Can a Commitment to Religion or Spirituality Help Ward Off Depression’s Debilitating Hold?
Lisa Miller on Uncovering the Surprising Data That Reveals the Preventive Role of the “Awakened Brain”
It was the summer of 2012. I hurried down the narrow, fluorescent-lit hallway of the psychiatry lab at Columbia University Medical School, coffee balanced in one hand, mind racing. Today our MRI (magnetic resonance imaging) team would finally get our eyes on the results of months and months of research. Ravi, the statistical analyst, caught up to me in the hall, his eyes wide, a stunned expression on his usually composed face. He held a stack of papers in his trembling hands.
“I ran the data many times,” he said. “It’s all very surprising.”
For close to a year our team had been working long, hard hours to design and implement a cutting-edge study to peer into the brain to learn more about preventing depression. Ravi worked closest to the machines and statistics, steadily punching buttons, collecting data, modeling the findings, running numbers. Today he would show us a first glimpse of the results that would tell us whether or not spirituality plays a role in preventing or protecting against depression. I love every part of science—the push and beckon of a question, the challenge and rigor of finding the best way to test what is true—but I especially love this part of science: the first reckoning with the data. This would be our first thrilling view of where the numbers led and we hoped what we saw might help us toward a new possibility for alleviating mental suffering. We live in an age of unprecedented mental anguish. Depression, anxiety, and substance abuse have reached epidemic proportions globally.
In 2017, 66.6 million Americans—more than half of the respondents on the National Survey on Drug Use and Health—reported binge drinking within the past month, and 20 million met the criteria for a substance use disorder. Thirty-one percent of American adults will develop a full-blown anxiety disorder at some point in their lives, and 19 percent in any given year. The World Health Organization reports that 264 million people on the planet are depressed; depression is the third most costly disability worldwide. Each year, 17 million American adults are depressed. Over 16 percent of youth in late adolescence currently face depression, and the impact of depression on suicide accounts for the second leading cause of death in adolescents, rivaled only by death by auto accident.
At Columbia University, where I teach, eight students died by suicide in 2016–2017. A study of more than 67,000 college students across 108 institutions in the United States published in 2019 found that 20 percent reported that they had engaged in self-harm such as cutting, 24 percent reported suicidal ideation, and 9 percent had attempted suicide.
While the stakes of our mental health crisis are truly life and death, many of us also suffer from less debilitating, though still painful, conditions: burnout and chronic stress; trouble concentrating and connecting; loneliness and isolation; lives that are rich in many ways yet feel somehow narrow, hollow, and cut off. Even when we experience success and satisfaction, we may sense that there’s more to happiness—that life could be more joyful, rewarding, and meaningful.
It seems that every person I meet has a parent, child, sibling, partner, or close friend afflicted by depression, anxiety, substance abuse, or chronic stress. And there’s not a lot on offer for those of us worried about a loved one, or struggling ourselves. Our mainstay treatments for depression—psychotherapy and antidepressant medications such as SSRIs—provide some help to people, but for others have disappointing results. Only half of treated patients see a disappearance of symptoms within a year of intervention, while another 20 percent find only a partial reduction of symptoms; and the positive effects that are gained through medication are not enduring—when we stop taking the drugs, depression or anxiety often returns.
I hoped that today’s lab meeting might reveal even an inkling of a sustainable solution to our devastating crisis in wellness and mental health. Ravi followed me into a crowded room and we squeezed into the last two open seats around the long wood laminate table. His fingers drummed the stack of papers.Was spirituality thus far invisible in the brain because it was insignificant to mental health or impossible to measure—or was it invisible because no one had yet looked?
He usually worked with a detached, skeptical cool. “We can run the data from the scanner,” he’d said, “but I seriously doubt we’ll find anything.” Myrna, the MRI team’s most senior colleague and the one who had secured the funding for this study, had agreed, saying, “I’d be very surprised if we find any kind of association between spirituality and depression, but we shall see.”
Contemporary psychotherapy tended to characterize spirituality and religion as a crutch or defense, a set of comforting beliefs to lean on in hard times. In our field, spirituality was a barely studied, nearly invisible variable. Over the past 20 years of my career, I’d seen surprising clinical and epidemiological evidence that spirituality could have a protective benefit for our mental health. But could we discern a concrete physiological function of spirituality in our health and development? Was spirituality thus far invisible in the brain because it was insignificant to mental health or impossible to measure—or was it invisible because no one had yet looked?
Myrna cleared her throat and started the meeting.
“Let’s take a few moments to review the initial MRI findings,” she said. “I believe Ravi’s compiled a handout with the new results.”
Our team had used Myrna’s multigenerational sample of clinically depressed and non-depressed women, and their children and grandchildren. We’d taken MRI scans of people at high and low genetic risk for depression to see if there were any patterns among the brain structures of depressed and non-depressed participants that could allow us to develop more targeted and effective treatments.
And we’d added a new—and controversial—question to our study. We’d asked all participants to respond to a major question used in the clinical science literature to quantify inner life: How personally important is religion or spirituality to you? In addition to comparing the brain structures of depressed and non-depressed candidates, we wanted to see how spirituality was associated with brain structure, and how spirituality correlated with risk for depression.
Ravi’s face still looked stunned and his hands jittery as he passed his stack of papers around the room. I took a two-page color handout from the pile. It was still warm from the printer. My eyes raced over the page, taking in the results, looking for whatever it was that seemed to have rattled Ravi. It took only a moment for me to see it.
On the top half of the page was a black rectangle with two brain images inside. The scan on the left showed the composite brain image of participants with low spirituality—those who had reported that religion or spirituality was of medium, mild, or low importance. The scan on the right showed the composite brain of participants with sustained, high spirituality—those who had said religion or spirituality was of high personal importance.
The difference between the two images made my heart race and my spine tingle.
The brain on the left—the low-spiritual brain—was flecked intermittently with tiny red patches. But the brain on the right—the brain showing the neural structure of people with stable and high spirituality—had huge swaths of red, at least five times the size of the small flecks in the other scan. The finding was so clear and stunning, it stopped my breath. The high-spiritual brain was healthier and more robust than the low-spiritual brain. And the high-spiritual brain was thicker and stronger in exactly the same regions that weaken and wither in depressed brains.
The room was utterly silent.
“It’s not at all what we expected to see,” Ravi said.
The air conditioner clanked on, a loud roar amid the stillness. Then a low chuckle rose from the back of the room.
“Well, well, Lisa,” someone said.
My closest, most treasured colleagues had been skeptical. But the data was persuasive. Spirituality appeared to protect against mental suffering.
The MRI findings marked a pivotal moment on the way to my breakthrough discovery that each of us has an awakened brain. Each of us is endowed with a natural capacity to perceive a greater reality and consciously connect to the life force that moves in, through, and around us. Whether or not we participate in a spiritual practice or adhere to a faith tradition, whether or not we identify as religious or spiritual, our brain has a natural inclination toward and docking station for spiritual awareness. The awakened brain is the neural circuitry that allows us to see the world more fully and thus enhance our individual, societal, and global well-being.The awakened brain offers more than a model for psychological health.
When we awaken, we feel more fulfilled and at home in the world, and we build relationships and make decisions from a wider view. We move from loneliness and isolation to connection; from competition and division to compassion and altruism; from an entrenched focus on our wounds, problems, and losses to a fascination with the journey of life. We begin to live beyond a “pieces and parts” model of identity and a splintered, fragmented view of who we are to one another, and to cultivate a way of being built on a core awareness of love, interconnection, and the guidance and surprise of life.
I didn’t set out to study spirituality per se. My discovery of the awakened brain began with a desire to understand human resilience and help people who were struggling. Bit by bit, striking data points and my patients’ stories of hurt and healing helped me see that spiritual experience was a vital, though overlooked, component of healing.
So what is spirituality? Many of us have had experiences we might describe as spiritual. A moment of deep connection with another being or in nature. A feeling of awe or transcendence. An experience of startling synchronicity or a time when a stranger showed up and did something that changed your life. A time you felt held or inspired or buoyed up by something greater than yourself—a higher power perhaps, but also nature or the universe or even the surge of connection at a concert or sporting event.
I’m a scientist, not a theologian. Faith traditions have a lot to say about ontological questions—the nature of reality, why we’re here, the existence and guidance of God or a higher power. As a scientist, I don’t address these issues. I look at how humans are built and how we develop over the life span.
I’ve discovered that the awakened brain is both inherent to our physiology and invaluable to our health and functioning. The awakened brain includes a set of innate perceptual capacities that exist in every person through which we experience love and connection, unity, and a sense of guidance from and dialogue with life. And when we engage these perceptual capacities—when we make full use of how we’re built—our brains become structurally healthier and better connected, and we access unsurpassed psychological benefits: less depression, anxiety, and substance abuse; and more positive psychological traits such as grit, resilience, optimism, tenacity, and creativity.
The awakened brain offers more than a model for psychological health. It gives us a new paradigm for being, leading, and relating that can help us act with greater clarity and capability as we face humanity’s greatest challenges. We can evolve our work and school culture toward greater purpose and meaning. We can revise our governments and health and social service institutions to better support and serve all. We can see our choices and the consequences of our actions through a lens of interconnectedness and shared responsibility. And we can learn to tap into a larger field of awareness that puts us in better touch with our inner resources, with one another, and with the fabric of all life.
Excerpted from The Awakened Brain: The New Science of Spirituality and Our Quest for an Inspired Life. Used with the permission of the publisher, Random House, an imprint and division of Penguin Random House LLC, New York. Copyright © 2021 by Lisa Miller, Ph.D.