It’s important to develop a working definition of mental health because that’s the language we use when we decide that what we’re experiencing has slipped from mental health to mental illness. Defining mental health also lets us set a benchmark to know when therapy is done.
Here at Makarios, I believe in planning for the end from the first session. To do that, I use the biopsychosocial model for mental health. Just like it sounds, the biopsychosocial model has three parts: your physical biology, your internal psychology, and your external social community. You need to have all three parts in balance to be mentally healthy. Let’s break it down.
Your biology is your physical health, the genes you got from your parents, any physical disabilities you have, the food you use to fuel your body, the drugs you choose to use or avoid, and details like your height and weight.
Your psychology is your self esteem, the way you think about the world, your social skills, your ability to cope with stress, the way you are in relationships with others, tendency toward optimism or pessimism, and your memories.
Your social community is your family, friends, and neighbors. It’s choosing to join a church, synagogue, or mosque. It’s the people you meet taking a painting or welding class for fun on the weekend. It’s any people you interact with in person or online.
Here’s how therapists use this information. When you first come to a session, your therapist will ask you about yourself, your family, maybe a bit about what you do, and your habits. It’s not just small talk- they’re trying to assess for how your biopsychosocial system is functioning.
Let’s say you come in to your first therapy session because you’ve been experiencing symptoms of anxiety and you’d like to go back to the way things were before the symptoms started. Here’s what your therapist would probably ask about:
- What changed in your life around the time your anxiety symptoms started?
- Did you start a new medication or start drinking more caffeine (biological)?
- Did you have an experience that was more stressful than usual or did you go through something traumatic (psychological)?
- Did you just begin or end a relationship, job, or hobby (social)?
- What have you tried so far to deal with the anxiety and how has it worked?
- Did you self-medicate with “downers” like alcohol or marijuana?
- Have you tried pop-psychology methods like mindfulness, meditation, going gluten free, or tapping?
- Have you tried therapy before? What methods did you like or not like?
- Do you have other people in your life you feel comfortable talking to about what you’re experiencing?
- Some people isolate themselves when they aren’t feeling well
- It’s important to identify people in your life you can talk to, or to find those people if you don’t have anyone you can trust
I used anxiety as an example because it can come from any one of a number of causes. You could have a chemical imbalance (biological) from substance use, poor eating habits, or genetic predisposition. Or it could come from psychological factors such as a change in the way you think about yourself and others, experiencing a new trauma or being reminded of a past trauma. Anxiety can also stem from social changes like a major loss, an identity shift from job transitions, or a relational rejection.
This is important because where your anxiety comes from shapes how we’ll treat it in session. Anxiety following the death of your favorite grandmother is very different from anxiety that comes from stress or from an overactive brain.
Most people experience stress-related anxiety. That’s why anxiety disorders are more common in people who are going to school or who have high pressure jobs. Stress is a psychological symptom, so the treatment will focus on realigning your psychology through reframing your thoughts. Cognitive Behavioral Therapy is one of the most popular methods because it has been empirically proven to work for most people, and if you’re using insurance to cover the cost of therapy, it’s one of the methods your insurance provider will pay for.
If you have a genetic predisposition toward anxiety, you likely have an imbalance in your brain chemistry. Medication can adjust the levels of neurotransmitters so you have normal brain functioning. People with biological anxiety can also experience anxiety from psychological stress and social factors, so you may need to combine meds with therapy for the best results.
The examples about anxiety are intended to illustrate how therapists use the biopsychosocial model of mental health to evaluate new clients. These examples are not intended to diagnose anxiety or any other mental disorder, and are not intended to suggest a course of treatment. See a qualified mental health professional for a diagnosis and treatment plan.