Mental health and mental disorders

The brain is one of the most complex structures in the universe. The 86 billion nerve cells of the brain communicate by various chemical messengers, known as neurotransmitters, in trillions of nerve cell connections, called synapses (Herculano-Houzel, 2012). Even if we know many parts of this complex brain machinery and its interaction with the rest of the body, our understanding of exactly how everything works is rather limited. That makes it difficult to know precisely what is malfunctioning in various mental illnesses.

The complex biological machinery of the brain produces the psychological mind. Just as the heart pumps blood, the gut digests food, and the muscles move the body, the mind is a bodily function of the brain. As with any organ of the body, when the brain does not develop properly, when it’s not nurtured, cared for, stimulated, and exercised appropriately, or when it is hurt, harmed, and injured in some way, it may malfunction. The mind is impacted, and the dysfunctions may manifest as mental illnesses.

The mind is where we experience and reflect on ourselves, our relationships, our environment, and the world. It is comprised of thoughts and feelings that direct our behaviors. Memory, sensation, interpretation, imagination, desire, intention, willpower, planning, and execution are essential mental faculties that constitute the mind. In mental disorders, our ability to exercise these faculties may be impaired. This in turn impacts how we function and relate to ourselves, others, and the social context we live in.

The historic conceptualizations of mental disorders have tended to focus either on causes related to the supernatural, the biology of the human body (somatogenic), or the psychology of the mind (psychogenic). “Supernatural theories attribute mental illness to possession by evil or demonic spirits, displeasure of gods, eclipses, planetary gravitation, curses, and sin. Somatogenic theories identify disturbances in physical functioning resulting from either illness, genetic inheritance, or brain damage or imbalance. Psychogenic theories focus on traumatic or stressful experiences, maladaptive learned associations and cognitions, or distorted perceptions (Farreras, 2022).” While supernatural theories have dominated the understanding of mental illnesses throughout much of history, and still are commonly held beliefs in various cultures and faith traditions, contemporary psychology and psychiatry predominantly focus on somatogenic and psychogenic theories, and consequently biological and/or psychological treatment strategies.

In its constitution adopted in 1948, mental health was defined by the World Health Organization (WHO) as; “a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity”(World Health Organization, 1948). Rather than focusing on one dimension of health, often to the exclusion of others, this definition of health seeks to reflect a more holistic model and perspective of health. The more holistic ‘biopsychosocial model’ of health and illness (Engel, 1977) has since gained widespread acceptance in healthcare, though clinical practice often fails to be truly holistic and often predominantly focuses on one aspect or another of health.

What is missing from WHO’s and Engel’s definitions and models, is the supernatural, or spiritual aspects of existence. Materialistic worldviews dominate medical and psychological sciences and may leave little or no room for a spiritual dimension of existence. There has been some reluctance to move toward an even more holistic ‘biopsychosocial-spiritual model’. In 1999, at the 52nd Assembly of WHO, it was proposed to revise the definition of health and insert “spiritual”, so it would state that: “Health is a dynamic state of complete physical, mental, spiritual and social well-being and not merely the absence of disease or infirmity” (World Health Organization, 1999). The proposed amendment failed, but the WHO has still emphasized the importance of the spiritual dimension in the prevention and treatment of illness.

The term ‘spiritual’ may have different meanings for different people. A broad and comprehensive definition is “the search for ultimate meaning, purpose and significance, in relation to oneself, family, others, community, nature, and the sacred, expressed through beliefs, values, traditions and practices” (Puchalski et al., 2014). Another term for the study of mental disorders is “psychopathology”. It is a derivative of three Greek words: ψυχή (psychē), πάθος (pathos) and λόγος (logos)—which literally translated would be something like “soul suffering study” (McRay et al., 2016). Many people experience that sooner or later in life, issues of meaning, purpose, and significance become of utmost importance. In mental illness, many people also experience existential and spiritual questions and suffering. Meaning, purpose, and significance are matters of the soul, and spirituality should therefore be included in concepts of mental illness and our strategies for treating them.

A holistic perspective on mental disorders adopts a biopsychosocial-spiritual framework for understanding and treatment strategies. This allows care and treatment to address all dimensions of human existence through the many and varied interventions available in order to minimize the duration and extent of suffering. When interventions are complementary, one should not exclude another. Such a holistic strategy for treating mental disorders increases the likelihood of achieving remission or optimal management of a chronic mental disorder.