1. religion and spirituality
2. buddhism

COMPASSIONATE HUMAN VALUES ENHANCING LIFE AND FUTURES OF
GLOBAL AGING
RELATION TO THE ENHANCING LIFE PROJECT
This project aims to study compassionate human values among informal carers of older
adults in two developed countries with rapidly aging populations: Japan and the United
Kingdom. It will collect ethnographic observations and first-person narrative accounts of a
wide range of carer experiences in both countries in order to gain a better sense of the
influence of culture on establishing pre-dispositions toward compassion, meaningful values
surrounding compassion, and social support for the cultivation of compassionate worldviews
as guiding social and spiritual principles.
By addressing the experience of compassion in two culturally distinct contexts of eldercare,
this study will draw out implications for the future of life in an aging world. Global aging is
both an ongoing process lived and embodied in the most intimate of spaces, and a future
aspiration, a hope to live longer, fuller lives together. By 2025, WHO estimates that the
population of people aged 60 or more to grow to 1.2 billion— more than double the number
just twenty-five years earlier. These global demographic changes will be uneven, and their
economic, epidemiological, and cultural impacts are uncertain (Giordano 2012). One
consequence that is beyond doubt, however, is that an increase in people living into advanced
old age will also bring about a greater need for family-provisioned care, mostly by women
and other older people who are more vulnerable to poverty and other forms of exclusion
which has a well-documented negative impact on health and mortality (Schulz & Monin
2012). One purpose of this project is to better understand the lived experiences of carers and
to draw lessons from their stories that can enhance the treatment of older adults and carers in
societies experiencing similar challenges of population aging while honoring the importance
of diverse cultural values and spiritual meanings associated with those challenges.
The spiritual laws for enhancing life and futures of older adults must also encompass their
carers as well, since it is in the relationship, this space of mutual recognition, where the moral
experience of intersubjectivity can emerge. Compassionate human values, those that support
an optimal moral experience of mutuality within the context of care and that reveal capacities
and potentials for cultivating spiritual and emotional flourishing across the life course offer
hope for the future. They provide guides to fulfill our basic needs to care and be cared for.
Approaching compassion in this way allows the implications of this investigation to go
beyond its immediate topic of family-provisioned informal eldercare to help us understand
how values and visions of compassion can enhance life for all: from the philanthropist
donating to humanitarian organizations, to the child nursing a wounded bird in a shoebox. At
all of these levels, what is at stake is our ability to imagine a shared future of deep connection
to forms of life that challenge the limits of individual agency and inspire us to look further, to
what this project provocatively terms “counter-worldly” lives.
BROADER IMPLICATIONS FOR OTHER FIELDS
This research will be a unique contribution to the field of Enhancing Life Studies by
investigating first, how compassion is embodied in small-scale, everyday acts of attentiveness
(Bein 2013, 90-95), and second, how these acts are understood as compassionate through
their incorporation into larger systems of meaning. By investigating what it means to offer
and receive compassion from these different perspectives across two distinct cultural
contexts, this project will generate both practical lessons for enhancing life in an aging world,
as well as a foundation for a sustainable long-term research agenda guided by interactions
between spirit, heart, and mind.
By focusing the study on compassion, this study will contribute substantially to the
development of a newly emerging area of study in the social sciences while at the same time
providing a basis for expanding and critiquing a rapidly growing literature in medicine and
social care. It is the latter that tends to have the greatest impact on how professional carers
such as nurses and care home staff embody and model compassion, and how social
institutions direct resources and create public campaigns that have a strong influence on
informal carers and wider social norms in general.
The findings of this study will have broad implications for eldercare research and policy at
the national and international levels. As the UN continues to work on an international
Declaration on the Rights of the Older Person (Fredvang & Biggs 2012), and WHO considers
“aging well” to be a global priority, ethnographic accounts of eldercare can provide moving
accounts of lived experiences to guide our interpretations of the overwhelming demographic
and epidemiological data on global aging.
This research also has implications for global humanitarian and advocacy organizations such
as HelpAge International and Alzheimer’s Disease International. Anthropologists have
already contributed to our understanding of the ways compassion provides alternate moral
visions that challenge political structures in other humanitarian contexts (Bornstein & Refield
2011; Fassin 2005; Feldman 2013; Ticktin 2011), calling critical attention to the potential
pitfalls of giving emotions political power. How do we decide who is deserving of
compassion and who is not? Whose suffering should earn our pity and whose do we ignore?
These questions play an important role in understanding the cultural ethos of social care. Few
studies have been published on compassion and international humanitarian work involving
eldercare (Livingston 2003), and this research would have potential for directing greater
attention to this area.
HYPOTHESIS AND GUIDING IDEAS
Based on research undertaken with carers in Japan from 2013-14, I have generated three
working hypotheses that will incorporate a cross-cultural sample of carers in the UK and
articulate the overall research framework with the broad aims of the Enhancing Life Project.
Each of these hypotheses will be subject to refinement as data is collected and analyzed.
Hypothesis 1: Cultural meaning systems provide scaffolding for embodied feelings of
compassion
Cultural meaning systems, especially those that provide guides for possible future selves by
introducing moral “counter-worlds” provide resources for anchoring subjective feelings and
embodied states. These resources may include, but need not be limited to cultural rituals and
beliefs related to grief, suffering, and illness; religious and spiritual concepts of personhood
and linked lives; culturally gendered roles and dispositions; ethnic and national identity; and
family history. Cultural meaning systems such as these may provide a unique language for
otherwise difficult to articulate, often contradictory feelings to become linked to
compassionate values. Not all cultural meaning systems will be uniformly adopted and some
may inhibit the satisfactory expression of personal feelings. This hypothesis suggests that an
important first step for a carer, is to begin to find words, images, and rituals within their
cultural world that are compelling enough to risk the formation of a possible compassionate
self and an investment in spiritual counter worlds.
Hypothesis 2: Maintenance and cultivation of compassionate values depends on the
refinement of subjective narratives
Carer support groups are spaces where personal narratives can be further refined and
emotional appraisals can be modeled by others who have themselves cultivated meaningful
identities as carers. These groups facilitate a self-regulating feedback process between
experiences and meaning systems so that new words, images, and rituals can be further
incorporated into the carer’s worldview. Similarly, religious participation may provide
narratives that support compassion values by interpreting suffering for the sake of others as a
sign of positive moral development and a source of spiritual strength. The refinement of
personal narratives in consonance with shared cultural narratives of compassionate values
presents compassion as an ongoing process of self-formation and a comforting futureorientation that restabilizes the sense of self as circumstances change.
Hypothesis 3: Compassionate values generated within the dyadic relationship between the
carer and the cared-for can be extended to others if adequately supported.
While the dyadic encounter with the cared-for forms the central locus for the formation of
compassionate possible selves, interviews conducted with bereaved carers indicated an
ongoing desire to continue caring. Having established a self-orientation and appraisal system
around compassionate values, carers may seek out opportunities to care through paid or
volunteer work as carers or by simple, everyday extensions of care for those around them.
This indicates that compassionate values need not be limited to the often romanticized image
of an embrace between mother and child, but can be leveraged into a political project
centered on emotions, aspirations, and the recognition of suffering. Understanding carers’
experiences should not be limited to those in the midst of caring, but should importantly
include those who have finished caring and can act as models for broader social and political
causes. To understand this is to see how the human becomes the humane.
Proving each of these hypotheses depends on finding “conceptual templates” (Luborsky
1987, 367) that repeatedly assert themselves in carer narratives and behaviors. That is, the
words, images, and rituals attached to compassion should be more than “personal
symbols” (Obeyesekre 1984) but should reveal an investment in culturally shared form of
intersubjective engagement and moral subjectivity. It is possible, though I think unlikely, that
from the perspective of carers, compassion is a minor part of their day to day life and their
relationship with the cared-for relative or with compassionate “counter worlds” is too
idiosyncratic to be considered part of a broader cultural worldview that can be linked to
historical events or spiritual laws.
SCHOLARLY CONTEXT
My interest in compassion arose from an interview with an 80 year old woman caring for her
90 year old husband in Japan. I was still searching for ways to somehow get out from under
the bureaucratic lingo of “care” and yet I needed some kind of conceptual anchor to link the
disparate experiences and feelings of the carers participating in my study. When this woman
mentioned the word “compassion,” a Buddhist term combining characters for love and
suffering, I decided to pursue it further. I found a strong resonance with the values of
compassion across Japanese carers of different backgrounds, and began to wonder how this
might to compare with carers in other cultural contexts.
I quickly found that the literature on compassion fit mainly into three categories: medical and
psychological studies of empathic imagination and compassion fatigue; social science studies
of the politics of humanitarian groups; and philosophical and theological studies expounding
on ethical and moral experiences of mutuality and transcendence. All three fields are relevant
to this study and to its guiding ideas.
This project builds on research that I have been conducting since 2005 in Japan on religion,
grief, and care in Japanese families (Danely 2014). My findings led me to argue that spiritual
worldviews, developed over the life course through a series of adjustments to experiences of
loss, served as narrative anchoring points for potentially destabilizing changes in the self and
in relationships with others. I continue my interest in subjectivity, narrative, and grief in my
fieldwork with carers (Danely 2015). In following ideas related to empathic imagination,
responsiveness to others, and compassion as they arose in carer narratives, I found immediate
resonance with work in medical and psychological anthropology on intersubjectivity,
suffering, and morality (Kleinman 2009, 2014; Parish 2014; Throop 2008, 2010, 2012; Toren
1999). These studies locate care at the center of what it means to be human and to share one’s
life with others, and each struggles in its own way with vulnerability, the opacity of the other,
the difficult or moral decisions, and the fleshy, intimate and meaningful practices of everyday
life. The study of compassionate values for enhancing life is most clearly articulated with this
body of scholarship, though its potential implications go much further.
This integrated and interdisciplinary approach is inspired by other anthropologists working in
the field of care ethics (Brodwin 2013; Mattingly 2014; Mol 2008; Pols 2015; Stevenson
2013), gerontologists engaging with phenomenological and ethnographic approaches to care
(Becker 1997; Dewar and Nolan 2013; Nortvedt 2003) and philosophers interested in social
and political implications of emotion, mutuality, and the ethics of care (McQueen 2014;
Noddings 1984; Porter 2006; Topolski 2014). It will bring these bodies of work into
conversation with each other and explore ways to further develop their mutual engagement
by grounding the research in rich empirical data collected through ethnographic observations
and interviews. The Project Timeline specifies venues across these disciplines where I plan to
disseminate findings and develop my Enhancing Life framework. This will distinguish this
study from the dominant scholarly literature on compassion in medicine.
Research on compassion in the context of health and social care has escalated in over the last
decade alongside the growing focus on person centered care and explicit policies that employ
the term “compassion” as a guiding practical aim. Lown (2014), for example, reports that
England’s chief nursing officer established “Compassion in Practice” as a primary vision for
the National Healthcare Service (NHS), requiring employees at all levels to “foster
organizational cultures of compassion and create incentives that advance compassionate care”
(2014, 7). Lown herself outlines “Seven guiding commitments” for making healthcare
compassionate, including the “commitment to support caregivers” (IV), and “Deepen our
Understanding of Compassion” (VII) (2014, 8-12).
Empirical studies that take up this last commitment have tended to focus on compassion
fatigue and to a lesser extent, compassion satisfaction, sometimes substituted with qualities
like resilience. Medical research, policy, and education constructs compassion as both a
highly valuable and desired skill—a subtle gentleness that is also potentially dangerous if
practiced in excess. Such studies are interesting because of the way they shift the “problem”
of eldercare away from the patient as a cause of “burden” to the carer who must learn how to
better sustain the emotional stress of care. Accordingly, the locus of intervention also shifts
from the cared-for to the carer. The most commonly studied carer intervention is some form
of mindfulness based training, interestingly a technique largely drawn from non-Western, and
especially Buddhist traditions.
At its best, the trend in research on compassion fatigue among health care professionals
identifies individual risks for those in positions with a high rate of burnout—a disturbing
notion that too much care is potentially fatal for the carer. This is an important problem, and
yet many care professionals have candidly expressed to me that rather than supporting selfcompassion, these studies were used as yet another tool to keep care professionals working
despite stressful conditions by locating the responsibility for self-care on the individual carer.
Practicing self-compassion was yet another task on top of everything else. Though many
scholars have recognized that compassion lies at the heart of much of the world’s religious
traditions and spiritual experiences, the reduction of compassion to a medical skill set that
must be regulated and placed under surveillance and audit (Curtis 2013) not only presents
additional pressures on formal carers, but inhibits the ability to creatively imagine and inhabit
compassion in alternate ways.
The trend towards studies of compassion and away from a focus on carer burden has had less
influence to date on studies of informal carers (Day & Anderson 2011), although a growing
body of literature is emerging from around the world that may provide hints regarding
cultural differences in coping, such as religious practices (Barry 2014; Heo 2014; Kim et al.
2014; Pearce 2005, e.g.).
Cultural psychologists have argued, for example, that societies that value interdependent selfconstrual, like Japan, experience emotions like compassion and sympathy to a greater degree
than their independent Western counterparts (Kitayama and Markus 2000). The most
thorough comparative study between Japanese and Western (US) attitudes towards aging and
family-provisioned care was conducted a generation ago by Hashimoto (1996), and while it
remains instructive for its systematic cross-cultural methodology, demographic and policy
changes over the last twenty years have changed the situation dramatically. There are no
ethnographic monographs comparing contemporary family-provisioned eldercare in Japan
and the UK comparable to Hashimoto’s study, despite the fact that their political, health, and
social care systems are much more comparable than either is to the US (more in Methodology
section).
Both caregivers and older adults alike suffer loss, grief and isolation, but for many, this
suffering provides a break from an attachment to past selves and a process of drift towards
greater intimacy with transformative counter-worlds. This process of relearning about
oneself, the care recipient, and spiritual reality can make one feel vulnerable, pressed up
against one’s own physical, emotional, and imaginative limits. It is telling that according to a
survey I conducted in 2014, the greatest source of stress among caregivers of older adults in
Japan, was “the inability to see ahead,” to risk a hope. Compassion, while often experienced
in moments of being present, can also construct futures that potentially make the work of
caregiving meaningful.
KEY CONCEPT
The key concept in this study is compassion. Goetz et al. 2010 define compassion as “the
feeling that arises in witnessing another’s suffering and that motivates a subsequent desire to
help” (2010, 351). Schulz, et al. (2007) takes this basic definition a step further by specifying
its component elements:
“Compassion has cognitive, emotional, and motivational components: The compassionate
individual must be able to recognize and empathize with the person in distress, feel some
connection toward the sufferer, experience both positive (e.g. love, concern) and negative
(e.g., upset, distress about the suffering of another) affect, and be motivated to reduce or
diminish that suffering.” (2007, 6)
Both of these definitions approach compassion as a primarily psychological trait located in
the individual’s (inner) response to the encounter with another’s suffering. Philosopher
Stephen Bein’s (2013) definition further extends the psychological approach to compassion
by elaborating the ethical and interpersonal nature of suffering and compassion:
“attentiveness to suffering and satisfaction, coupled with the will to bring about the
alleviation or cessation of suffering and the continuation and multiplication of
satisfaction” (2013, 88). These scholars differ in the degree to which agents engage in
empathic imagination (witnessing/empathizing/attentiveness), the nature of the motivational
response that results from this encounter (desire/motivation/will), and the resulting action
(help/reduce suffering/multiply satisfaction). What they have in common, I think, is what
Rev. Dr. Martin Luther King Jr. describes in his example of the ‘Good Samaritan’: someone
with the capacity to project the “I” into the “thou,” and be concerned about his brother (King
1968).
A more anthropological elaboration of compassion should include not only the invisible
(often implicit or embodied) pre-dispositions for action detailed above, but also the visible
actions and the inter-subjective contexts or conditions that enable the action and allow it to
flourish in social life. A comprehensive project on compassion aimed at enhancing life must
involve all three of these components, and in order to do so, must employ a variety of
strategies and perspectives that are able to cross the fields of anthropology, psychology,
philosophy, and theology. Since compassionate dispositions, actions, and contexts can vary in
important ways across cultures and contexts, it is not enough to limit research to those
aspects that can be found commensurable across cultures or to draw too many conclusions
based primarily on western samples and analytical frameworks.
METHODOLOGY
Funding is sought to support research on compassion among family carers of older adults in
the UK and to analyze these results together with the emergent themes from research I
conducted in Japan from 2013-2014, which I am now beginning to interpret and analyze. This
study will attempt to improve the efficiency of data collection by incorporating the most
successful strategies from the research conducted in Japan while staying open to adaption to
local circumstances.
As mentioned above, Japan and the UK have several social and political similarities that go
well beyond the love of tea and monarchs. Most relevant to this study is that both have a
national publicly supported social welfare system for elder care that is being put under stress
by a rapidly aging population. Both Japan and the UK have large “baby boom” populations
entering their 70s over the next ten years, most of whom will be cared for by female family
members between the ages of 45-60 (Dalhberg et al. 2007). This is despite the fact that public
opinion polls show 33 percent of Japanese feel the family should bear the greatest
responsibility for eldercare, while only 13 percent of British respondents felt the same way (a
major exception to this is Britain’s sizable South Asian population (Victor 2014)) (Pew
Research Center 2013). Despite cultural and religious differences, older adults in Japan and
Britain face increasing prevalence of elder abuse, neglect, and isolation, in part because of the
low status and poor working conditions of care professionals and the stress faced by unpaid
carers, more and more of whom a must quit work and other sources of security and identity in
order to care (Broadbent 2014). While Japanese carers may draw on Buddhist concepts of
compassion, the British are more likely to understand selfless actions as expressions of pity,
sympathy, or a Christian caritas (charity). Thus, one might expect the shared challenges of
global aging to be attended to and supported in fundamentally different emotional and
spiritual values and meaning systems.
First, I will arrange visits to carer support groups in the Oxfordshire area with whom I have
already established contact. A 2014 survey of Oxfordshire county conducted by Carers UK
found the highest number of “unknown carers” (informal, unpaid carers) of any other Carers
UK branch in the country, and boasts close to 100 carer support groups. I am collaborating
with Carers Voice Oxfordshire to present my work in Japan to carer groups as a point of
initial contact and recruitment. The purpose and scope of the study will be explained to group
members at these events and with permission I will attend groups regularly, taking notes on
carer stories interactions with each other. Particular attention will be paid to morally
ambiguous or fraught situations in which the carer may need to risk autonomy, or even suffer
for the sake of practicing compassion. As carers speak freely, the linguistic and imagistic
representations of their frustrations and satisfactions will be jotted down to be written up as
fieldnotes immediately afterward (Emerson, Fretz & Shaw 1995).
Interviews will be conducted in order to gain a more comprehensive autobiographical
narrative of caring and to provide a space where potentially embarrassing or personal
spiritual ideas have a chance for expression. Interviewees will be approached after two or
three meetings in the groups and asked if they would be interested in arranging a longer
interview session to learn more about their experience. While it is impossible to precisely
replicate the Japanese research methods, I will follow the same protocol: interviews will be
open-ended, allowing respondents to freely talk about what concerns them most, and my
basic prompts will follow a beginning-middle-end three-part narrative model. Participants
will first be asked to talk about their life before becoming a carer, what life is like as a carer,
and what expectations or aspirations they have for their future. Participants will also be
prompted to speak freely on key themes from the Japanese data sample, such as compassion,
for the basis of comparison. In order to expand beyond the groups and include carers who are
unable or unwilling to attend groups, I will ask if participants know of any other carers who
might be interested in participating and that they could introduce to me. This snowball
sampling technique was useful in Japan where carer support groups are far less prevalent but
many carers have several friends and neighbors who are involved in care work.
Having attended groups, conducted interviews, and established rapport with some carers, I
will shadow carers as they go about everyday caregiving tasks, observing and participating
when fitting. These shadowing observations provide chances to observe the relationship
between carer and cared-for as well as the environment, and technologies that forms part of
their meaningful environment. In Japan this might include incontinence pads, rails, toilet
adjustments, reclining beds, medicines, as well as shrines, artwork, food smells, and music.
Feeding, changing, comforting, and aiding mobility all had their own pace, supportive
strength, non-verbal cues, and exchanges of facial expressions. These kinds of observations
are critical to understanding the intersubjective experience of compassion.
Mid-way through fieldwork in the UK, I will take one month to make a short follow-up trip
to Japan. On this trip I will provide share information about the British study with previous
participants and collect any responses. I have also had invitations to present the Enhancing
Life project research at the Tokyo Metropolitan Institute of Gerontology and Kyoto
University. This trip will also allow chances to confirm various details and ask additional
questions to carers, as well as to attend groups and make more in-home observations.
Throughout the core data collection period (Q3-Q7), I will be developing analytical concepts
to be tested in the field. Interviews will be transcribed in full and thematically coded with the
aid of a research assistant. A sub-sample will be coded by both PI and assistant to improve
validity. I will be using NVivo10 qualitative data analysis software and the codebook
developed with the assistant to analyze transcripts, fieldnotes, and other documents in the
field, distilling the large amount of text produced in qualitative research into manageable sets.
The coding process will center on the key concepts such as compassion, the self, relationship,
aging, family, social care services, health, death and spirituality. In order to include
perspectives from psychology, philosophy, and politics, coded portions related to these fields
will be tagged and compared across the two cultures.
A multidisciplinary approach is central to this project’s significance. Observations and
interview transcripts will be analyzed against a background of literature on empathy in
nursing and psychology. Imagery and emotions will be used to develop concepts from
phenomenology and provide empirical evidence that can illuminate and challenge arguments
regarding the ethics of care. Social and cultural anthropology provides a framework to situate
the intersubjective conditions that enable people to inhabit and act according to
compassionate values in their cultural context. Finally, compassion draws on and enacts the
spiritual; an attention not only to mind, but to mindfulness, or soulfulness will allow this
study to develop our understanding of spiritual laws and reality across religious and cultural
traditions.
This project’s significance lies in its innovative approach to caregiving in different cultures
using ethnographic methods to examine compassion and its relevance to cultural, spiritual,
and experiential counter-worlds. This funding will not only allow me to add a crucial crosscultural component to my research, but it will also provide the resources necessary to produce
a book-length monograph guided by the mentoring opportunities of the project seminars.
Finally, Enhancing Life Studies provides support for two courses I will teach titled, “Culture
and Care.” I will, in a sense, be working alongside my students (mid-course and advanced) as
they do locally-based fieldwork on care environments, discussing questions and issues that
arise, experimenting with forms of presentation and reflection, and considering translational
applications and potentials for global impact. By integrating teaching, writing, research, and
mentorship, the Enhancing Life Project initiative can improve the reach and power of this
research, bringing it to a wider public audience, and supporting ongoing discussions about
how individuals develop compassionate human values, and how societies might develop
these values toward creating their futures.