The lived experience of Buddhist-oriented religious coping in late life: Buddhism as a cognitive schema

Paradigm

Data used for the current study were part of the data collected for the doctoral research project of the author, which was granted ethical approval by the Institutional Review Board of the author’s university. This study employed interpretative phenomenological analysis (IPA; Smith et al., 2009; Smith and Osborn, 2008) as the methodological paradigm. IPA is a qualitative methodology that seeks to phenomenologically examine lived experience in itself in the best possible way (Smith et al., 2009). It involves a process of “double hermeneutic,” in which “the researcher is trying to make sense of the participant trying to make sense of what is happening to them” (Smith et al., 2009: 3). Moreover, IPA uses idiography to shed light on “how particular experiential phenomena (an event, process or relationship) have been understood from the perspective of particular people, in a particular context” (Smith et al., 2009: 29).

Participants

In an IPA study, participants are purposively selected to “‘represent’ a perspective, rather than a population” (Smith et al., 2009: 49). Besides purposive selection, the IPA sample is also characterized by reasonable homogeneity and the smallness of size (Smith et al., 2009; Smith and Osborn, 2008). Accordingly, the small sample for the current study consisted of six older Buddhists (three males and three females), who were purposively selected to ensure relative homogeneity among them. The homogeneity lay in that they were (a) Chinese Singaporeans, (b) older than 65 years, (c) community-residing, (d) cognitively able to understand and respond to interview questions, (e) formal Buddhists in the sense that they had attended a conversion ceremony, making a vow to take refuge in the triple gem (comprising the Buddha, the Dharma or Buddhist teachings, and the Sangha or the Buddhist monastic order), and (f) high in self-rated religiousness.

The mean of participants’ age was 74.8 (SD = 7.0, range = 68–88) years. The years of their practicing Buddhism averaged 29.3 (SD = 9.0, range = 23–47) years. In total, 67 percent (4) of participants were married and 33 percent (2) were widowed; 67 percent (4) of participants were primary school educated and 33 percent (2) were secondary school educated. For the purpose of confidentiality, this article does not reveal participants’ authentic identities and uses pseudonyms instead where necessary.

Procedure

Six participants for this study were recruited through personal recommendation. All of them signed informed consent forms. Efforts were made to ensure that prior to giving consent, they had a clear understanding of necessary information about participating in the project, including the project’s purpose and procedures and their corresponding role and rights (e.g. the right to withdraw from the project at any point of time).

The author conducted face-to-face semi-structured interviews with all of the participants. Five participants were interviewed twice and one participant thrice, so a total of 13 interview sessions were completed. Each interview session lasted between 60 and 90 minutes. The main interview language was Mandarin. During the interaction with participants, the author demonstrated warmth, genuineness, respect, and empathy to them, which facilitated the establishing of rapport and mutual trust with them. The schedule for semi-structured interviews was composed of socio-demographic questions and questions concerning religious beliefs, practices, and coping (e.g. Could you tell me a story on how Buddhism was involved in your coping with late-life stress? What Buddhist beliefs and practices are especially important to your coping?). The phrasing and sequencing of the interview questions were flexible to accommodate to “the concerns of the participant” (Smith et al., 2009: 64). Probes (e.g. “Could you explain more about this?” and “Could you tell me more about this?”) and prompts were used where appropriate to elicit in-depth responses during interviewing. Participants were debriefed upon conclusion of every interview session.

All of the interviews were audio-recorded using a SANYO digital voice recorder, and all these audio data were transcribed verbatim. The transcripts were analyzed using the IPA analytic strategy (Smith et al., 2009; Smith and Osborn, 2008). The first step was identifying themes in the first case. The author read the transcript carefully and closely several times and wrote in the right-hand margin of the transcript any notes or comments on what was considered prominent or significant. The comments were either descriptive or conceptual. Themes were derived from the comments by identifying and labeling what was essential in the comments. These themes were written in the left-hand margin of the transcript. The second step was concerned with integrating the themes emergent from the first case. The author listed all these themes on a sheet of paper in the same sequence as they appeared in the transcript. Having determined logical or conceptual connections among these themes, the author clustered the interconnected themes, after which the author checked the internal consistency of each cluster. Then, the author created a table in which each cluster of themes was given a superordinate theme title. The third step was analyzing succeeding cases in the same way as the first case. Trying to factor out the ideas arising from the analysis of the preceding case(s), the author analyzed each of the succeeding cases in its own right. In the final step, the author detected and formulated cross-case patterns. Three main questions were used to guide this step: “What connections are there across cases? How does a theme in one case help illuminate a different case? Which themes are the most potent?” (Smith et al., 2009: 101). This helped to ensure that the identified patterns reflected the heart and soul of participants’ experiential meanings. After determining the patterns, a master table of superordinate themes and subthemes for all of the cases was finalized.

Two strategies, namely reflexive journal keeping and member checking, were adopted to enhance the rigor of research.

Meaning-making coping

Different religions have different content of beliefs, which shapes different approaches to meaning-making coping (Hall et al., 2018). In this study, one prevalent form of meaning-making coping was the attribution of stress to karma (causality). Karma refers to not only “volitional actions that become manifest as wholesome or unwholesome thoughts, speech, or actions” (Jing, 2006: 95) but also the consequences of volitional actions: “every thought, utterance, and deed is a seed that ripens over time until, under suitable conditions, it comes to fruition as an event or circumstance” (Van Hien Study Group, 2003: 352). The ripening of karmic seeds may occur during the present life, the next rebirth, or the succeeding rebirths (Jing, 2006). The law of karma states that good karma will generate positive outcomes, while negative outcomes will result from bad karma.

Karma attribution provided participants with a clear and coherent answer to why they suffered from stress and an assurance that any stressful event was ultimately understandable and meaningful. This helped participants to assimilate a stressor into their existing cognitive schema:

According to Buddhism, illness results from karmic factors in the past lives or from primary and secondary causes in the present life. So when you are ill, you need to see a doctor [pause], you also need to confess and repent in a Buddhist manner, and you should profoundly believe in the law of cause and effect. When you are ill, don’t blame heaven or others. (Mr. Teo, age 88)

The notion of karma involves the idea that “everyone has the potential at each moment to alter the course of his future karma” (Van Hien Study Group, 2003: 352). Holding such a view motivated Madam Yap (age 70 years) and other participants to engage in merit-making actions during stress that were believed to result in favorable effects. This afforded them a sense of perceived control over stressful situations. Madam Yap once felt that she had lived a life of regret and thought that it was too late for her to redress her life. Therefore, she felt depressed to the point of even contemplating suicide. After being diagnosed with major depression, she received pharmaceutical and psychotherapy treatments, to no avail. When feeling at the end of her rope, she encountered a counselor who was a long-term Buddhist practitioner. The encounter was interpreted by Madam Yap as something resulting from her karma. The counselor enlightened her that in the Buddhist view, suicide does not exterminate one’s karma but rather constitutes a kind of severely evil karma because it is the felony of killing. The counselor advised her to chant the name of Amitabha Buddha and the mantra of the Bodhisattva of Mercy and to visualize the image of Amitabha Buddha and the beautiful scenery of his pure land because doing so would create positive karma. Madam Yap took the advice to heart. Accordingly, her faith in Amitabha Buddha grew stronger, so did her hope to enter the Pure Land of Amitabha Buddha upon death. With the counselor’s help, Madam Yap reviewed her life through a different lens, coming to realize that she had paid her karmic debts by living a miserable life. Such rationalization was greatly instrumental in her recovery from depression. This coping episode illustrates that belief in the notion of karma may function as an antidote to depression by, among other things, fostering and bolstering a sense of meaning, hope, and mastery.

The other prevalent form of meaning-making coping was the interpretation of stress as a form of duḥkha (suffering). The truth that life boils down to a state of duḥkha comes first in the Four Noble Truths of Buddhism. Participants tended to use this truth to account for the inevitability of stress in life. As one participant explained,

But human beings definitely have stress. According to Buddhism, our world is a dirty and turbid world. The first noble truth of Buddhism is the truth of suffering. Life has a lot of sufferings, worries, stresses, and anxieties. But we have to endure . . . . If I am under stress, I say to myself: “This is life. Everybody suffers. Life is suffering. Stress is a kind of suffering. You’re already very old; there is no much time left for you to live in this world. Why not tolerate stress, co-existing with it?” (Mr. Sum, age 74)

Another participant stated,

Physical declines are miserable, hard to accept. Your wrinkles are on the increase and you are becoming ugly. Your teeth are gone and you can’t hear clearly. But what can you do? This is natural, inevitable. Birth, aging, illness, and death all are sufferings. We should learn how to break through these physical limitations and let go of the body. (Madam Soh, age 74)

The extracts above illustrate that the interpretation of stress as a form of duḥkha serves to normalize stress inasmuch as suffering is integral to life. The normalization of stress enabled participants to appreciate, accept, and assimilate it, which facilitated their tolerance of it.

In sum, Buddhist meaning-making coping transformed stress into interpretable, comprehensible, and meaningful experience with constructive implications, which allowed participants to approach and address stress stoically and positively.

Meditative coping

Participants used meditation to cope. For example, to overcome stress, Mr. Lam (age 68 years) engaged in visualization, a form of concentration meditation:

Gently close eyes and relax. Focus attention on breath and breathe gently. Hm, visualize a calm lake and in the middle of the lake, hm, there is a lotus flower, beautiful and pure. Then imagine that the Buddha is sitting cross-legged on the lotus flower and the warm light from the Buddha heart is coming at me. Hm, my heart is open to the warm loving light from the Buddha. Feel the loving energy; hm, it is flowing into my heart, and gradually, throughout my whole body.

Such visualization served to distance Mr. Lam from the stressor, thus facilitating renewal of his emotional energy. To restore mental tranquility, Mr. Sum (age 74 years) also employed visualization:

When under stress, I visualize the image of the Bodhisattva of Mercy with one thousand hands and one thousand eyes. The Bodhisattva of Mercy has a merciful heart. In order to emancipate sentient beings from sufferings, the Bodhisattva of Mercy treks and endures.

Mantra meditation can help to cultivate a mental one-pointed focus on a group of spiritual words, which can suspend the experience of stress (Kristeller, 2007). This was illustrated by the case of Madam Soh (aged 74 years). She had a phobia of taking elevator after an accident of getting stuck in an elevator. Although she could keep the phobia at a manageable level, it did constitute a persistent sore annoyance to her. A Buddhist friend advised her to chant the six-word mantra of the Bodhisattva of Mercy while taking elevator, and she followed the advice. It turned out that the single-minded concentration generated by chanting the mantra mitigated her phobia.

Studies (e.g. Gamaiunova et al., 2019; Tang et al., 2007) have revealed the effectiveness of meditation in reducing stress. For participants, meditation served a stress-buffering function. Mr. Teo (age 88 years) explained,

Meditation means that you are not attached to external phenomena and your internal mind. When I sit in meditation, I relax myself, and focus my attention on my breath, single-minded. This is like you letting an elephant’s trunk grab a stick, in this case, it won’t be able to grab anything else. Likewise, if your mind concentrates on one point, it won’t be able to think of other things, including those things that can cause you stress.

The above quote suggests that channeling mental energy to a neutral or positively valenced object of experience through meditation is instrumental in stress reduction. The stress-buffering function may also lie in the capacity of meditation to help garner the mental energy needed for overcoming stress. As Madam Eng (age 75 years) elucidated,

Visualization can help us gather energy. This is like the Three-Gorge Dam in China intercepting the water. You see, the water seems to stand still, but it contains great power. This will enable us to accumulate energy to break through challenges and stresses.

It can be said that detachment is central to the function of meditation in reducing stress in participants. By evoking a single-minded and present-focused state of consciousness in participants, meditation helped them to detach themselves from the stressful experience, thus avoiding overreaction to it or rumination about it.

Ego-transcendence coping

The essential teaching of the Buddha, according to Abe (1997), is nothing but that of searching for and attaining the true self. In a sense, attachment to the ego (the false self) is the origin of all sufferings (Moacanin, 1992). Only after transcending the ego, one can attain the true self (Abe, 1997). This ego-transcending process is akin to the transition from a chrysalis to a butterfly, which empowered participants to tackle stress. This point is exemplified by the case of Madam Eng (age 75 years). She was acutely aware that her beautiful and energetic body was declining. This awareness distressed her to the extent that she felt it necessary to seek help from a spiritual advisor. The advisor recommended her to meditate on the impurities of the body as a foul skin bag so as to loosen attachment to it. He also helped her to trace her distress to her narcissistic attachment to physical beauty. Understanding that there was no point lamenting over what had been lost and obsessing about extrinsic beauty, she mustered the courage to transcend her old ego and to develop a fresh perspective on herself:

I’m honest with myself. For the first time, I said wrinkles, decayed teeth, grey hair, etc., etc., all these don’t matter . . .. Buddhism teaches us not to get attached to phenomenal appearances, so that we can become more detached. Then there’ll be no stress arising from thinking that I’m an older person, an unattractive older person.

Ego-transcendence coping was also utilized by Mr. Lam (age 68 years). When his business was on the verge of bankruptcy, he isolated himself socially and experienced bitterness solitarily. Preoccupation with his glorious past rendered it difficult for him to face the grim reality. Conventional coping had proved to be woefully inadequate for tackling such tremendous stress. At this juncture, a Buddhist monk’s edification made him realize that preoccupation with wealth, fame, status, and power had resulted in his inflated ego and attachment to this inflated ego was the leading cause of his distress. This epiphany enabled him to abandon his egoistic goals, which facilitated his discovery of a spiritual self that was not defined in terms of worldly possessions. Finding this spiritual self empowered him to rise to the challenge.

The two cases above suggest that non-attachment to the ego can disempower the ego, alleviating ego-induced stress. The following case will show how ego-transcendence can occur in the faith context.

Although it is through faith in the saving power of Amitabha Buddha that believers of Amitabha Buddha pursue emancipation, such faith must be finally connected with surrendering the ego mentally, for spiritual emancipation to occur (Chen, 2006). This connection is exemplified by Mr. Teo’s experience. At the age of 68 years, one of his legs failed to stand stably due to practicing qigong improperly, rendering him wheelchair-bound. He was anxious that he might be permanently confined to a wheelchair. To cope, Mr. Teo (age 88 years) placed complete trust in the healing power of Amitabha Buddha:

. . . I just chanted the name of Amitabha Buddha most sincerely. I tried to keep my stream of consciousness pure and clean. I was always mindful of Amitabha Buddha . . . . There seemed no distinction between chanting and no chanting. Every moment of chanting was a moment of clarity and illumination . . . I chanted the Heart Sutra . . . . I observed that my five aggregates [i.e., form, sensation, perception, mental formation, and consciousness] are empty. I tried to experience egolessness. Ah, wonderful, you know, my leg did get better little by little, and the qi-channel was smooth again. I was able to walk again. Amitabha Buddha.

It appeared that Mr. Teo’s steadfast faith in the healing power of Amitabha Buddha was intimately connected with his relinquishing ego-attachment, which helped him rise above the adversity.

The functions of Buddhism as a cognitive schema in coping

As Krause (2008) argued, if one opts to view stressors and attendant psychological distress through a religious lens, he or she will be more likely to attribute these problems to religious causes and to solve them in religious ways. The findings of this study showed that participants tended to hold a Buddhist view of stressful events and circumstances and accordingly adopt Buddhist ways of coping. McIntosh’s (1995) concept of religion-as-schema can provide an integrated explanation of how the Buddhist belief system helped participants to cope. In the light of this concept, the Buddhist belief system can be perceived as offering a cognitive schema for informing and facilitating coping. In particular, the Buddhist cognitive schema shapes the three coping categories identified above: meaning-making coping, meditative coping, and ego-transcendence coping.

The Buddhist cognitions of duḥkha and karma are central to the process of meaning-making coping. These constructs serve as basic cognitions that participants hold to evaluate the stressful events and circumstances (McIntosh, 1995). What is important about such religious cognitions as duḥkha and karma is that they can provide coherent and convincing interpretations of stressors, facilitating the discovery of meaning in stressors. For example, the law of karma is believed to operate in past lifetimes, the present lifetime, and future lifetimes. Thus, what happens in the present lifetime may be attributable to the karma created in the previous lifetime, and the karma created in the present lifetime may be responsible for what will happen in next lifetime. Such an explanatory power renders inapprehensible stressors apprehensible and unjustifiable stressors justifiable. This can increase what Rothbaum et al. (1982) termed “interpretive control” over stressful circumstances (p. 24). In addition, the cognition of karma can help foster both a sense of individual responsibility for one’s own stress and a sense of personal agency to address it. This would align the karma cognition with the idea of internal locus of control (Phillips et al., 2009), increasing the meaningfulness of attributing stress to karma. As in Leung and Chan’s (2010) study, one participant gained a sense of responsibility by attributing her breast cancer to karma resulting from the wrongdoings in her past lives: “I have to take the result, as it is karma. Just like when you have a loan, you have to repay the money” (p. 169). Furthermore, her cognition of karma led to a sense of control over her situation when she decided to “seize the present, be positive, and sow good seeds of karma for . . . future lives” (Leung and Chan, 2010: 169). This case exemplifies the function of the Buddhist cognitive schema in meaning-making coping.

The function of the Buddhist cognitive schema in meditative coping lies in providing a detached cognition to divert mental energy from stressful stimuli. Here, meditation functions as “a neutral distractor” (Kristeller, 2007: 684), diverting participants’ attention from a stressor and facilitating their sustained attention on an intended neutral or positively valenced object. Meditation predicts better sustained attention (MacLean et al., 2010; Valentine and Sweet, 1999). Such mediation-based attentional regulation is a form of cognitive control (Birdee et al., 2018; Teper and Inzlicht, 2013), which is functionally connected to lessening ruminative or obsessive thinking about negative stimuli (Hemo and Lev-Ari, 2015) and accepting emotion-induced stimuli (Gamaiunova et al., 2019). Resultant from such regulation can also be “an active disengagement of usual reactivity, analysis, or letting the attention move unbidden to the next association, emotion, or response” (Kristeller, 2007: 681). Thus, it is reasonable to perceive the meditative state as a state of consciousness constructed and mediated by the detached cognition, which can help loosen the hold of “the ordinary phenomenal mind” (Kang, 2018: 345).

It is equally important to recognize and understand the function of the Buddhist cognitive schema in ego-transcendence coping. The Buddhist belief system acknowledges the conventional existence of a relative self: “. . . although the self appears to be real, it is only the appearance that is real” (Epstein, 2007: 8). In other words, the cognition of the ego (the relative or false self) is merely a cognitive representation that is experienced as inherent, essential, and permanent, but in the final analysis, is insubstantial, unfounded, and impermanent (Abe, 1997; Epstein, 2007). As Abe (1997) noted,

According to the teaching of the Buddha, the idea of self (in the ordinary sense) is an imaginary, false belief which has no corresponding reality, and it produces harmful thoughts of “me” and “mine,” selfish desire, craving, attachment, hatred, ill-will, conceit, pride, egoism, and other defilements, impurities and problems. (p. 68)

In this sense, a life building on ego-attachment is a stressful life. Ego-transcendence coping, as this study showed, entails a shift from an egoic cognition to a trans-egoic cognition (Wilber, 2001). Such a shift eases participants’ “defensive loads”—burdens of defending the ego (Epstein, 2007: 2) and decreases their egocentricity (Tornstam, 2005). The shift to a trans-egoic cognition also empowers participants “to develop into more spacious personalities” (Jung, 1989: 140) and seek the transformation from “the ordinary phenomenal mind” into “the transcendental essential mind” (Kang, 2018: 345), so that they have “sufficient meaning” (Jung, 1989: 140) to make sense of and come to terms with stress. In this sense, ego-transcendence coping constitutes what Wong et al. (2006) called “transformational coping” (p. 16).

Xu (2018) proposed a conceptual framework of Buddhism-as-a-meaning-system with reference to coping in old age, which is oriented to Buddhism-based meaning construction and discovery in the existential, cognitive, and behavioral dimensions. Arguably, the conceptualization of Buddhism as a cognitive schema can resonate with and reinforce the dimension of cognitive meaning within the framework of Buddhism-as-a-meaning-system in two ways. One way is establishing the meaningfulness of such Buddhist cognitions as the karma cognition, the detached cognition, and the trans-egoic cognition for the dynamics of coping in late life. The other way is demonstrating the significance of the belief in spiritual empowerment by Buddhas and Bodhisattvas for coping in older adulthood.

Implications for practice with older Buddhists

Religious cognitions can be an increasingly significant intrapsychic resource for coping with aging (Koenig et al., 1988). There is a growing trend toward incorporating religious cognitions into gerontological practice (Dudley, 2016; McInnis-Dittrich, 2009). The discussion above suggests that the Buddhist belief system can function as a cognitive schema, which guides the coping efforts of older Buddhists dealing with stress. Accordingly, when helping older Buddhists to cope, spiritually sensitive gerontological professionals can help them mobilize and optimize Buddhist cognitive resources in at least three ways.

First, in terms of meaning-making coping, older Buddhists may draw on Buddhist cognitions to make sense of and find meaning in stressors (e.g. disease is due to karma), so that stressors can be rationalized and thus be accepted. Given the uncertain or uncontrollable nature of many late-life stressors (Aldwin, 2007; Zautra et al., 2000), the cognition of karma appears particularly useful in this regard. For example, older Buddhists can be helped to understand that they still have the leverage to manage seemingly uncertain or uncontrollable stressors because they can create positive karma at any time. This belief would give them a sense of hope and meaning when they seek to find a way out of suffering. Second, ego-transcendence coping would help older Buddhists to cultivate a trans-egoic cognition, from which they can derive reasonably adequate cognitive resources to transform themselves. Here, older Buddhists can be helped to reframe a stressful encounter as an opportunity for personal growth and transformation. Third, meditation can help older Buddhists to develop a detached cognition, which can be instrumental in preventing preoccupation with stress and mitigating the intensity of stress. All these coping approaches, which are based on the Buddhist cognitive schema, are expected to provide older Buddhists with meaning, detachment, and transcendence when they experience stress.

Implications for future research

This study provides insights into the dynamics and nuances of Buddhist-oriented religious coping in late life. However, three potential limitations of the study should be noted, which might affect the generalizability of the study findings. First, given the data were analyzed by one person alone, there was no interrater reliability. In addition, data were generated from a small homogeneous sample in Singapore. Finally, there might be social desirability bias and recall bias in participants’ responses.

Future quantitative studies can use statistically representative samples to test the qualitative findings of this study and hypotheses that may be generated from these findings. Future research can contrast coping experiences in non-religious older samples and older Buddhist samples or in older Buddhist samples and younger Buddhist samples. To obtain a more dynamic, subtle, and complete picture of Buddhist-oriented religious coping in old age, it would be valuable to use a longitudinal approach. Gaining deeper insights into the Buddhist cognitive schema would shed more light on Buddhist-oriented religious coping in old age. Thus, research into the evolution and development of the Buddhist cognitive schema in older Buddhists’ coping process appears warranted. Also worthy of exploration is negative religious coping among older Buddhists. Empirical research has begun to reveal negative aspects of Buddhist-oriented religious coping. For instance, according to Phillips and associates (2012), the Buddhist doctrine of karma may be misinterpreted as a form of fatalism by some Buddhists, who believe that “past actions have created a chain of events that cannot be changed” and thus feel helpless (p. 159). As a matter of fact, the notion of karma is not fatalistic because “everyone has the potential at each moment to alter the course of his future karma” (Van Hien Study Group, 2003: 352).