things that they may be able to incorporate into their day to day and to help strengthen their spiritual life.

Dr. Lisa Miller

You know, Vivek, I think that oftentimes parents don't know how to talk about spirituality or they worry they'll say the wrong thing or it was pretty silent, radio silence in their family. But all we need to do is take as real and of deep interest what our children spontaneously share with us because they are naturally spiritual beings. They're not a blank slate. And then also offer back our authentic experience. I'll share with you that it was my father, really, it was within the 24 hours of when his own mother passed. It was four in the morning. I'd gotten up, I always woke up early, came downstairs, but there was my dad sitting on the carpet like not on the couch, not on a chair, on the carpet. and he looked at me in the most open, soulful way. And he said, "You know, Grandma was in my dream last night." - Hm. - And Grandma loved to dress up in pretty clothes and pretty jewelry but “in my dream," said my father, "Grandma was in a very everyday plain gray suit that she often wore with us around the house." And I'm watching my dad reconnecting with his dream open like a window. And he says, "You know, there Grandma and I were walking down the street side by side along Grand Avenue where we'd grown up together. And I take this to mean," said my dad, "That Grandma had always been my mother, she will always continue to walk with me and be with me as my mother." - So I've gone on in 20 years, and I can tell you that yes, most people on earth are aware that our ancestors walk with us, whether it's day of the dead or ancestor worship, it's part of the human knowing. But in my deep heart, I am opened and able to perceive that reality because my father transparently shared his most tender moment with me.

Dr. Vivek Murthy

Wow. What a powerful moment with your father and what a great reminder to me and all of the other parents out there, and even those who aren't parents who have kids in their lives, that it's those small moments that can have lasting impressions on the people around us. So, thank you for sharing that. And Lisa, thank you for this incredible conversation about a dimension of our lives that's so important, so rich, so powerful, but that we don't talk enough about. And I'm grateful not just for this conversation, but for all the research that you've been doing and the conversations that you were starting and accelerating in our country and even more, and beyond that is that people hopefully will understand that the efforts we put toward cultivating our spiritual health are just as important as what we may put toward our physical health. And we should recognize that in our day-to-day lives, and also as we think about our kids and about the institutions where they learn, where they play, where they pray, and where they grow up in their neighborhoods. So, thank you so much, Lisa, for this time. I'm grateful for you and I hope that we'll get to talk again soon. - Thank you for joining this conversation with Dr. Lisa Miller. I hope you'll tune into our next episode of House Calls with Dr. Vivek Murthy. Wishing you all health and happiness.