Rethinking Mental Health: Towards a Holistic Organismic Paradigm (Part 4 of 4)
Part Four: Supporting the Natural Health Process
After outlining the basic needs and many of the possible types of nourishment barriers that can appear (in Part Three), the final, and of course, most important part of this model is exploring the implications for supporting an organism’s health. While this same basic model can presumably apply to all living organisms and living systems, for now, I’ll narrow down the scope of this exploration to the health of the human being.
Recall also that I’ve already narrowed down the scope of this exploration to those nourishment barriers that are most directly associated with one’s cognitive constructs—those that we generally consider to be “mental disorders,” as outlined in Part Three. Recall from Part Three that I’m using the term nourishment barriers to refer to anything that interferes with the ability to meet one’s needs, and that I then broke this down into two separate categories—those barriers that arise from primarily external sources (i.e., the simple lack of an available resource) versus those barriers that are more internally derived (those that are most closely associated with one’s cognitive constructs and that are most closely associated with what often gets referred to as “mental disorders”). While the former category is obviously extremely important and in fact is likely to lead to the development of the latter (consider, for example, the high correlation of poverty and the development of the so called mental disorders), I’m generally limiting my discussion here to those barriers that are most closely related to those conditions we often think of as mental disorders—those that are most closely associated with one’s cognitive constructs (one’s personal experience and understanding of oneself and the world).
What I feel is the single most important implication of this framework is recognizing that all organisms contain an innate drive towards optimal health as well as the profound wisdom to facilitate this process. This manifests as simply the ability to recognize one’s needs and the desire and capacity to work towards meeting them. So, the process of attempting to restore health that has been compromised generally entails working out what is interfering with the meeting of one’s needs (one’s nourishment barriers) and resolving them. Fortunately, in spite of the many different patterns of nourishment barriers outlined in Part Three (and perhaps others I haven’t identified here), it appears that there is really only one kind of nourishment barrier—that of limiting core beliefs—deeply held understandings that interfere with the ability to meet one’s needs in the most efficient manner given the situation at hand. However, I think it can be helpful to break this up into two overarching categories—intrapsychic conflicts, which are those limiting core beliefs that consist of the direct assessment of one’s own inner experience as harmful, and other kinds of limiting core beliefs:
Intrapsychic Conflict—Evaluating one’s own inner experiences (emotions, thoughts, impulses, images, memories, sensations, etc.) as being harmful, and therefore engaging in a kind of intrapersonal tug-of-war. I often like to refer to this kind of dynamic as “shooting the messenger.” Most of these inner experiences can be seen as being merely messages regarding which needs are or are not being met. Whereas it is certainly important to try to determine the accuracy or usefulness of any particular message, it is generally much more beneficial to cultivate a willingness to be open to whatever arises within one’s experience than to get involved in these kinds of intrapsychic wrestling matches. By resorting to strategies that try to suppress or directly alter these experiences, we risk missing out on valuable information, and we risk wasting our energy on a more-or-less futile internal struggle when this energy would probably be better spent developing more effective and sustainable methods for meeting the unmet needs that these inner experiences are likely pointing to. In their more extreme forms, these kinds of intrapsychic conflicts can manifest in ways often considered psychotic (e.g., struggling with anomalous perceptions such as voices or visions or becoming deeply engrossed with inner experience at the expense of not being able or willing to engage with others externally).
Other kinds of limiting core beliefs—In addition to those limiting core beliefs involving the direct struggle against one’s own natural inner experience, other limiting core beliefs can develop that typically involve either the evaluation that some needs must be sacrificed in order to meet others and/or the evaluation that certain needs simply cannot be met at all. I believe this is often the result of mistaking what are actually dialectics (both/and situations) for dichotomies (either/or situations)—for example, believing that we have to choose between having either autonomy or love from others, rather than recognizing that a healthy relationship consists of both autonomy and love from others. These kinds of limiting core beliefs may very well originate as accurate assessments of a particularly difficult situation; however, they represent a real nourishment barrier when they remain somewhat entrenched after the situation has improved. In their more extreme forms, these kinds of limiting beliefs can manifest in ways we think of as psychotic (e.g., so called paranoia or messianic striving).
I suspect, then, that virtually all of the nourishment barriers (at least those considered primarily mental in that they’re most directly associated with one’s cognitive constructs) could be seen as arising from either direct intrapsychic conflict, other limiting core beliefs, or some combination of the two. A psychotic process, in which one’s cognitive constructs shift into a relatively chaotic state, simply creates the conditions in which someone becomes particularly vulnerable to relatively intense versions of both of these.
Effective Methods of Support
Moving on to explore the most effective methods of supporting oneself and others in moving towards optimal health, it will help if we consider that there are only a relatively small handful of core needs that essentially gives rise to all of our other needs—these being peace, meaning, autonomy/self connection, and connection with others; see Figure 1 above), and that there are essentially only the two types of nourishment barriers mentioned above (intrapsychic conflict and other limiting core beliefs). Therefore, we can deduce that the best methods for supporting health are those that address these most fundamental needs and any associated nourishment barriers.
When we look to most of the major schools of psychotherapy and other kinds of psychosocial support, we find that, generally speaking, they are already naturally trying to target the various nourishment barriers outlined above, although they each tend to emphasize different phases (without necessarily describing them as such), and of course the practitioners of each generally believe that their own methods are the most effective. When research studies have been conducted comparing the outcomes of the different approaches, however, a very interesting finding emerges. It appears that the single most important factor determining therapeutic outcomes is not any particular method or technique, but the quality of the client/therapist relationship itself. And when questioned about the particular qualities of the relationship that clients find most helpful, they generally report these as including the sense that the therapist really cares about them and genuinely wants to understand them while also supporting their authenticity and choice. In other words, we’re really talking about the principles that Carl Rogers, one of the founders of humanistic psychology, emphasized decades ago—genuineness, positive regard, and empathy. So what is it about a relationship with these particular qualities that is so helpful?
This kind of relationship essentially creates a safe container where a person can connect more fully with their own experience and also with another human being, feeling encouraged to do so in a relatively open and curious way. One important aspect of this kind of work is that the attitude of openness and curiosity towards one’s inner experience that is cultivated here naturally works towards dissolving any intrapsychic conflicts. Another important aspect of this is that the therapist acts as a kind of safe and caring “reflecting board” where feelings and needs are brought to the forefront, and any limiting core beliefs naturally rise to the surface where they can be explored and reevaluated. A third important aspect of this situation is that the person is able to experience a healthy relationship with another human being, where one’s autonomy is valued at the same time that intimacy is allowed to deepen safely.
In other words, within such a relationship, we have a situation in which the most fundamental needs are generally being met (self connection and autonomy, connection with another, meaning and peace), and the main types of nourishment barriers (intrapsychic conflict and other limiting core beliefs) are being naturally addressed and worked through. The real beauty of this kind of relationship is that it does not need to be limited to a professional therapist, but actually represents nothing more nor less than that which occurs naturally within a healthy human relationship. I think it’s actually a real tragedy that we live in a society that generally values material wealth over the fostering of such relationships, and we have a mental health care system where the head honchos (typically the psychiatrists) are trained much more extensively in the use of drugs than in cultivating this kind of healthy interpersonal connection. Even psychologists often receive far more training in particular psychotherapeutic “interventions” than they do in developing the ability to cultivate this kind of relationship with their clients. We have already seen a natural movement in our society towards sanctuaries and family support systems designed to foster this kind of support for people in real need. If we want to live in a thriving and healthy society, then putting our resources into encouraging and expanding this movement is clearly in the best interest of all of us.
Even when such a healthy interpersonal relationship is not immediately available, we all have the capacity to practice powerful self-connection. Recall that emotions are not our enemies, no matter how unpleasant they may be—they are simply the messengers, letting us know how things are going with regard to meeting our needs. Unpleasant emotions typically are associated with needs that are not being met, and pleasant emotions are typically associated with those that are. As discussed above, if we perceive our emotions as something “bad” or “wrong,” and get involved in a wrestling match with them, trying to change them or push them away, then we will likely get tangled up in painful intrapsychic conflicts. However, if we recognize our emotions for what they are, we can open up to them and try to hear their message—what needs are getting met, and what needs are not? So, developing this level of self connection—that we could also call self empathy or connecting with one’s aliveness—not only puts us into direct contact with the information we need to achieve optimal health, but it also dissolves intrapsychic conflict and likely brings awareness to other limiting core beliefs.
As discussed earlier, mindfulness is a practice developed several thousand years ago in India that consists of simply cultivating the ability to be present and accepting with regard to one’s inner experience. One benefit, as already discussed, is the potential to develop an awareness of one’s own subjective experience at a very deep level. However, the cultivation of the ability to be at peace with one’s subjective experience is just as important as the cultivation of awareness. So this kind of practice clearly offers the potential to address both of the main types of nourishment barriers—dissolving intrapsychic conflict and resolving other limiting core beliefs.
By developing this combination of such powerful self-connection along with increased tolerance of difficult feelings and experiences, mindfulness practice allows us a way to strengthen our ability to perceive our situation more clearly and also to contemplate more effective responses.
In other words, considering that most of what we generally call mental disorders are ultimately associated with either problematic assessment of one’s situation and/or problems in responding in effective ways, mindfulness practice offers a way to directly resolve a lot of these problems by increasing one’s capacity to both meet one’s needs in a satisfying manner and to resist the impulse to respond in potentially impulsive and harmful ways during those times when one’s needs are not being satisfyingly met. It’s like offering someone the possibility of going to the gym to strengthen one’s organismic capacity as a whole, rather than merely strengthening one particular muscle.
So in this way, mindfulness practice clearly has the potential to greatly promote health. Although these benefits have been well known in parts of Asia for millennia, the field of Western psychology has finally appreciated this very powerful method, and consequently, it is being incorporated into many of the mainstream Western psychotherapeutic approaches.
As has been discussed, peace and meaning are among the most essential needs that we have, and according to this framework, these two are actually very closely related in that they essentially make up the two poles of the peace/existence dialectic. In order to better understand this, it will help if we first explore the issue of meaning. In order to want to continue to exist, it is very clear that we need to connect to some kind of personally meaningful activity or direction in which to channel our life energy. While the methods mentioned above can certainly aid in this regard, they’re often not enough. According to the framework presented here, the peace/existence dialectic lies at the very heart of our experience (see Figure 1 above), and being a dialectic, it’s helpful to recognize that a workable resolution consists of developing a strategy or a way of being in the world that transcends both poles.
Recall that the existence pole consists of both a mind and a body aspect (meaning and physical sustenance) and the peace pole consists of experiencing that which transcends our dualistic existence altogether—what is often experienced as an aspiration for spiritual communion or simply the connection with something that transcends the limited self. So with this framework in mind, we can recognize that in order to cultivate a life that contains both “good enough” meaning and “good enough” peace, we need to find a way to channel our life energy in a direction or towards a cause that both includes and transcends our personal sense of self. This could be as simple as raising or supporting a family, or it could involve devoting oneself to a particular cause, ethical principle, or spiritual practice or tradition. Ernest Becker sometimes referred to these practices as “immortality projects” in that they fend off the deeply held terror of our own mortality. I believe that this perspective has some merit; however, I feel that it’s placing too much emphasis on just one side of this dialectic. I believe that any truly meaningful aspiration not only staves off the fear of our own mortality, but also connects us to the awe, wonder, and beauty that are naturally evoked when we reach beyond the bounds of our limited self and grasp the much greater dance of life of that we are all a part.
Healthy Body, Healthy Mind, Healthy World
Maintaining a healthy body is of course also essential for full organismic health. Recall that body is essentially the material structure that emerges from the organismic process and allows certain patterns of knowing and response to remain relatively resilient over time. And mind is simply the subjective experience of this entire process—what it all feels like from the inside. Given this understanding, it’s simply common sense that if the body does not receive adequate nourishment (physical sustenance) or is injured or damaged in some way, then the entire organism including one’s subjective experience will likely be adversely affected. Fortunately, such physical sustenance is not particularly difficult or complicated, since organisms by their very nature strive to gain maximum benefit from whatever resources are available. Generally speaking, such sustenance consists of regular nutritional food, water, shelter, exercise, and protection from other invasive or potentially harmful organisms (such as parasites and predators); and if these basic bodily needs are not adequately met, then a whole host of problems can arise that ultimately act as various kinds of nourishment barriers within the organismic process.
This framework also provides an interesting perspective for understanding those problems we often refer to as “physiological diseases.” While this topic takes us into areas in which I don’t personally have a lot of expertise, I do find some of the implications that arise from this framework interesting. Recall that any particular organism is actually part of a much broader hierarchical arrangement of organisms—from the single cell, to an organ or organ system, to the entire multicellular organism itself, to the ecosystem to which these belong, and finally to the entire biosphere. The health of each of these is ultimately dependent upon the health of the other orders of organismic organization on either side of it on this ladder of organizational complexity. For example, in the case of a human being, if a single cell develops the particularly limiting core belief in which it “forgets” that it is a member of a larger organism, it may resort to fixating on its own individual survival and develop into a cancerous growth that ultimately kills the entire organism. Similarly, if the immune system of a complex organism develops a limiting core belief in which it determines that some part of the larger organism is harmful, an autoimmune disorder may develop. And to give one final and particularly poignant example, if the human organism develops a similar limiting core belief and “forgets” that it is merely one member of the broader ecosystems and the Earth’s biosphere in general, then this organism may act very much like a cancerous cell, focusing on its own individual survival while wreaking great havoc on the higher-ordered organisms upon which it is so dependent (the ecosystems and even the entire biosphere).
So, by considering that this same organismic process is occurring on each different organismic level, we may find it easier to work towards a more holistic system of health that’s more supportive not only of individual organisms but of the entire web of life to which all organisms belong. A controversial topic closely related to this idea is that of selfishness vs. altruism. Within the context presented here, there really is no such thing as altruism, at least not in the sense of intentionally acting in a manner that is beneficial for others. Rather, we recognize that as the illusion of distinct boundaries between “self” and “other” fades, and we experience our sense of “self” expanding to encompass other organisms and ultimately the entire web of life, our “selfishness” also naturally fades. As we identify with this more expanded sense of “self,” we naturally want to act in ways that are of the greatest benefit to “others,” especially those “others” who we begin to incorporate into our own sense of self. To put this in another way, we could say that it is innate for all organisms to act “selfishly,” but that the way this manifests is determined by the organism’s experience of what “self” actually is.
Implications for Mainstream Medical Model “Treatment”
In stark contrast to the methods of support mentioned above, so-called medical model “treatment” operates from the unsubstantiated premise that all so called mental disorders are caused by some disease process occurring with the body (and typically the brain in particular). Those who subscribe to this way of thinking often pay lip service to the importance of psychosocial factors, but usually only in the sense that these may make it more or less difficult for a person to cope with their disease. So as would be expected with this kind of framework, the primary treatments of choice consist of physiologically-based interventions, which nearly always include psychiatric drugs and encouraging/coercing people into having “insight into their illness” so that they’ll take them. Let’s take a moment to look at the implications of this kind of treatment based on the framework presented here.
When we convince someone that they have some kind of disease process occurring within their brain that in turn gives rise to certain subjective experiences (such as emotions like sadness, anger, or anxiety, or certain kinds of thoughts, beliefs, perceptions, images, memories, impulses, etc.), what do you think is likely to occur? Intrapsychic conflict, of course. The person’s own fear and general aversion towards these inner experiences are likely to increase, they become more likely to enter into tug-of-war relationships with their own inner experiences or increase the strength of those already existing, and are therefore likely to become more deeply entrenched in what would otherwise most likely be relatively transient experiences. Periods of grief or sadness intensify into chronic “depression,” the natural ebb and flow of anxiety intensifies into full fledged “anxiety disorders,” transient psychoses or other anomalous experiences harden into lifelong “psychotic disorders,” etc. And not only is this kind of distressing inner turmoil more likely to occur as a result of such treatment, but because the person is actually encouraged by “professionals” to go ahead and “shoot the messenger,” the person is now much more likely to miss out on valuable information regarding the unmet needs that most likely lie at the root of whatever the actual problem was in the first place.
So what about the drugs? Well, generally speaking, drugs can be seen as a particularly powerful method of “shooting the messenger,” whether they be psychiatric drugs or illicit drugs. In the absence of drugs, people who want to avoid unpleasant emotions or other unpleasant inner experiences generally find themselves having to resort to relatively mundane strategies of distraction or repression.
But these are like mere BB guns when compared to the heavy artillery of psychoactive drugs. Anytime we develop strategies that allow us to avoid feeling our own emotions (or other kinds of inner experience), we are essentially buying short term relief at the expense of the kind of authentic self connection that is generally required to address our needs in a more sustainable manner. And just as we would expect based upon the holistic organismic framework being presented here, we find a particularly robust and consistent pattern resulting from psychoactive drug use—short term relief (sometimes) at the cost of significant long term harm (usually). While I believe that this kind of strategy may have some usefulness, especially as a form of crisis intervention when the person feels completely overwhelmed by their inner experiences, it’s important to acknowledge the very steep price that comes with this strategy in the form of reduced self connection, the reduced capacity to tolerate unpleasant experiences, and whatever other side effects may be caused by the particular drug.
While on the topic of drugs, it’s interesting to consider the implications that this framework provides for why placebos work the way that they do. Placebos are strikingly effective for many (perhaps most) of the conditions that are listed here as nourishment barriers, in spite of their being completely inert physiologically. When someone receives a placebo, the person typically believes that they may be receiving some kind of support for whatever condition it is with which they’re struggling. If we consider that most of these conditions (especially those we’re calling primarily mental) arise from intrapsychic conflict (i.e., assessing one’s emotions and other inner experiences as being harmful in some way), then the placebo response makes perfect sense. Something is taking care of the offending emotion or other inner experience, so it’s finally okay to let down one’s guard.
In other words, the placebo often results in the person revising their assessment of the perceived harmful experience as being not so harmful anymore, which in turn allows them to let go of their intrapsychic struggle, which in turn is likely to reduce or even eliminate the very thing that was causing so much unnecessary distress in the first place. So just as the “disease model” understanding of mental disorders acts as a nocebo in that it promotes increased intrapsychic conflict, a placebo provides the means to ease this conflict.
So, Wrapping It All Up into a Nutshell . . .
. . . life consists of an often mysterious blend of mind and body, order and chaos, joy and suffering, and autonomy and symbiosis taking place within a profoundly dynamic, interdependent, and interconnected relational field. The very essence of all living organisms consists of a powerful drive towards health and wholeness, and the great wisdom to carry this out. Optimal health is an organism’s most natural state, and anything short of this suggests that certain needs are simply not being adequately met. The obvious implication of this is that the most effective means of supporting an organism’s health includes supporting it in identifying its unmet needs and in removing any associated nourishment barriers. This includes especially addressing any barriers to its natural ability to accurately perceive, evaluate, respond to and learn from its environment. Any system of support or other kind of system that delivers inaccurate information, doesn’t honor the organism’s own understanding, limits the organism’s freedom to respond in a natural manner, and limits its freedom to learn and grow in a natural manner, is a system that interferes with health, healing and growth.
If we seek to move in the direction of a genuinely healthy and sustainable world, and if we take the time to reflect upon how well our society’s institutions of health, education, safety, peace and order are doing with regard to the principles mentioned above, then it becomes painfully clear just how much work we have to do. It is definitely time to put on the work gloves.
-- Paris Williams
A version of this post previously ran on the website Mad in America.