The Biopsychosocialspiritual Model

of Mental Illness

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, deathawareness, 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
conversation 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 worlds spiritual traditions).
From the Buddhist philosophical perspective in particular, a persons 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!

Further Reading
1. Lukoff, D. From spiritual emergency to spiritual problem: The transpersonal roots of the new
DSM-IV-TR category. Journal of Humanistic Psychology 1998;38:21-50 1998
2. Parks, T. How is your personality formed? The Guardian, 2013, 22nd June.
3. Shonin E, Van Gordon W, Griffiths MD. Buddhist philosophy for the treatment of problem
gambling. Journal of Behavioural Addiction, 2013;2:63-71.
4. Shonin E, Van Gordon W, Griffiths MD. Meditation Awareness Training (MAT) for improved
psychological wellbeing: A qualitative examination of participant experiences. Journal of Religion
and Health, 2013; DOI:10.1007/s10943-013-9679-0.
5. Yang C, Lukoff D. Working with spiritual issues. Psychiatric Annals, 1998;36:168-174.
Ven Edo Shonin and Ven William Van Gordon