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Books by Lynn Underwood

Spiritual Connection in Daily Life, by Lynn Underwood, introduces sixteen simple questions that i... more Spiritual Connection in Daily Life, by Lynn Underwood, introduces sixteen simple questions that invite us to become more aware of experiences such as deep peace, joy, sense of inner strength, and giving and receiving love. The questions form Underwood’s Daily Spiritual Experience Scale, used in hundreds of studies and projects, translated into thirty languages, and used for years by counselors, therapists, nurses, clergy, and social workers. Spiritual Connection in Daily Life offers a step-by-step guide to using these questions to cultivate richer, deeper, and more satisfying lives. People with many different kinds of spiritual beliefs will also find a common language for communicating with others about the role of the “more than” in their lives.

Papers by Lynn Underwood

Altruism and Altruistic LoveScience, Philosophy, and Religion in Dialogue, 2002

American Journal of Psychiatry, 2007

AIDS Care, 2004

Assessment of quality of life (QoL) in persons living with HIV/AIDS (PLWHA) is becoming crucial t... more Assessment of quality of life (QoL) in persons living with HIV/AIDS (PLWHA) is becoming crucial to research and evidence-based practice in this area. This paper describes the analysis of the WHOQOL HIV field test instrument, which was given to 1,334 PLWHA from seven culturally diverse centres (Australia, Brazil, Italy, Thailand, Ukraine and two centres in India: Bangalore and New Delhi). The instrument demonstrates good psychometric properties (alpha values for domains between 0.70 and 0.90) and good discriminant validity, with poorest QoL found for those who reported that they were least well. Men reported poorer physical well-being (F=13.1, p<0.001) and level of independence (F=16.1, p<0.001), while women reported poorer environment (F=25.8, p<0.001), social support (F=11.3, p<0.001) and spirituality (F=7.5, p<0.01). Older people (>34 years) demonstrated poorer QoL on physical (F=20.6, p<0.001) and levels of independence (F=18.3, p<0.001), while younger people showed poorer environmental (F=34.6, p<0.001) and spiritual (F=23.5, p<0.001) domains of well-being. The instrument provides a promising means for QoL assessment for HIV/AIDS in diverse cultural settings.

Altruism & altruistic love: science, philosophy, & religion in dialogue, 2002

This section takes up some of the social scientific research into the nature and reality of altru... more This section takes up some of the social scientific research into the nature and reality of altruistic acts, altruistic love, and compassionate love. The studies examine rescue behavior that places the agent at risk, as well as daily acts of love, care, and kindness which seem to be based on valuing the other and to be primarily motivated by desire for the good of the other. The studies in this section address underlying motivations, as well as observable actions. They also highlight the disagreement in social science over the authenticity of ...

The Daily Spiritual Experience Scale (DSES) is a 16-item self-report measure designed to assess o... more The Daily Spiritual Experience Scale (DSES) is a 16-item self-report measure designed to assess ordinary experiences of connection with the transcendent in daily life. It includes constructs such as awe, gratitude, mercy, sense of connection with the transcendent and compassionate love. It also includes measures of awareness of discernment/inspiration and a sense of deep inner peace. Originally developed for use in health studies, it has been increasingly used more widely in the social sciences, for program evaluation, and for examining changes in spiritual experiences over time. Also it has been used in counseling, addiction treatment settings, and religious organizations. It has been included in longitudinal health studies and in the U.S. General Social Survey which established random-sample population norms. It has publications on its psychometric validity in English, Spanish, French, Portuguese, German and Mandarin Chinese. Translations have been made into twenty languages including Hindi, Hebrew and Arabic and the scale has been effectively used in a variety of cultures. The 16-item scale does not have a psychometrically representative shorter form although a 6-item adaptation has been used. The DSES was developed using extensive qualitative testing in a variety of groups, which has helped its capacity to be useful in a variety of settings. It was constructed to reflect an overlapping circle model of spirituality/religiousness and contains items that are more specifically theistic in nature, as well as items to tap the spiritual experience of those who are not comfortable with theistic language. The scale has been used in over 70 published studies. This paper will provide an overview of the scale itself, describe why it has proved useful, and discuss some studies using the scale. See http://www.dsescale.org/ for more information on the scale.

Journal for the Scientific Study of Religion, 2020

Social scientists have increasingly recognized the lack of diversity in survey research on Americ... more Social scientists have increasingly recognized the lack of diversity in survey research on American religion, resulting in a dearth of data on religion and spirituality (R/S) in understudied racial and ethnic groups. At the same time, epidemiological studies have increasingly diversified their racial and ethnic representation, but have collected few R/S measures to date. With a particular focus on American Indian and South Asian women (in addition to Blacks, Hispanic/Latinas, and white women), this study introduces a new effort among religion and epidemiology researchers, the Study on Stress, Spirituality, and Health (SSSH). This multi-cohort study provides some of the first estimates of R/S beliefs and practices among American Indians and U.S. South Asians, and offers new insight into salient beliefs and practices of diverse racial/ethnic and religious communities.

Altruism and Altruistic LoveScience, Philosophy, and Religion in Dialogue, 2002

American Journal of Psychiatry, 2007

AIDS Care, 2004

Altruism & altruistic love: science, philosophy, & religion in dialogue, 2002

Journal for the Scientific Study of Religion, 2020

Progress in studying the relationship between religion and health has been hampered by the absenc... more Progress in studying the relationship between religion and health has been hampered by the absence of an adequate measure of religiousness and spirituality. This article reports on the conceptual and empirical development of an instrument to measure reli-giousness and spirituality, intended explicitly for studies of health. It is multidimen-sional to allow investigation of multiple possible mechanisms of effect, brief enough to be included in clinical or epidemiological surveys, inclusive of both traditional reli-giousness and noninstitutionally based spirituality, and appropriate for diverse Judeo-Christian populations. The measure may be particularly useful for studies of health in elderly populations in which religious involvement is higher. The measure was tested in the nationally representative 1998 General Social Survey (N = 1,445). Nine

Religions, 2021

This paper describes the development and initial psychometric testing of the baseline Spiritualit... more This paper describes the development and initial psychometric testing of the baseline Spirituality Survey (SS-1) from the Study on Stress, Spirituality, and Health (SSSH). The SS-1 contains a mixture of items selected from validated existing scales and new items generated to measure important constructs not captured by existing instruments, and our purpose here was to establish the validity of new and existing measures in a racially/ethnically diverse sample. Psychometric properties of the SS-1 were evaluated using standard psychometric analyses in 4563 SSSH participants. Predictive validity of SS-1 scales was assessed in relation to the physical and mental health component scores from the Short-Form 12 Health Survey (SF-12). Scales exhibited adequate to strong psychometric properties and demonstrated construct and predictive validity. Overall, the correlational findings provided solid evidence that the SS-1 scales are associated with a wide range of relevant R/S attitudes, mental h...

Research in the Social Scientific Study of Religion, Volume 30, 2019

British Journal of Cancer, 1991

All cases of cutaneous malignant melanoma, CMM, diagnosed in Northern Ireland between 1974-1978 w... more All cases of cutaneous malignant melanoma, CMM, diagnosed in Northern Ireland between 1974-1978 were reviewed, classified and followed up until the end of 1984. The overall 5 year survival is 54%, among the worst reported in recent literature. Multivariate analysis of these cases confirms some previous findings from other studies, but also reveals features not apparent in univariate analysis. Prognosis worsens with increasing thickness and the presence of ulceration. Likewise histopathological type has an independent effect on survival, ALM having the worst prognosis. Tumour profile emerges as a significant feature affecting prognosis, flat lesions having the poorest outlook, given their thickness. Survival is worse with increasing age. Anatomical site is less important than suggested by previous univariate analysis. Sex has little influence on prognosis when adjusted for the other variables. Cell type and pigmentation are of no prognostic value. Several features including diagnostic delay contribute to the poor overall survival for CMM in Northern Ireland. Educational intervention is essential if this trend is to be reversed.

British Journal of Cancer, 1986

Three hundred and four suspected cases of malignant melanoma diagnosed in Northern Ireland over a... more Three hundred and four suspected cases of malignant melanoma diagnosed in Northern Ireland over a 5 year period have been reviewed. Two hundred and forty fulfilled the diagnostic criteria of invasive cutaneous malignant melanoma (CMM) and were accepted as suitable for analysis an incidence of 3.12. The female to male ratio for CMM in this study is 3:1. This excess of female lesions occurs at all major anatomical sites and for all tumour types. There are many thick melanomas in the province, and 67% of cases were greater than 1.7mm thick. Each tumour type has a distinctive age curve. The implications of these findings are discussed. The evidence suggests that intrinsic factors are as important as extrinsic factors.

Part 1: Definitions 1. The ABCs of Altruism 2. Pythagorean Bodies and the Body of Altruism 3. Mor... more Part 1: Definitions 1. The ABCs of Altruism 2. Pythagorean Bodies and the Body of Altruism 3. Morality, Altruism and Love 4. The Tradition of Agape Part 2: Human Motivation and Action 5. The Human Experience of Compassionate Love: Conceptual Mapping and Data from Selected Studies 6. Addressing the Altruism Question Experimentally 7. Explicating Altruism 8. Extraordinary Acts of Ordinary People: Faces of Heroism and Altruism Part 3: Evolutionary Biology 9. A Darwinian Naturalist's Perspective on Altruism 10. Relating Self, Others, and Sacrifice in the Ordering of Love 11. The Fall and Rise and Fall and Rise and Fall and Rise of Altruism in Evolutionary Biology 12. Some Obstacles to Altruism 13. Emerging Accounts of Altruism: "Love Creation's Final Law"? Part 4: The Science of Altruism 14. Implications for the Neurobiology of Love 15. A Note on the Neurobiology of Emotion 16. Impairment of Interpersonal Social Behavior Caused by Acquired Brain Damage 17. The Communication of Emotions and the Possibility of Empathy in Animals 18. Empathy, Evolution and Altruism Part 5: Religion 19. Science and Religion on the Nature of Love 20. Separation, Attachment, and Altruistic Love: The Evolutionary Basis for Medical Caring 21. Compassion out of Wisdom: Buddhist Perspectives from the Past toward the Human Future

The talk describes how the Daily Spiritual Experiences Scale can be useful for large scale cohort... more The talk describes how the Daily Spiritual Experiences Scale can be useful for large scale cohort studies of the Underserved, studying Health Disparities and Genomics. It summarizes development of the scale and its use in research. www.dsescale.org

The kinds of things that help to give life meaning, purpose, and satisfaction are often grounded ... more The kinds of things that help to give life meaning, purpose, and satisfaction are often grounded in concepts we term religious or spiritual, a sense of the “more than” in daily life. This can be the case for those who find roots in religion as well as those not comfortable with religious language. Spiritual and religious attitudes and values help to shape: how people view the world, what they consider important, what they do, how they act, how they feel, identity and affinity, and also why they may mistrust or hate other people.

The Daily Spiritual Experience Scale (DSES) is a set of 16 multiple-choice questions, psychometrically validated, which can be also be used in an open-ended way. It measures ordinary experiences of relationship with, and awareness of, the divine or transcendent. It measures experiences rather than beliefs, and the ordinary rather than the extraordinary. It has been used in over 150 published studies, linking it to many good outcomes for many kinds of people. Tens of thousands of people have taken the test, and it has been translated into over 30 languages. It has proven useful for most religions and in secular settings for those not comfortable with religion. The DSES is proving to be helpful for assessment, personal exploration, and communication in interpersonal, therapeutic, organizational settings.

This presentation and the subsequent extended discussion with faculty, students, and fellows, explored ways that the questions might be useful for communication between people of different beliefs, allowing them to share about things that are important in their daily lives. Exploring answers to the questions can allow people to connect with others about things that have value and meaning to them without coming up against the walls that discussion of beliefs can lead to. Common ground can be found in the depths of the discussion, even when beliefs differ. This can be helpful in the resolution of conflict, and building bridges in peacemaking process. DSES scores have also been linked to less burnout in practitioners of various kinds.

This hour-long live radio broadcast with call-ins explored the topic of Unconditional Love, Compa... more This hour-long live radio broadcast with call-ins explored the topic of Unconditional Love, Compassionate love. The hosts are Philosophy Professors from Stanford University, and Lynn Underwood was the guest.

Research shows that the metaphors we use affect our behaviors and attitudes in significant ways t... more Research shows that the metaphors we use affect our behaviors and attitudes in significant ways that we are often unaware of. The machine metaphor recurs in our descriptions of the brain and the overall functioning of the body and has become an automatic default. It can be useful in simplifying complex systems, and medical training encourages this. Even efforts to promote humanism in medicine slide in this direction, as communication, empathy and ethical decisions are formulated in mechanistic terms.
Self-reports by the person who is suffering are essential to the identification of the roots of the problems and opportunities for treatment, even when no “physical” causes are found. However if one buys into the machine metaphor too much, the experience of the person is given less weight in the overall assessment, while objective features such as brain scans, blood chemistry and physiologically evident symptoms are given the final say. Measurements based solely on a machine model lead to interventions that presuppose a kind of person that is not congruous with the way we live our lives, and what we value most in ourselves and others. Visual art, film and literature can provide ways of viewing the human person that can counteract the machine metaphor, and open opportunities for creative approaches to treatment and evaluation of outcomes. This presentation will specifically use self-portraits and portraits by others, of those with chronic disease, disability and mental distress, to highlight this approach.

Recent research has asserted the value of incorporating the spiritual orientation, concerns and n... more Recent research has asserted the value of incorporating the spiritual orientation, concerns and needs of the patient into the healthcare relationship, and accreditation requires attention to this aspect of the patient. In this way we can attend to beneficence and respect for patient autonomy. These aspects of the patient may play an important role in patient decisions, behaviors, concerns, priorities and feelings, especially in certain clinical situations. However attempts to address the spiritual aspects of the person can raise a number of ethical problems: Lack of caregiver sensitivity and competence in this arena can lead to offense, alienation or harm. Differences in beliefs can raise barriers. Religious language can be a conversation stopper and impair communication and care. Discussion of religious and spiritual issues can lead to proselytizing or religious prescribing which can violate the patient’s autonomy. Use of the Daily Spiritual Experience Scale and the questions it includes can help to deal with these problems and facilitate mutual understanding. This presentation will also address some of the ethical values and issues incorporated into the scientific design of the questionnaire that have been critical to its effectiveness and have ethical implications for our general approach to designing and administering questions for research and patient care.

The arts and humanities are essential to effectively grapple with the questions that arise from a... more The arts and humanities are essential to effectively grapple with the questions that arise from advances in neuroscientific technologies and treatments. They are essential for medical practitioners as they make treatment and policy decisions. But even those not professionally involved with health care need the arts and humanities as we make decisions about what kinds of pharmaceutical and neurosurgical interventions are appropriate for ourselves and those we care for, policy decisions regarding issues such as human responsibility within health care and criminal justice, and decisions about how to regulate and respond to marketing of neurotechnologies of various kinds.
Also, neuroscientists and interpreters of neuroscience make claims about how ethics operates and the nature of the human person. The humanities can provide us with tools for doing the kinds of reflection necessary to effectively accept or discard these claims. The arts can help to reveal qualities and issues in novel and useful ways.

This presentation will lay out the scope of the problems, and highlight some particularly thorny issues. Also, it will outline some of the ways to engage students, those in the health sciences and others, with these topics using the humanities and arts to better equip them for the particular challenges neuroscientific knowledge and technologies have brought to the fore. In this context the presenter will draw on four years of classroom experience teaching both Neuroethics and general medical humanities using these methods.

Examination of how we envision the nature of the human person is essential to adequately address many of the issues that increasing knowledge and technology in neuroscience has raised. Film, memoir and poetry, as well as insights from philosophy and religious studies, can usefully inform our decision-making and attitudes. The visual arts, particularly portraiture and self-portraiture can give us special insight into the nature of the human person. The emergence of popular and scientific appreciation for the complexities of decision-making enable us to see why approaching a complex topic through the arts can give insight that can complement and enhance other kinds of analysis. The arts can enable us to enter into situations in ways beyond merely speculating on how we think we would feel in a given situation. Empathic engagement as well as enhanced sensibilities can result from the inclusion of the arts and humanities in these discussions.
The presentation will outline some of the issues and give specific examples of humanities and art resources that have been effectively used in teaching situations.