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Join clinical psychologist Lisa Miller and neurosurgeon Philip E. Stieg as he discusses how the human brain is hard-wired for connection and the neuroprotective effects of spirituality. Discover practical ways to cultivate a sense of community, enhance mental health, and find joy in reconnecting with nature.

Lisa Miller is a clinical psychologist and author of The Awakened Brain; The New Science of Spirituality and Our Quest for an Inspired Life.

Philip E. Stieg is a neurosurgeon and host, This Is Your Brain podcast.

They discuss the KevinMD article, “Awaken your brain for a happier, more connected life: the key to combating depression and isolation.”

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Transcript

Kevin Pho: Hi, and welcome to the show. Subscribe at KevinMD.com/podcast and get CME for this episode by clicking on the CME link in the show notes. Today we welcome Lisa Miller and Philip Stieg. Lisa is a clinical psychologist and author of the book The Awakened Brain: The New Science of Spirituality and Our Quest for an Inspired Life. Philip is a neurosurgeon and host of the This Is Your Brain podcast. Together they wrote the KevinMD article “Awaken your brain for a happier, more connected life: the key to combating depression and isolation.” Lisa and Philip, welcome to the show.

Lisa Miller: Thank you.

Philip E. Stieg: Thank you, Kevin.

Kevin Pho: So I’m going to ask each of you just to briefly share your story and journey. Lisa, why don’t you go first?

Lisa Miller: I started out as a clinical psychologist in the late ’90s, working on inpatient units in New York City. What I quickly came to see at that time was very bright, well-trained, well-intentioned people using the models of the time, working together, but we simply were not seeing patients get better. It was not the case that people with recurrent major depression, with forms of the diseases of despair, were getting better.

And I started hearing patients asking for what they needed, which was a connection of the spiritual heart. They wanted to sit by my side: “Please, will you pray with me, Dr. Miller?” “Who’s going to hold Yom Kippur on the service? The chaplains and doctors are leaving.” There was a spiritual hunger, and in our most painful moments, it is there for all of us.

So that launched what has been, for me, 25 years of clinical science looking at what turns out to be an innate capacity for spiritual life in every one of us. Whether through the lens of a twin study or an MRI study, time and time again a strong, bold signal is clear: We are naturally spiritual beings. And when we realize this innate capacity, we are far more resilient. We are far more equipped, not just for recovery but for renewal. It is really the seat, the hub of the wheel, from which we are built.

Kevin Pho: And we’re going to talk about that more when we get to your article. But first, Philip, just briefly share your story.

Philip E. Stieg: And so mine’s a little bit different. I have to say that I came from a spiritual background, but then I went into science and got my PhD in an area that didn’t really exist when I got it. It was called neuroscience; back then, that wasn’t a subject matter. During that process, I realized that I needed more regular, instant feedback than I was getting from science, which takes years to achieve something meaningful. So I went back to medical school to become a neurosurgeon, and then my career progressed along academic lines. I started at UT Southwestern, then I went to Harvard, spent some time at the Karolinska Institute, and finally arrived here at Weill Cornell Medicine at NewYork-Presbyterian Hospital as the professor and chairman.

And then, as that career progressed, I also said that I wanted to pay back, or give back. So I had an NPR radio show for a while; that all changed. And so then I started the podcast This Is Your Brain to try to educate people about the importance of maintaining brain function, and that led to the delightful meeting with Dr. Lisa Miller, so we could talk about bringing my life full circle, combining spirituality with brain health.

Lisa Miller: It’s been such a joy to get to know Phil. When I was on this podcast, we realized we had so much to talk about that we decided to collaborate.

Kevin Pho: Excellent. So let’s talk about this article, titled “Awaken your brain for a happier, more connected life: the key to combating depression and isolation.” So Lisa, tell us, how did this article come about?

Lisa Miller: Thirty years ago, we threw all religion out of the public square and actually became radically exclusive. We threw the spiritual baby out with the bathwater. We became a non-conversant society, and so too we also lost the rich embrace of spiritual pluralism. As a society, we’ve grown up. We have worked hard on diversity and inclusivity around race and gender and orientation, and we’re now up to bat. It is time to lean forward and make a rich embrace around spiritual diversity, so that we can be free. I want to know you in the most deep and important way.

So that is how we got here. We have a society which is, for the moment, non-conversant about spiritual life. And what this means is that 40 years is long enough for someone to grow up and have a child who grows up and is now in Gen Z. And sure enough, there have never been levels of personal spiritual life, personal faith observance, as low in any generation in the United States as we now find in Gen Z. And indeed, statistically, the sharp decline in spiritual life in Gen Z goes hand in hand with the pandemic in the diseases of despair. In Gen Z, the rate of death by suicide rivals the rate of death by auto accident as the number one killer. If you were to say there was a dystopic film in which young people took their lives, it would be where we are now. This should be on the front page of every major paper every day. This is our crisis.

Kevin Pho: And Lisa, what are some of the reasons why there’s been a deficit of spiritual conversation over the past few decades?

Lisa Miller: Right now we have a generation, Gen Z, who for the first time may have never prayed or meditated or done any type of transcendent practice by the side of a parent or a grandparent, who may have never read any sacred text with an eye toward it being real, ontologically real, as reflecting something built into the fabric of life itself. Implicit in the air and water of academia is really an evisceration of meaning. The so-called skeptic is viewed as somehow sharper if the skeptic can eviscerate all meaning out of life.

But that is not our only human capacity for knowing. Just as we’re endowed with logic and empiricism, we are endowed with hardwired ways of knowing, organic epistemologies, if you will: intuition, mystical awareness, built to be able to perceive into the deeper layer of life. And so I invite people to be a little bit curious, to listen to the pang of hunger for more, and say yes. We now have a science that can speak to the skeptic long enough to satisfy the hunger of the empiricist, because the good science is now published. And there, I invite you to open up other parts of yourself and see if maybe there is a deeper way of knowing that you might feel, and long ago perhaps there was a way paved through prayer, meditation.

Philip E. Stieg: Part of the conversation that we had on the podcast, however, was that fundamentally, humans are designed for connectivity, for being and for sharing. And what has happened over these past 40 years, with the industrialization of society and the mobility of society, is our families have moved apart. I just had a family reunion. My family lives in California, Oregon, Chicago and Wisconsin. When I was a kid growing up, every Sunday the extended family got together, and you learned how to connect and share.

I think also the spirituality component is where I’ve changed. It isn’t necessarily organized. We’re not talking about theology and doxology; we’re talking about a walk in nature, so you feel the presence of that being or whatever, and you actually have time to reflect and contemplate on who you are. And all of those activities, I personally believe, reduce the polarization that we’re all seeing in society right now, which leads to depression and isolation.

Lisa Miller: Spirituality is innate. Whereas religion is 100 percent environmentally transmitted, we are all, from day one, inborn naturally spiritual beings, and we have identified the neural docking station through which we are built to see and know, to perceive, that we are loved and held, guided and never alone. In studies, this is an innate capacity. And when we operationalized what had been found in twin studies into a scanner task for MRI studies, we saw exactly where in the brain there are circuits through which we know and perceive a transcendent relationship: We are loved and held, we are never alone, and we are guided. There’s even a shift in our attention network through which we find new openings and new doors. We are built to be on the spiritual path.

Kevin Pho: So Philip, let’s talk about that intersection between spirituality and patient care. Talk a little bit more, from a physician standpoint, about where that comes into play when, say, taking care of patients.

Philip E. Stieg: Importantly for me, well, let’s describe what the problem in medicine is right now. It’s access, and it’s time. A patient now not only has the family doctor; they’ve got 20 other consulting doctors, and the flow of information is complex. It’s gotten better with the electronic medical record. But what I’ve done personally is, when a patient walks into my room, the first statement isn’t “Well, I’ve looked at your MRI, here’s what we’re going to do.” It’s “I see you’re a 50-year-old right-handed woman, married, single, children.” And then I ask, “What are the stresses? What do you do on a day-to-day basis? What are your goals in life?”

All of that gives me a little bit of a framework for what I think the patient is going to value when I tell them they’ve got an aneurysm in their head or a large brain tumor, because a lot of the decisions that they have to make are variable. We’re talking about quality of life versus saving life. Obviously, if somebody comes into the emergency room with a traumatic injury, there aren’t many decision processes; you have to do what you have to do. But for elective kinds of things, you have to engage the patients so that they feel like you’re trying to know who they are. And I believe strongly that because of that, they trust my opinion more.

Kevin Pho: So Philip, what kind of questions would you ask the patients to address that spiritual component?

Philip E. Stieg: You kind of get a sense when somebody’s talking. I mean, I’m from the Midwest, so I don’t really beat around the bush very much. I say, “Are you religious?” And if somebody comes across to me as being depressed, I’ll say to them, “Do you have a minister, a rabbi or whatever? Is there somebody there that you can talk to?” If not, then I would get them to a neuropsychologist to start with, and then escalate it up, maybe to a psychiatrist, where medication might be essential.

Lisa Miller: Well, whoever gets Dr. Phil is very fortunate. I will say that sometimes someone comes in through the ER and there’s someone who’s been a resident for three weeks, and we have found you can have three very simple standard questions: Is spirituality and religion important to you? Does it have something to do with what’s going on now? And would you like spiritual or religious support? In my work with the U.S. Army, those three questions have been implemented. They’re so simple and patient-centered. So it doesn’t matter what faith tradition the treating therapist might be; it is a patient-oriented series of questions, in their voice and language.

Philip E. Stieg: And one thing is, there’s been a lot made about diversity in that, and personally, I really try to make an attempt at being diverse, trying to understand an individual’s cultural background. I mean, I’m never going to know what it means to be Black or Chinese or Indian, but I certainly try to portray to them that I’m willing to have that conversation and be open to making suggestions that would be relevant to them.

Kevin Pho: So Lisa, I’m in a primary care setting, and you mentioned in the article that there’s that connection between spirituality and how we can address things like anxiety and depression. So talk more about that connection.

Lisa Miller: There’s a very strong body of peer-reviewed, published science that shows tremendously robust protective effects of spirituality against the diseases of despair, depression and anxiety. For instance, take a standard deviation above as compared to below the mean, where adolescents will say, “I turn to my higher power, God, Hashem, Allah, the universe, in times of difficulty. I seek direction. I am loved and held, guided.” That capacity for the transcendent relationship, versus “I don’t really know what you’re talking about; maybe something’s going on.” A standard deviation above as compared to below the mean is associated with an 80 percent decreased relative risk of going through the window of risk, the trailhead to a lifetime course of substance abuse.

In a meta-analysis, a study of studies, all good empirical studies rounded up to yield, tragically, 2,000 completed suicides and 5,000 matched controls, there’s a 62 percent decreased relative risk of completed suicide. That went up to 82 percent protective when spiritual life is shared. This is how we are built.

In the air and water of our frozen public square, we have become a radically transactional society: What do you do? What can you do for me? Where are your kids? But actually, we are not built to live transactionally, alone. We’ve become radically materialist, for not speaking of spirit or the deeper source in life. We’ve become stuck on things and material objects. We are not built to be radical materialists, and our kids are sick and suffering. The greatest gift we can give them, in primary care, in therapy, in parenting, schools and grandparenting, is support for their natural birthright, the strengthening and awakening of their spiritual core.

Kevin Pho: So Lisa, take us into one of your therapy sessions. You shared a few powerful statistics. Maybe put that into a little bit of an anecdotal story, where you incorporated spirituality and moved the needle for a particular individual.

Lisa Miller: When is spirituality relevant? At every moment, whether we’re talking about treatment, prevention, wellness or formation. The spiritual core is always the center, the seat of perception through which we know who we are, what we’re doing here on Earth and how to treat each other.

So right now on the Columbia and Barnard campuses, at the level of wellness and formation, we see tremendous hunger among our Gen Z students, the yearning, which is a hardwired yearning. It is literally a hardwired process, a surge, a quest for spiritual individuation. And when this capacity for spiritual life boots up in young adulthood, it feels like a half-empty glass of spirituality: What is my purpose? What is my meaning? And I don’t mean, am I going to be a doctor or lawyer or teacher. I mean, as a soul on Earth in this life I’ve been given, I want to know what a meaningful life is, so I can go live one, in an ultimate sense.

And so we now offer spiritually oriented formation and wellness groups. They’re called Awakened Awareness groups, drawing on the science in The Awakened Brain. This has now become a multisite study: Barnard and Columbia and Lewis and Clark and Swarthmore and Utah Tech and William and Mary. All these schools are seeing the same challenge, and there is an answer. Your students have a spiritual hunger, and traditionally, coming of age has been about crossing the bridge to an augmented spiritual understanding and contribution in our world.

Kevin Pho: We’re talking with Lisa Miller and Philip Stieg. Lisa is a clinical psychologist and author of the book The Awakened Brain: The New Science of Spirituality and Our Quest for an Inspired Life. Philip is a neurosurgeon and host of the This Is Your Brain podcast. So I’m going to ask each of you for the path forward when it comes to that intersection between spirituality and our wellness and mental health, and then maybe end off with some take-home messages for our clinician audience. So Philip, why don’t you go first?

Philip E. Stieg: So you leave the hardest question for last, I see. The path forward, I think, is that individuals really need to become a little bit more introspective. We have to become less consumer-oriented, less consumption-oriented, and more thoughtful about ourselves. How do we feel when we look in the mirror? Is there anxiety, or is there pleasure? When we’re sitting with our family, is there anxiety or pleasure? And be thoughtful about those interactions. And then, once we are comfortable in that smaller sphere, I would hope that we become more comfortable in our social interactions.

One other key component in my mind for the path forward is, I think, in the educational system. One thinks about all of the things that our children are being forced to learn right now, which I think are extraneous and should be taught by the family. The one thing that we don’t teach well is how to be a parent. A parent teaches the children how to think, how to be reflective. Hopefully they give them some spiritual sense, either religious or nature or whatever. But if we started teaching at a young age what it is to be a real parent, I think we could alleviate a lot of the problems that we’re seeing today.

Kevin Pho: And Lisa, tell us the path forward, and end off with some of your take-home messages.

Lisa Miller: When we look at the data, two-thirds of depressions, of struggles, of times of despair, are developmental depressions. It is depression as a knock at the door for a spiritual awakening, a deepening: What is life showing me now? How can I love more deeply? How can I love regardless of what comes back? This type of profound, sacred look into who I am going to be is the response, a spiritual response to suffering. And every time we do this, we strengthen the muscle. We literally thicken the cortex of the regions of the awakened brain, so that it becomes a go-to way of looking and being in the world.

So depression is not lost time or downtime. Depression is the opportunity of our lifetime for a deeper awakening, from an achieving awareness that is radically unilateral, “What do I want? How am I going to get it?” to “Hey, I didn’t get it, so what is life showing me now?” And that’s a double door that could take us on something much more like an adventure, a spiritual quest.

Philip E. Stieg: And just one comment. I used to hate saying this, but I view the brain as another organ, or as a muscle. I think it’s the most unique organ that we have, but it can adapt, and it can change over time, and it has its own disease processes. The difficult thing is most people don’t want to talk about their psychological problems or their emotional problems or their spiritual problems, and as a society, we have to teach ourselves that it is acceptable to talk about those things, and it’s fixable. There’s hope at the end of the day, rather than “I am what I am, and I’m stuck with it for the rest of my life. I’m going to be this grump around everybody.” No, it doesn’t have to be that way. It’s like any other organ. You’ve got a bad heart, you get new stents. You’ve got a bad hip, you get a new hip. You’ve got a bad brain, you start working at trying to structure it. And there is considerable data that shows that the more you concentrate on certain things, like Lisa was saying, if you are spiritual, the cortex, the thickness of your brain, is thicker, because you do those things. It’s a fixable organ.

Kevin Pho: Lisa, Philip, thank you so much for sharing your time and insight. Thanks again for coming on the show.

Lisa Miller: A joy to join you.

Philip E. Stieg: Thank you very much. Really appreciate it.