Lynn G. Underwood is Vice President of the Fetzer Institute, a non-profit private foundation, where she develops collaborative research projects with other organizations and does program planning, review, and evaluation. She received her Ph.D. in Epidemiology from Queens University School of Medicine in the United Kingdom following medical studies at the University of Iowa School of Medicine. She spent ten years in the field of cancer epidemiology doing research into pathogenesis, prevention, and early detection. Subsequent work in study design led to teaching clinical trials at Case Western Medical School in the Department of Epidemiology. She co-edited Measuring Stress, a text intended as a tool to help in study designs examining the interface between stress and health, published by Oxford University Press. She has led the development and co-sponsorship of various workshops with the National Institutes of Health, including one on the biobehavioral aspects of pain with 10 NIH Institutes, one on stress and asthma with the NHLBI, and one on spirituality and aging with the NIA. She also develops Fetzer-sponsored research funding initiatives. Current research interests include the role of various dimensions of religiousness and spirituality in living with disability.

Compassionate love is seen as a valuable aspect of life, and one that should be fostered and encouraged. To adequately conduct research that might aid this, it is important to clearly articulate the various essential components of compassionate love, the conditions that might foster it, factors that might impede its expression, in addition to developing methodologies for assessment. There is something essentially ineffable and powerful in the reality that the terms agape, compassion, unconditional love, and self-giving love try to describe. Altruism is nested within them, but these terms, which might be summarized as compassionate love, capture an investment of self deeper than the practical.

Key Features - Free choice for the other, within the limits of one’s own freedom. “Compassion is a manifestation of love. And love, whatever else it may be, is something that involves choices. Love is the one true source of freedom in the midst of the suffering human finitude entails. Choosing between options is a condition of freedom in finitude.” (Sulmasy, 1997).

Cognitive understanding of the situation. This includes evaluations of contexts and meaning in religious and nonreligious frameworks. Ethical judgments and issues of justice can enter in here, as can knowledge of the details of culture and individual differences. To value the other at a fundamental level is essential.

Understanding of self. This includes knowing ourselves adequately in order to choose as freely as possible. To express compassionate love, we need to set aside our own agendas, let go for the sake of, to strengthen, to give life to the other. Seeing clearly our own agendas is important.

Openness and receptivity. This includes the awareness of being part of something important beyond oneself, and the freedom to let oneself be open. The role of divine inspiration could also be included here. This attitude also allows one to see opportunities for the expression of compassionate love.

Response of the heart. The emotional part of the brain is essential to much of good decision-making (Damasio, 1994), and this extends to decision-making in the area of compassion. Emotional understanding-empathy and sympathy-play a role in fully grasping the situation in order to choose the appropriate action. We listen with the heart to balance mercy and justice.

Limitations of Freedom - Compassionate love takes place on a substrate of conditions. Freedom is required, yet each person’s freedom is limited in a variety of ways: physical limitations, such as disability, or material resource limits; social structures and environment can create undue pressures for self protection, or can obstruct altruistic behaviors through resource restrictions. Social support from others can increase ability to give; emotional limitations-people have varying degrees of baseline empathic ability, and emotional stability; cognitive factors, such as contexts for meaning-religious and non-religious frameworks of values and priority structures, and intellectual capacities to understand needs in a situation.

Motives That Detract From Compassionate Love - There are a set of motives that detract from the quality of loving compassion of an act. Some of these motives are frequently present in our acts of compassion, but as these factors dominate, the quality of loving compassion in the act decreases. These include factors such as need for love and affection, need to be accepted by others or by God, need to belong, guilt, fear, seeing the other as an extension or reflection of self (ego), pleasure in looking well in the eyes of others, control of the other through their indebtedness, desire to exercise spiritual power over others, desire to reinforce positive image of self and feelings of superiority, and desire to avoid confrontation.

Additional Issues - There are other issues that need to be addressed in any research or investigation of factors that might encourage the expression of compassionate love, including: Where are our boundaries between self and other-how do we define our self-issue of true self, and masks or inaccurate understandings of self? Where does compassion for self come in? How do we effectively balance mercy and justice as we try to express loving compassion? Another important issue is that of creating spaces for compassionate behavior from others, being open to receiving the generosity of others, and creating opportunities and settings in which the expression of compassionate love in others is encouraged.

Empirical Studies - Looking at all of this from the subjective experience of the person attempting to express compassionate love, it is a challenging territory to walk through and to make the appropriate free choices. Even seeing the territory clearly is not easy. In addition to some excellent scientific research already conducted in this area, a number of studies that can help us see how individuals map this territory in daily life are currently in various stages of completion.

To adequately assess what is happening when someone expresses self-giving love for another, self-reports are indicators of the inner experience during the giving of compassionate love. Self reports are limited in a variety of ways, and should not be relied upon alone to measure whether a person is feeling and expressing compassionate love. Assessment of the objective features of words and actions designed to be compassionate are also necessary, such as perceptions by others especially the recipients and other objective measures of compassionate acts. It is also important to consider other outcomes of such expressions, both effects on the intended recipient, and internal effects on the person giving, such as spiritual and moral growth. Despite their limitations however, self-reports can give subtle illumination of motivations and other internal conditions that are key to the expression or inhibition of compassionate love, in ways that can contribute substantially to our understanding.

In a project with the World Health Organization (Lofty, 1998), a group of people from the major faith traditions and multiple cultures gathered to develop a measurement instrument on spiritual contributions to quality of life. Work in focus groups in various countries followed this initial meeting. The working group determined that one of the important features of spiritual quality of life across all traditions was giving selfless love and compassion and tested questions that might draw out the degree and importance of this in peoples lives. The importance of an emotional component varied across religious groups.

In another set of studies, the object was to assess daily spiritual experiences (DSE), the inner experiences that accompany ordinary spiritual life, with the goal of looking at the subject’s relationship with physical and mental health outcomes. A scale was developed which included the item: “I feel a selfless caring for others,” designed to measure feelings of compassionate love (Underwood and Teresi, 1999). In a US study that made use of this scale, the average score was “most days,” with a 13% response rate “many times a day”, while 5% said “never or almost never.” In the same study, using this scale, higher scores on this item were correlated with greater emotional empathy and perspective taking, and with greater other-forgiveness. A qualitative study of compassion from Buddhist, Christian and Jewish perspectives is also currently underway to determine how a self-report assessment might best be constructed. In another qualitative study in Lithuania that is looking at health outcomes, also examining what enables people to make positive moral choices in difficult circumstances, factors important in encouraging agape in people included experience of suffering by the giver, older age, family and peer environments, and the role of the media. Further results of these studies are present in the longer paper.

Innovative Methodology - To enrich the typical self-report methodology, an additional approach has been articulated well in the field of contemplative psychology (de Wit, 1987). This refers to the psychological insights and beliefs that are often implicitly present in the vision of religions and become concretized in the authentic spiritual practices of individuals, described as the contemplative life. Religious traditions have developed methods to help people in their religious development and discernment and these methods can aid in exploring motives, defining them, and discerning loving, compassionate action. This contemplative approach can give insight into the processes involved in expressing compassionate love and increase the quality of our awareness of motives, enable us to effectively sift through them, and more effectively choose actions. It can also illuminate the motives and sources of compassion that are most likely to lead to personal and spiritual growth. Results of structured interviews with monastics explore the usefulness of this method. Insights from this approach can inspire further experimental and observational studies, lead to better self-report, and to more loving, compassionate behavior.

In Conclusion - It is important to understand the key features of compassionate love, the substrate of conditions that influence freedom of expression, and motives that detract from the quality of loving compassion. A model using these components maps these factors. Clarification of additional issues such as the identity of self and its boundaries and balancing mercy and justice are important for the effectiveness of such a model. Scientific research methods in this area include objective assessment, self-report, and experimental models. Methods that utilize more clear discernment and awareness of internal processes need to be developed. Understanding gained in this way can give additional insight into how compassionate love might be fostered in individuals and societies.