Different Ways of Understanding Mental Health

Imagine three people looking at the same person. She has been struggling for several months. She feels anxious when she wakes up, has difficulty concentrating, sleeps poorly, avoids friends, experiences frequent stomach discomfort, and has started wondering whether anything in her life really matters.

The first person says, "We need to understand what is happening biologically." The second says, "We need to understand her biology, psychology, relationships, and environment." The third says, "Yes, and we also need to understand how she experiences herself in her body, how these systems interact, and what is happening to her sense of meaning and connection."

These responses represent different ways of looking at mental health. None of them necessarily has to be wrong. The important question is whether the model we use is large enough to capture what is actually happening.

The Biomedical Model

The biomedical model has been enormously important in modern health care. Its basic logic is straightforward: symptoms may reflect an underlying biological problem, so we try to identify the relevant biological process and treat it.

This approach works exceptionally well for many conditions. Suppose someone develops severe fatigue, difficulty concentrating, and low mood. It would be easy to assume that the person is depressed. But imagine that medical testing reveals severe hypothyroidism. We have now discovered an important biological contributor to the person's experience.

Or imagine someone repeatedly experiences a pounding heart, sweating, trembling, and a sense of terror. Those symptoms can occur during panic attacks, but similar symptoms can also occur in some medical conditions. Before assuming that every episode is psychological, relevant medical explanations may need to be considered.

This is one of the great strengths of the biomedical model. It reminds us that mental symptoms occur in biological organisms.

Your Mental State Has a Biological Context

Imagine yourself after a full night's sleep, having eaten normally, feeling physically comfortable, and sitting somewhere you feel safe. Now imagine yourself after three hours of sleep, having skipped two meals, experiencing a headache, and rushing to deal with an unexpected problem.

Would you respond to the same frustrating email exactly the same way? Probably not. Your values have not changed and your personality has not disappeared. The biological conditions under which your mind is operating have changed.

The brain requires energy, oxygen, sleep, nutrients, circulation, hormonal regulation, and countless other biological processes to function normally. Mental life does not float above biology. It depends on it.

Where the Biomedical Model Becomes Limited

The problem comes when biological explanation becomes biological reductionism. Reductionism occurs when we assume that because biology contributes to an experience, biology completely explains that experience.

Consider depression. Two people can receive the same diagnosis while having remarkably different lives. One recently lost a spouse. Another has lived with severe social isolation for years. Another has chronic pain. Another experienced repeated childhood trauma. Another appears outwardly successful but feels trapped in a life that has little personal meaning. Another develops depressive symptoms alongside a medical condition.

These people may share certain symptoms, but the processes contributing to their suffering can be very different. A diagnosis can tell us something important. It rarely tells us everything.

The Biopsychosocial Model

In 1977, psychiatrist George Engel argued that medicine needed a broader framework. Instead of understanding illness exclusively through biology, he proposed considering biological, psychological, and social dimensions together. This became known as the biopsychosocial model.

This represented an important shift. Instead of asking only, "What biological mechanism is involved?", we can ask, "What biological, psychological, and social processes are interacting in this person's life?"

Let's return to our hypothetical person who wakes feeling anxious. A biological assessment might consider sleep, physical health, medication, hormonal factors, substance use, and other physiological contributors. A psychological assessment might explore worry, beliefs, emotional patterns, trauma history, coping strategies, and avoidance. A social assessment might examine relationships, loneliness, work stress, financial pressure, discrimination, caregiving responsibilities, or lack of community.

The same symptoms now become part of a much larger picture.

Try It Yourself: Three Lenses

Think of a period when you were under significant stress. First ask what was happening biologically. Perhaps you were sleeping poorly, physically exhausted, ill, in pain, eating differently, or experiencing persistent physiological arousal.

Next, ask what was happening psychologically. Perhaps you were worrying, grieving, criticizing yourself, feeling helpless, avoiding something, or struggling with uncertainty. Then consider the social dimension. Perhaps you were isolated, fighting with someone, overwhelmed at work, caring for another person, moving to a new place, or lacking support.

Notice what happens when you put all three answers together. Your experience often becomes easier to understand because the different parts provide context for one another.

The Problem Is Often in the Interaction

The real strength of the biopsychosocial perspective is not simply that it gives us three lists of possible causes. The important idea is that the three levels interact.

Imagine someone who develops insomnia during a stressful period. Poor sleep increases emotional reactivity. Greater emotional reactivity creates more conflict with a partner. Relationship conflict increases stress. Stress makes sleep even more difficult.

We now have a loop:

Stress → poor sleep → greater emotional reactivity → relationship conflict → more stress → poorer sleep

Which part is biological? Which part is psychological? Which part is social? The categories are useful for studying the problem, but the actual human experience crosses all three.

This distinction matters because mental health difficulties are often maintained by loops rather than by a single cause. Changing one part of the loop can sometimes influence the entire system.

The Body-Mind-Spirit Model

A body-mind-spirit perspective keeps the strengths of the biopsychosocial model but asks us to look more closely at embodied experience, regulation, relationship, and meaning.

The word "spirit" can easily be misunderstood. It does not mean that mental illness is caused by invisible spiritual forces, nor does it require religious belief. In this course, spirit refers broadly to the dimension of human experience concerned with meaning, purpose, values, connection, identity, transcendence, and our relationship to something larger than our immediate individual concerns.

For one person, this may be explicitly religious. For another, it may involve nature. For another, family, art, service, community, creativity, or a commitment to particular values may provide that sense of meaning.

The important point is that humans do not merely regulate physiological states. We interpret our lives.

Imagine Losing the Same Job in Three Different Ways

Consider three people who are unexpectedly fired from similar jobs. The external event is approximately the same, but each person experiences it differently.

The first thinks, "This is frightening, but I have people who will help me. I'll figure something out." The second thinks, "I knew it. I'm a failure. Nobody will ever want me." The third thinks, "I hated this career anyway. Maybe this is finally my chance to change my life."

The event is similar. The meaning is completely different. That difference in meaning can influence emotion, physiology, behavior, and what happens next.

The first person may feel frightened but reach out for help. The second may experience intense shame and withdraw. The third may experience a mixture of fear and excitement.

Meaning does not erase reality. Losing a job still has practical consequences. But human beings do not respond only to events. We also respond to what those events mean to us.

Why the Body Deserves Special Attention

If the biopsychosocial model already includes biology and psychology, why explicitly talk about the body?

One reason is that subjective bodily experience can easily disappear inside the word "biological." Biology might refer to genes, hormones, neurotransmitters, inflammation, or brain activity. But having a body is also an experience.

You can feel your heartbeat. You can notice your breathing. You can feel tension in your jaw. You can experience heaviness in your chest. You can feel an impulse to step backward when someone comes too close. You might notice that your shoulders rise when a particular person enters the room.

These experiences are related to biology, but they are not captured simply by measuring biological variables. Research on interoception examines how signals from inside the body are sensed, processed, interpreted, and incorporated into conscious experience.

This gives us another important question: What is the person experiencing inside their body?

An Experiential Example

Imagine that someone asks you, "Are you angry?" You immediately answer, "No."

Now stop and notice your body. Your jaw is tight. Your hands are pressing against your thighs. Your chest feels hot. You notice an impulse to push something away.

Your conscious story says, "I'm not angry." Your body is providing additional information.

This does not mean the body is always correct and the conscious mind is wrong. A tight jaw does not automatically mean anger. The same sensation could occur for many reasons. Bodily experience is information that needs to be understood in context.

A useful question might therefore be: "What might I be experiencing that I have not fully recognized yet?"

The Body Can Also Mislead Us

A body-mind approach should never romanticize bodily sensations. The body does not provide perfect truth.

Imagine feeling your heart suddenly pound. Your body provides information: your heartbeat has become strong or fast. Your brain must then make sense of that information.

You might interpret the sensation as excitement. You might interpret it as anxiety. You might become frightened and think something is wrong with your heart. Context, previous experience, attention, expectations, and other bodily signals can all influence the interpretation.

This is why body awareness is more sophisticated than simply "listening to your body." It involves becoming curious about the conversation among sensation, interpretation, context, memory, and emotion.

Embodied Cognition

This brings us to a larger scientific idea called embodied cognition. There are several versions of embodied cognition, and researchers continue to debate exactly how strongly thinking depends on sensory and motor processes.

For the purposes of mental health, we do not need to adopt the strongest version of the theory. A more modest principle is enough: thinking does not happen independently of the organism that is doing the thinking.

We think while tired or energized. We remember while calm or activated. We make decisions while hungry or satisfied. We interpret social situations while feeling safe or threatened. We think through a brain that is continuously receiving information from the body and environment.

Our physical state does not completely determine what we think, but it forms part of the context in which thinking occurs.

Mental Health as Regulation

This leads to another way of thinking about mental health. Mental health is not simply the absence of symptoms. It also involves the capacity to adapt and regulate.

Can you become activated when action is needed and settle when the situation is over? Can you experience sadness without becoming completely overwhelmed by it? Can you feel anger without automatically attacking someone or suppressing the feeling entirely? Can you tolerate some uncertainty? Can you ask for support? Can you recover after stress?

A well-regulated nervous system is not a nervous system that is permanently calm. Fear, anger, excitement, sadness, and physiological activation all have important functions.

What matters is flexibility. Can the system respond to changing circumstances and then adjust when those circumstances change?

Mental Health as Relationship

Now imagine that you have learned every emotional regulation technique in this course. You breathe effectively, understand your thoughts, exercise, sleep well, and meditate, but you have no meaningful relationships.

Would we consider that complete mental health? Probably not.

Humans develop and live within relationships. Connection, attachment, belonging, intimacy, conflict, rejection, cooperation, and community all shape psychological experience.

A comprehensive model therefore asks not only, "Can this person regulate themselves?" It also asks, "What happens to this person in relationship with other people?"

Sometimes a person functions remarkably well alone but becomes intensely dysregulated in intimate relationships. Sometimes the reverse is true. Understanding the relational context can reveal patterns that are invisible when we study the individual in isolation.

Mental Health as Meaning

Finally, imagine someone whose body is healthy, relationships are stable, career is successful, and daily life is manageable. Yet every morning they wake with the thought, "What is the point of any of this?"

Something important is still happening.

Human beings care about whether life feels meaningful. We want to know what matters. We want our actions to connect with our values. Many of us want some sense that our lives belong to a larger story.

This is where existential and spiritual dimensions become relevant. Not every psychological problem is a problem of meaning, but sometimes anxiety is partly about mortality. Sometimes depression involves profound loss of purpose. Sometimes grief changes a person's entire worldview. Sometimes trauma disrupts assumptions about goodness, trust, justice, or safety.

Treating symptoms alone can miss these dimensions.

Four Questions Instead of One

A body-mind-spirit approach therefore gives us several ways of looking at the same experience.

First, we can ask what is happening biologically. What is happening with sleep, physical health, the brain, nervous system, hormones, immune system, metabolism, or other bodily processes?

Second, we can ask what is happening psychologically. What emotions, thoughts, memories, expectations, behaviors, and learned patterns are involved?

Third, we can ask what is happening relationally and environmentally. What relationships, social conditions, cultural influences, and environmental stresses are affecting the person?

Finally, we can ask what is happening at the level of meaning. What does this experience mean to the person? What has happened to their sense of identity, purpose, values, belonging, or hope?

These questions do not compete with one another. They complement one another.

Try This: Look at One Problem Through Four Lenses

Choose a manageable problem from your own life. It might be procrastination, anxiety before social events, difficulty sleeping, irritability, or avoiding a particular task.

Begin with the body. What happens physically when the problem appears? Perhaps your chest tightens, your breathing changes, or your energy suddenly drops.

Then consider the mind. What thoughts, emotions, memories, or expectations appear? Perhaps you anticipate failure or judgment.

Next, consider relationships and environment. What around you contributes to the pattern? Perhaps the problem becomes worse around particular people, or perhaps you function much better when another person is present.

Finally, consider meaning. What does the situation represent to you? Perhaps completing the task would expose you to judgment. Perhaps succeeding would create new responsibilities. Perhaps failing would confirm an old belief about yourself.

Your "procrastination" may now look different. What originally appeared to be a simple problem of motivation might involve physiological activation, fear, learned expectations, social evaluation, and personal meaning.

That does not make the problem hopelessly complicated. It gives you more places from which to approach it.

The Goal Is Not to Explain Everything

There is a danger in any comprehensive model. Once we learn that many systems interact, we may begin looking for explanations everywhere.

Is my anxiety caused by my microbiome? My childhood? My vagus nerve? My hormones? My attachment patterns? My thoughts? My diet? My relationships? My sense of purpose?

Sometimes the answer is much simpler. Sometimes a person is exhausted because they are not sleeping enough. Sometimes someone is anxious because they are facing a genuinely difficult situation. Sometimes grief hurts because someone important has died.

A broad model should increase clarity, not create endless self-analysis.

The goal is not to find every possible contributor. The goal is to identify the factors that are actually important for this person, in this situation, at this time.

A Better Question

Different models of mental health give us different pieces of the picture. The biomedical model reminds us that mental life depends on biology. The biopsychosocial model reminds us that biology exists within psychological and social contexts. A body-mind-spirit model adds close attention to embodied experience, regulation, relationships, and meaning.

We do not necessarily have to choose one model and reject the others. We can understand them as different levels of the same picture.

Instead of asking only, "What disorder does this person have?", we can also ask:

"What is happening in this person's body, mind, relationships, environment, and world of meaning, and how are these processes influencing one another?"

Posted in: August 2026