Bullying, spirituality, anxiety and depression

A recently developed Cognitive Behavioral Theory (CBT)-based process has been used to understand and explore the nature of spirituality and spiritual experience and its healing characteristics. Experiences of self-worth and dignity (both are operationalized) as the core of spirituality are directly injured by bullying with resultant depression and anxiety. Bullying experiences with progression to actively bullying are devastating to our spiritual core and undermine fundamental faith in self, others and life. This level of injury is often not recognized by many bullying programs. This preliminary communication is presented for researchers in these areas to consider how this process may be used for further research and prevention and intervention efforts.

Abbreviation

OR: Odds Ratio; CBT: Cognitive Behavioral Theory; FOS: Framework of Spirituality; ACES: Adverse Child Experiences Study; EPRC: Emergent Phenomenology Research Consortium; DSM: Diagnostic and Statistical Manual of Mental Disorders

Bullying has repeatedly been shown to correlate with anxiety [1] and depression [2] with further related consequences of self-harm [3], suicide [4,5] and violence [6]. Consequences into adulthood include dramatically higher psychiatric disorders [7] including agoraphobia (OR = 4.6), panic disorder (OR = 3.1), and generalized anxiety disorder (OR = 2.7). Apart from psychiatric and mental disorder diagnosis, it has been shown to do harm to self-esteem [8], self-worth [9] and even dignity [10]. There have been studies to determine risk factors [11] and protective factors [12,13] including spiritual connections [14]. There have also been many attempts and programs for intervention to address or prevent consequences [15] and to identify effective components of intervention [16]. Attempts have been developed for a personality-targeted intervention for more vulnerable victims to bullying [17]. A more recent proposal has brought a new perspective of Dignity Theory [18] that may demonstrate a powerful perspective for this devastating problem.

A CBT expanded process has been described to explore the nature of spirituality and spiritual experience [19]. Use of this process has recently identified the depths of the “soul” experience of bullying to show its relationship to self-worth, dignity and spirituality. This paper is a preliminary communication to present these ideas for further exploration, as the effects of being bullied and progression to bullying are shown to be spiritually devastating. It provides further understanding of the hopelessness, despair, hatred and violence related to bullying that often leads to the self-damaging effects of suicide, and the social damaging effects of antisocial violence and a life of incarceration.

Its cognitive behavioral theory foundation and specific framework provide a tool for further exploration of the effects of bullying with operationalized concepts of self-worth and dignity making it amenable to research and development of interventions. This preliminary communication comes from the clinical use of this process with adults with years of being bullied that progressed to bullying with antisocial behaviors and violence. This method has been replicated but has yet to be reviewed with scientific research. It is hoped that researchers in this important area may benefit from this early presentation and that it may provide some unique perspective for pursuing research on this process and its relationship to bullying.

In this paper, bullying is used in its general sense to include physical, sexual, and emotional bullying and includes cyber-bullying which primarily causes emotional harm and social injury.

The use of the term spirituality refers to the personal experience of non-ordinary awareness related to relationship and connection to a transcendent or ultimate reality. This is separate from religion which refers to the institutional aspects of beliefs and practices related to a specific religious community or tradition. A person can be both spiritual and religious, spiritual and not religious, religious and not spiritual, or neither (Koenig et al 2012). Another term that is often used is religiousness which relates to beliefs and practices related to the transcendent that may or may not be related to a specific religious tradition or group. An example of this might be someone that prays but does not identify with a specific tradition or meditates or practices yoga and does not identify with Buddhism or Hinduism or lives an ethical and moral life and does not identify with any religious tradition.

As the concepts of worth and dignity are critical to this process and are not often noted in research areas of bullying, initial focus will be on clarification of these ideas. Specific descriptions of their relationships to spirituality, bullying, anxiety and depression will follow.

Framework of Spirituality (FOS)

This FOS has been described, including its origin and its relationship to religious thought [20], adolescent development [21] and general psychodynamic theory [19]. This paper will elaborate on its specific application to bullying, anxiety and depression.

In summary, the foundation of the FOS (Figure 1) is Cognitive Behavioral Theory (CBT) beginning with its focus on description of experience using perceptions of thoughts, feelings and actions. Each of these perceptual domains are extended beyond usual CBT to what are referred to as “distinctions of Being” (capitalized to refer to its integrated, ontological experience of life) of self-worth and dignity. Self-worth is operationalized as the integrated experience of self-confidence, self-esteem, and self-competence/self-efficacy. Dignity is operationalized from its definition of “the quality of being worthy of esteem or honor” [22] as expressions of what we honor most about being human in each of the domains – Reason, Compassion and Courage. In the FOS each of these expressions has three components – the central expression (ie Reason), an initial openness (ie choice), and an expanded social expression (ie, wisdom). It is important to note that in this framework, dignity is not being used as a noun or something that we have or achieve but is used functionally as an expression of being. The important difference and value of this approach will be discussed later.

Figure 1: Each of the elements of this framework is described in the text. The expansion to the Creative Forces/Creative Openings occurs as the spiritual core (Σ) is opened.

Bullying harms and damages a person’s experience of self-worth and dignity in multiple ways to be elaborated. Processing of these harmful experiences leads to a core strengthening of self-worth and dignity. At a certain point of resolution and acceptance, there is a spontaneous opening to spirituality and spiritual experience with its mystical characteristics of connectedness, wholeness, aliveness, serenity or peace and meaning and purpose as well as feelings of certitude, non-locality, timelessness, clarity of thought, gratitude, happiness and synchronicities.

As illustrated in the FOS (Figure 1), this process opens to a further level of distinction referred to as the “Creative Forces” or “Creative Openings,” so named as this openness is often experienced very powerfully and intense. A person becomes open to the powerful experiences of Love, as recognized by the Greek “agape”, love of the divine or in Eastern traditions love of a Higher Self. The opening to Truth is as recognized by Mahatma Gandhi’s Satyagraha or “Truth-Force” [23]. This is the foundation of his methods of non-violence grounded in our moral sense that involves our gut reaction when someone’s worth and dignity are violated. Opening to the final creative force of Faith is particularly relevant to our purposes. The victimization of bullying damages faith in a person’s self, others and life experience in general. This may then progress to the act of bullying. This progression is a resultant expression of pain from loss of faith in the world as not being safe, secure, loving, and hopeful as will be described further. The use of the word faith in this context is of faith as an action, not as a belief. It opens to the opportunity and powerful actions of faith as part of experiences of taking a leap across a chasm or unknown, with no guarantee of what is on the other side, or even that one will complete the leap successfully.

Spiritual core

Our clinical work suggests that there is a spiritual core within each person, that becomes closed to awareness as experiences of damage to self-worth and dignity occur throughout life. Much of our work with a non-clinical population in self-development groups demonstrates how the very common ACES [24], even without DSM diagnostic labels of anxiety or depression leads to development of attitudes about self, others and life that close a person to this spiritual awareness. Bullying impacts almost all areas of self-worth and dignity and this spiritual core.

This spiritual core is what is referred to as an emergent phenomenon (EPRC https://theeprc.org/) that is designated by the Greek symbol Σ in recognition that it is not yet a clearly defined entity and refers to an “additional” non-ordinary awareness beyond that of everyday living. Details of the characteristics of Σ have been described [19].

The understanding in this paper regarding the impact of bullying comes from a current study (in progress) with men that have many years of addiction with legal charges and years of incarceration. The study includes a specific psychotherapeutic weekly group intervention over 8 sessions that demonstrates and promotes the opening to this spiritual core. In the healing process, insights regarding the damage of bullying to this spiritual core have been revealed.

In this framework, bullying is recognized as “any action that intentionally damages self-worth and dignity.” It is the intentionality of the action that causes harm differently than the ACES or other non-intentional traumatic experiences. This damage may occur at every level of the FOS – the Domain of Being of thoughts, feelings and actions; the Domain of Self-worth affecting self-confidence, self-esteem and self-competence/self-efficacy; the domain of the Expression of Dignity including making choices with reason, expressing empathy and compassion, and acting with honesty and courage; and the domain of the Creative Forces/Creative Openings with damage to the Truth-force, Love and Faith.

Clarification of worth and dignity

Exploring and understanding this process requires further explanation. Our usual work in mental health and Positive Youth Development [25] minimally includes specific reference to self-worth, and rarely or inaccurately uses the language of dignity. As self-worth and dignity are distinctions of Being, which implies an integrated experience in each of these domains, our process is that of an ontological endeavor rather than a psychological endeavor (This is true if we use the usual understanding of psychology as the study of thoughts, emotions, and behaviors. This is less so in a framework where the focus of psychology is on its etymological foundation where “psyche” refers to “soul”) As a result, our usual daily English language is limited as demonstrated below.

Also, the use of the word dignity in this process is functionally different than that which is promoted in the widely accepted field of “Dignity Theory” [26]. In this discussion I refer to the paper by Milosevic, et al. [18] which relates Dignity Theory to bullying and relevant social values.

Many sources have struggled with attempts to clarify the many meanings and importance of dignity. Milosevic et al describe their choice from Dignity Theory that defines dignity as “the inherent worth of every human Being” and “does not have to be earned.” Dignity is seen as a right of all people and they “posit bullying and cyberbullying as an attack on a person’s dignity” with bullying being “dignity violations.” They describe a source of bullying and these violations as coming from a “false dignity” which is a sense of “honor that one derives from one’s worldly success, status, or other merits that are valued in a particular social and cultural setting.” “False dignity is not part of dignity but rather the opposite of dignity and perhaps more akin to pride or vanity.” An example is given of a teenager bullied by another teenager who compares herself to the bullying teenager and feels “less worthy” and leads to her own bullying behaviors. It is described that the initially bullying teenager is bullying from a false dignity. The suggestions by Milosevic of a dignity-based intervention to bullying is related to Donna Hicks’ [26] ten elements of dignity. They include 1) acceptance of identity without judgment, 2) recognition and validation, 3) acknowledgement of their concerns, 4) inclusion and belonging, 5) safety without shame or retribution, 6) fairness and equality, 7) independence and empowerment, 8) understanding of other points of view, 9) benefit of the doubt, 10) accountability and responsibility for personal actions.

Milosevic’s attempt to introduce dignity as an important concept in bullying is applauded. However, in the description below it is suggested that there is some confusion within Dignity Theory that relates to the basic definitions and usage of the words worth and dignity. Beginning with these definitions:

Worth=that quality of a person or thing that lends importance and value that is measurable by the esteem in which the person or thing is held [22].

Dignity= the quality of being worthy of esteem or honor [22].

First of all, these definitions highlight worth and dignity as “qualities” which is what makes this work and spirituality ineffable – hard to put into words. As an example, try to put the quality of “soft” into words.

Next, note that dignity is defined by using the word worth suggesting that they are related but are specific and unique words and experiences. In much of the work of Dignity Theory as well as in most documents in the world that refer to both worth and dignity, there is much misuse of these words, often using dignity when worth is really being referred to and vice versa. The specific uses must be separated clearly if we are to use this work with youth.

In looking at the use of the word worth, there are three main uses. The first is of the “worth of Being.” This can best be expressed with the phrase “All people are worthy of life, liberty and the pursuit of happiness.” This is an unprovable, inherent axiom that occurs from having been created as a person. The question of “Would humans have worth if we were not human?” has an answer as enigmatic as “What is the sound of one hand clapping?” Just as clapping of one hand cannot be understood since the definition of clapping includes at least two hands, human worth cannot be understood outside of the experience of being human!

Another use of the word worth refers to “worth as an experience of Being.” This is the experience of self-worth, in its integrated aspect of being to include self-esteem, self-confidence, and self-competence/self-efficacy. As a note, each of these have been described and measured in psychological research [27].

The third use of the word worth refers to value which is neither inherent or self-related because value is contextually dependent. Value is socially determined and may refer to monetary value/worth as an object, or utilitarian value/worth for what an object can do such as achievements.

These definitions of worth suggest that it is “worth as Being,” and not dignity, that is inherent and axiomatic because we are human. Worth does not have to be earned and can never be taken away. In fact, this inherent worth is truly “inalienable” as it remains even if “life, liberty and the pursuit of happiness” are all taken away, as the worth from being human can never be taken away.

Worth as an experience of Being, or self-worth, equates to what is labeled false dignity in the example given above with the teenager. Their description states that the girl feels “less worthy,” which is related to her comparison with others. It is her injury to self-worth (self-esteem) and dignity (lack of empathy) that leads to her bullying and is not coming from a false dignity. Her bullying actions then injure both self-worth and dignity of her victim. Attributing the initial bullying behavior to a false dignity misses the source of bullying as coming from injury – injury to self-worth and dignity. Their use of the term false dignity suggests that honor and pride are not healthy by confusing them with vanity, which is an initial compensation to injured dignity on the progression toward narcissism as noted below.

The third definition of worth as value is also sometimes called dignity when we look at honor from success or achievements. An example of this might be a king that has dignity as we honor him. What we are honoring him for is contextually dependent as we attribute it with certain value in wealth or power status. Additionally, in Dignity Theory as described, the ten elements of dignity are actions that promote both self-worth (acceptance of identity, recognition, acknowledgement, inclusion) as well as dignity (independence, understanding, accountability).

Dignity Theory looks at dignity as a noun, something that one has. The FOS looks at dignity not as a noun but as an expression of Being. Leading from the definition of dignity, which highlights honor as the critical characteristic, dignity is derived from “What do we honor most about being human?” in each of the domains as alluded to earlier. It is important to note that adolescence is the time at which dignity develops as the hormonal and brain changes provide a new opportunity for using reason to make choices; and the new sexual feelings and other expansive feelings can expand empathy and compassion; and the new social opportunities allow more practice of honesty and courage.

Bullying, anxiety and depression in each domain

To understand the detailed application of the FOS, each domain will be reviewed along with the reactions to injury of each element and their relationship to bullying, anxiety and depression. It should be noted that all of the references below to injury can be the result of bullying, as bullying can injure experience in all areas of being.

In the domain of Being (Figure 2), an integrated and strong experience of thinking, feeling and doing has a person being clear in communication and expression, and when they are injured, being confused or unfocused. This confusion and unfocus is often mis-diagnosed as attention-deficit-hyperactivity disorder, and medicated when the symptoms are the result of trauma to these fundamental perceptions and functions.

Figure 2: Domain of Being.

Damage to these fundamental experiences and perceptions are particularly devastating as they can damage a basic sense of reality. A father’s biting statements of “You’re such a stupid kid!” or “What do you know, you have a learning disability” can have lifelong effects with a child feeling stupid or thoughtless. A parent yelling “Don’t you dare cry or I’ll give you something to really cry about” can have effects of getting choked up whenever there are any feeling reactions, or become numb or dissociated and unaware of any emotional responses to life. A parent’s repetitive “Don’t do that” or “Don’t touch that” or “Don’t go there” leaves a mark of being helpless and a rapidity to quit or a fundamental belief that “I can’t.” When all three of these basic functions and perceptions are injured, a person develops constant desperation and panic resulting in a personal hopelessness that is pervasive and becomes their habitual normal. In this domain, these injuries have such an impact on thinking, feeling and behavior that the child may not exhibit or be able to report the usual symptoms of anxiety or depression due to suppression of all functions. As a result, somatic symptoms (headaches, vomiting, abdominal pain, etc) may become the expression of these injuries due to a severity of anxiety and depression that causes limitations of expression and awareness.

In the domain of self-worth (Figure 3), an integrated and strong experience of self-worth has a person feeling worthy and when it is injured, feeling unworthy or worthless. Shame is recognized not just as an emotion, but as a total “Being” reaction to injured self-worth, leaving a person feeling unworthy.

Figure 3: Domain of Self-worth.

As noted earlier that self-worth is often not referred to in mental health settings, it is more likely that the injuries to each of the components of self-worth will become the focus in therapy and interventions. For instance, feelings of inadequacy may be identified clinically and not even recognized that it is a reaction to injured self-confidence.

Similarly, feeling unlovable or unloved is a reaction to injured self-esteem; as well as feeling incompetent or useless is a reaction to injured self-competence/self-efficacy.

These injuries can readily occur when a bully criticizes or makes fun of a person’s appearance including skin color, a person’s family, what a person is doing including in relationships, or makes fun of any weakness or disability. In most situations, the combination of these reactions is the source of depression but may also be a source of anxiety depending on the context and severity. These reactions become part of the "internalizing disorders" that may develop.

Of note, the language that we use in understanding and clinical use is somewhat limited and inaccurate and may need to be reconsidered when we work with youth. Above, the “feeling” of inadequacy was stated as a reaction to injured self-confidence. As this is in the perception of thinking in our CBT model, inadequacy is not accurately just a feeling. The reaction to injury of these components is a total “Being” reaction involving thoughts, feelings and actions. The experience of inadequate occurs in thinking (I think I am inadequate), feeling (I feel inadequate) and doing (My actions are inadequate). Essentially, the experience is “I am inadequate.” The reactions to injury of each of the components (inadequacy, unlovable, useless) was noted in the description above as feelings when in actuality they are experienced in our total being. As we continue to look at bullying, the use of a more comprehensive language reminds us and emphasizes the devastating effects that bullying has on the total experience of being rather than just on feeling or thought as suggested by our usual language.

In the Expression of Dignity (Figure 4), an integrated and strong experience of making choices with reason, relating with empathy and compassion to both others and self, and living with honesty and courage has a person feeling honor and pride. When it is injured, there is a feeling of dishonor, or even being dirty or ugly in a disgusting manner. Guilt is recognized not just as an emotion, but as a total “Being” reaction to injured dignity. A person can be overpowered and even paralyzed with guilt responses of “I should have made a better choice with reason” or “I should have had more empathy and compassion” or “I should have been more honest and stood up for myself.” These perseverative self-denigrating responses lead to an anxiety and depression that can reach an existential level as the greatest human strivings are squelched and damaged. The components of dignity – reason, compassion, courage - are necessary to discover and pursue a meaning and purpose for life. The honor and pride of strong expression of dignity is part of what leads to opening to a new level of awareness of spirituality and a non-ordinary transcendent experience of life.

Figure 4: Domain – Expression of Dignity.

Damage to the individual component of dignity of making choices with reason can lead to feelings of being controlled. This may occur for example, with bullying that forces a child to do something against their own choice such as sexual assault with bullying, or even a bully demanding that their victim do certain, often demeaning actions. Damage to empathy/ compassion can lead to feeling unimportant as a parent is non-empathic when they make fun of their own child or give no acknowledgement to suffering or pain from an injury or to a problem in school or with peers. Examples of damage to courage may include being asked to lie by a parent hiding an affair or hiding their drinking; or “the talk” by a parent of color to their son “Don’t you dare go out at night, you know the cops are going to get you and beat you” can lead to feeling weak or small or even hunted and expendable.

This damage to dignity is a critical experience, especially for adolescents, as they learn that compensation for these injuries makes them feel better. They develop reactions of controlling others, or feeling extra-important or special, or super-strong or powerful, such as by becoming a bully themselves or becoming powerful and rich with drug money or part of a gang. This is where Dignity Theory’s reference to false dignity, attaches harmful behaviors to the word dignity and misses the opportunity to acknowledge that the reactions are coming from deep hurt to what is experienced as the “soul” and “spirit” of life. As these “successful” compensations become repetitive, the development of oppositional defiant behaviors can progress to become a habitual identity that develops as the core of narcissism and narcissistic personality disorder.

The domain of the Creative Forces/Creative Openings (Figure 5), has received no recognition in the research and literature of bullying or of anxiety and depression. The strengthening of self-worth and dignity through processing the injuries of trauma and bullying, spontaneously lead to opening to spirituality and spiritual experience. The mystical characteristics of this opening of our spiritual core have been described elsewhere [19]. Important to this domain are the practice and expansion of open-mindedness, open-heartedness and open-handedness—openness without judgment. The value of this approach to adolescent development has been highlighted elsewhere [21].

Figure 5: Domain of Creative Forces / Creative Openings.

An integrated and strong experience of opening to the Creative Forces/ Creative Openings has a person open to a spiritual attitude in life, being fulfilled, whole, and even the opportunity for self-actualization and enlightenment.

Usually, the first awareness of opening to the Creative Forces is the awareness of the force of love. This is not love as an emotion, or even love as a commitment as in “I love you,” but is an opening to love as noted by the Greek agape- love of the divine. Or, as in the Hindu tradition, it is the opening of atman (soul) to brahman (the divine). It is an expansive experience of connection, compassion, and love - connection to all people, all parts of the world and to all of the glories of life. As noted earlier, the opening to the Truth-force is captured by Mahatma Gandhi’s “satyagraha” or the Truth-force which was the foundation of his commitment to non-violence. It is not truth like right or wrong but is the moral truth that recognizes when a person’s worth and dignity are being injured. It is the source of the gut reaction that people felt as they watched George Floyd’s life being taken in violence. It is our fundamental, evolutionary, total Being experience of morality and ethics in life as to how we should treat one another – with empowering worth and dignity.

The opening to Faith is crucial to understanding the impact of bullying as well as to the nature of the bully. This is not faith as a belief but faith as an action. Our brain is developed to have faith as an everyday experience such as the faith that one has every night that they will go to bed and wake up alive in the morning. Or the faith that when we walk out of the door in the morning that we will not fly off the face of the earth due to the spinning at 25,000 miles an hour. Our brains are developed to have hundreds of these “faith” experiences managed daily, often out of awareness. This Creative Force is the faith of taking a leap across a chasm or unknown with no guarantee of what is on the other side or that we will even make it across the leap. It requires the fullness of self-worth and dignity with reason, courage and compassion as a powerful expression of the life process and what is honorable about being human – a full expression of dignity.

Damage to this domain is crucial for understanding the bully experience – both of the victim and the perpetrator. Damage to the Truth-force leads to demoralization and often to violence. The moral compass has been damaged as hurting of others becomes a compensation for having been hurt. Damage to the force of Love leads to alienation and disconnection with an accompanying hatred – of others, of life, of self. Damage to the force of Faith leads to the experience of being disabled or disempowered with a resultant giving up on the world, self, others and often life. The violence, hatred and disempowerment from these spiritual forces being hurt becomes consolidated in actions of violence and antisocial behaviors of the extreme bully including the ideologically driven activist / terrorist. The devastating combination of damage to all components is the experience of dehumanization, being shut out or shut off from normal human life experience. As with the previous personal hopelessness, this damage leads to a social hopelessness. Incarceration is common as it embodies the alienation from humanity that is experienced internally. It also expresses the hatred for the world and self-hatred associated with no faith, no hope for ever being loved, or loving one’s self fully.

It almost goes without saying that these experiences of damage to the Creative Forces are related to anxiety and depression. However, at this stage the anxiety and depression have a different, more action related form as hurtful experience has led to the crushing or deadening of the experience of self-worth and the expression of the honor of dignity.These reactions become part of the "externalizing disorders" that may develop. In its severe form it involves the crushing or murder of the soul or human spirit [28]. This may appear as a callousness or uncaring lack of empathy or compassion, as in sociopathy, that covers the anxiety depression and hopelessness and keeps it from awareness and expression.

Conclusion

As can be seen, bullying is devastating to all that is great about being human. For most victims of bullying there may be presence of anxiety and depression but the true devastation is often not recognized or acknowledged. The injury to a victim is the beginning of this process and must become interrupted to prevent progression to the extreme of being a bully perpetrator with the tragic outcome that has just been described. The suffering of anxiety and depression with early bullying can rapidly lead to hopelessness with increasing incidence of suicide as a result of bullying having destroyed their faith in life. It is hoped that this framework for understanding bullying can be used and developed further. Our clinical experience suggests that when the pain and suffering is processed, the opening of our spiritual core that is always present in all people can be the source of both healing and happiness.

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