This big question has been on my mind for over thirty years, since I first realised my teachers had no satisfactory answer. What is mental health? Intuition always told me that it is more than the absence of psychiatric symptoms... Much more!
It is good that medical students learn about healthy anatomy and physiology first, then about pathology, about what goes wrong with the body. However, like other already qualified doctors training to be psychiatrists in the 1970's, I was plunged directly into dealing with psychotic patients, psychotherapy cases, and heavily dysfunctional families. It was mainly ‘learn-as-you-go'. There was little about normal psychology, although classes on developmental psychology helped orientate us a little.
I eventually came to understand the need to think about mental health according to five inter-related dimensions. Some of what follows may seem obvious, but it is worth spelling out in order to reflect on it again later.
The first of these dimensions is ‘physical': concerning matter and energy, atoms and molecules. Lithium carbonate, a naturally occurring salt, for example, has a mood stabilising effect, useful in some people with bipolar disorder. Neuro-transmitters, hormones, toxins and medications affecting mental health are among some of the more complex chemicals we need to know about. Proteins and genes are made of chemicals too, of course: peptides and DNA.
The next dimension is ‘biological'. Based on the chemistry of carbon, oxygen, hydrogen, chlorine, potassium, calcium, sulphur, iron and other elements, it is essentially animate. Biological systems, organs and organisms are alive. Health at this level will obviously impact on mental health at the next.
The third, ‘psychological' dimension depends on the whole body, and particularly on one organ, the brain, the seat of individual consciousness and four basic, seamlessly interconnected sets of function: sense perception, thought (cognition), emotion (affect) and impulse (to speech and action). In the healthy mind, these four functions are in balance, mediating and interacting with more complex functions like memory and imagination; thoughts and emotions, in other words, about the past, the future and of what may be happening elsewhere.
Next, human beings' interacting with each other brings the fourth ‘social' dimension into operation. We communicate with each other through our bodies and minds, mainly through touch, vision and hearing, through behaviour and language (spoken and written). Pre-verbal contact and communication are vital in infancy, preparing us for non-verbal forms of interaction later. Retaining a strong capacity for empathic awareness, for example, the ability to detect directly the emotional condition and experiences of another person in real time as they are happening, is usually a sign of robust mental health.
Another important aspect of the social dimension concerns the formation and dissolution of social groups. The effects of both belonging and being rejected have consequences for the mental health of individual members. This is one of several areas where there is scope for improving our understanding of the relationship between personal and social psychology.
Those who adhere to the secular/scientific model may think that this goes far enough, that the basic disciplines studied by psychiatrists - physics, chemistry, biology, psychology and sociology - are sufficient to explain everything important to us in the universe. I disagree. The fifth ‘spiritual' dimension is essential, definitive, crucial and central to completion of the picture.
The spiritual dimension has no boundaries. It is ultimately unquantifiable and indefinable. However, it forms part of each person's unique and deeply personal experience. At the same time, it has universal qualities. Necessarily, therefore, it engages us firmly with mystery.
Paradoxically, that is why it makes vital sense. After all, there is scientific uncertainty - and therefore an element of mystery - in regard to all four preceding dimensions. The origins of the universe, of existence, however much we think we know of them, have not been revealed unequivocally in a way that defeats uncertainty. There is mystery yet too about the beginnings of life, and about the basis and nature of human consciousness. It is true that we humans - through the rapid and successful development of science - seem to be relatively knowledgeable. Think deeply, though, and it eventually becomes clear that we cannot claim total and absolute knowledge... about anything!
As scientific knowledge expands, questions continue to proliferate. Only the spiritual dimension, dealing with the absolute and embracing mystery, brings to completion a holistic vision of existence, so that what appears initially as a hierarchy of increasingly complex dimensions - from physical to social - is revealed as circular, with the spiritual dimension as the origin, central guiding element and ultimate goal of creation.
At the end of his researches, published in ‘The Varieties of Religious Experience' in 1902, pioneer psychologist William James offered five conclusions, which may be summarised as follows:
1. The visible world is part of a more spiritual universe from which it draws its chief significance.
2. Union or harmony with that higher universe is our true end.
3. Prayer or inner communion with the spirit thereof (today, we would add meditation) is a process wherein work is really done, and spiritual energy flows in and produces effects, psychological and material, within the phenomenal world.
4. Religion (today, we would prefer, "Engaging with spiritual beliefs and practices") brings a new zest, which adds itself like a gift to life, taking the form either of lyrical enchantment or of appeal to earnestness and heroism.
5. It brings an assurance of safety and a temper of peace, and, in relation to others, a preponderance of loving affections.
The spiritual dimension of individual souls and a universal spirit can be thought of in the context of mental health as being a vital source of meaning and purpose, of energy and motivation. It is associated with a comfortable sense of belonging and worth, of affinity with others and with nature. It can be understood, therefore, as a crucial element in establishing and maintaining health and harmony at all human levels: biological, psychological and social.
Just as time and space are inextricably linked, it is important to remember that any apparent separateness between the five dimensions of human experience is also illusory. To try and answer any question concerning human existence and welfare without considering all five will lead to false conclusions, and therefore to unnecessary suffering. When more people understand the poetic logic, the wisdom, of the spiritual dimension, they (we) will make fewer mistakes.
Copyright Larry Culliford