A frequently aired criticism of psychiatry is that it places too much emphasis on the role of biological factors as determinants of mental illness. Many people believe that an exclusively biological model of mental illness is a reductionist approach and that mental health problems are caused by a complex range of factors. According to Dr. Lucy Johnstone (as quoted by the Guardian newspaper earlier this week), there is “overwhelming evidence that people break down as a result of a complex mix of social and psychological circumstances – bereavement and loss, poverty and discrimination, trauma and abuse”.
A model of mental illness that is increasingly subscribed to by mental health professionals and academicians is one that acknowledges the contribution and interplay of biological, psychological, and social factors. This is known as the ‘biopsychosocial’ model of mental illness. Whilst the biopsychosocial model appears to provide an encompassing explanation for why mental health problems arise, an important dimension seems to have been overlooked. There is increasing scientific evidence that spirituality plays a significant role in the etiology, maintenance, and treatment of mental health problems. Types of spiritual aptitudes that have been shown to be influential in this regard include (for example) dispositional mindfulness, faith, meditative insight, loving-kindness, compassion, death-awareness, and patience.
The Diagnostic and Statistical Manual of Mental Illness (DSM) includes ‘Religious or Spiritual Problems’ as a V-code (V62.89). This means that a religious or spiritual problem could be the focus of clinical attention, but should not be confused with a mental illness. The DSM gives examples of religious or spiritual problems as “distressing experiences that involve loss or questioning of faith, problems associated with conversion to a new faith, or questioning of spiritual values that may not necessarily be related to an organized church or religious institution”.
Although the DSM (and mainstream clinical literature more generally) acknowledges that spiritual factors can cause personal conflict, the emphasis is placed on conflict that arises specifically due to loss of faith and/or questioning of spiritual values. Very little consideration is given to the wider role that spiritual factors play in the etiology of diagnosable mental illnesses.
Thus, we would argue that a ‘biopsychosocialspiritual’ model of mental illness – that acknowledges the importance of biological, psychological, social, and spiritual factors as determinants of psychopathology – represents a much more acceptable and inclusive model. This is consistent with the view of a growing number of transpersonal psychologists (and that of most of the world’s spiritual traditions).
From the Buddhist philosophical perspective in particular, a person’s levels of spiritual development (and therefore the risk of them experiencing mental health problems) relates not only to the amount of spiritual insight acquired during this lifetime, but also to the amount acquired during all previous lifetimes. In other words, Buddhism asserts that people are born into this life with a ‘karmic baggage’. This karmic baggage is an additional factor (i.e., in conjunction with the degree of spiritual progress made during this lifetime) that may account for any deficits in spiritual awareness.
We think there is quite a lot of progress to be made before mainstream health disciplines begin to accept that spiritual factors play a central causal role in the onset of mental pathologies. So perhaps now is not the right time to introduce a model of mental illness that requires clinicians not only to assess impairments in spiritual intelligence that relate to this life, but also those that relate to previous lifetimes!
Ven Edo Shonin and Ven William Van Gordon