Abstract
Contemporary psychiatry has become increasingly focused on biological treatments. Many critics claim that the current paradigm of psychiatry has failed to address the escalating mental health-care needs of our communities and may even be contributing to psychopathology and the burden of mental illness. This article describes the foundations of Integral Theory and proposes that this model offers a framework for developing integral psychiatry and a more effective and compassionate mental health-care system. An integral model of psychiatry extends biopsychosocial approaches and provides the scaffolding for more effective approaches to integrative mental health care. Furthermore, rather than focusing on psychopathology, the Integral theory model describes the emergence of human consciousness and supports a mental health-care system that addresses mental illness but also promotes human flourishing.
Introduction
There has never been a period in human history when so many diverse perspectives have demanded expression on the local and world stage. Fuelled by rapidly evolving information technologies, and emboldened by their access to powerful cataclysmic weapons, multiple ethnic populations and demographic groups are demanding to be heard. The complexity of these competing worldviews can be confusing, even overwhelming at times. This escalating complexity is not limited to political systems and is manifesting in all areas of human endeavor including health care.
In concert with these diverse perspectives, medical science is unleashing staggering new treatments that raise multiple ethical challenges. Patients are excited about these scientific miracles but also appropriately concerned that their personal beliefs and preferences will be respected. The Integral model provides a framework for understanding how we can navigate these myriad perspectives and potentials, effectively and respectfully.
Integral Theory
Integral theory, as described by the contemporary American philosopher Ken Wilber, is essentially a philosophical map that brings together more than 100 ancient and contemporary theories in philosophy, psychology, contemplative traditions, and sociology. Rather than attempting to describe “the one correct view,” Integral theory attempts to describe a framework for understanding and valuing the perspective of each theory and philosophical tradition and understanding how they relate to one another. Through this respectful and integrating worldview, Integral theory recognizes the evolutionary impulse that incorporates, rather than devalues or destroys, previous perspectives. The integral worldview therefore includes the essential perspectives of prerational, traditional, modernist, and postmodernist worldviews but also recognizes the limitations of each of these worldviews in addressing the increasingly complex challenges manifesting in the 21st century. Integral theory extends upon postmodernism by moving beyond its core construct of deconstructionism (and the absence of an absolute truth) to a constructivist viewpoint that recognizes that all worldviews have validity in the context of the evolutionary stage and local conditions within which they are manifesting. This constructionist approach therefore enables one to understand and work skillfully with all the worldviews that are simultaneously manifesting in an interconnected 21st century world—whether this is in a nongovernmental agency or the clinician’s office.
The term, “Integral” has been used by several philosophers over the
past 2 centuries. However, Ken Wilber has been the most influential proponent of
this term and has expanded the philosophical foundations. Through his review of all
major philosophic and religious traditions, Wilber writes: Integral theory describes a comprehensive map that pulls together multiples
includes comprehensive, inclusive, non-marginalizing, embracing. Integral
approaches to any field attempt to be exactly that: to include as many
perspectives, styles, and methodologies as possible within a coherent view
of the topic. In a certain sense, integral approaches are
“meta-paradigms,” or ways to draw together an already existing
number of separate paradigms into an interrelated network of approaches that
are mutually enriching.
1
I don’t believe that any human mind is capable of 100 percent error.
So instead of asking which approach is right and which is wrong, we assume
each approach is true but partial, and then try to figure out how to fit
these partial truths together, how to integrate them—not how to pick
one and get rid of the others.
2
Why Explore a New Framework for Mental Health Care?
Psychiatry faces considerable challenges that are not being adequately addressed
by our current models of mental health care. It can be reasonably argued that we
are experiencing a major crisis in mental health that may threaten our ability
to maintain stable societal systems. These challenges include the following:
The rapid increase in mental illness. The suicide rate in the
United States has increased 31% during the period from 2001
to 2017 from 10.7 to 14.0 per 100,000 and we are witnessing
increasing levels of mental health disorders in our
populations.3,4 Although there
are several sociocultural factors influencing this trend, these data
indicate that the current biological allopathic psychiatry paradigm
has proven itself to be inadequate to addressing this escalating
challenge. Biological psychiatry is exploring the clinical utility of
potent new therapies (eg, entheogens) that hold the potential for
dramatic effects on human consciousness, both positive and
negative. The population is becoming increasingly tethered to
information interfaces (eg, smartphones) that have been shown to
produce behavioral changes and physical changes in neural structures
underlying social and metacognitive functions.
5
Despite the rise of so-called “social media,”
the data indicate that individuals are experiencing increased
loneliness, with its accompanying negative impact on mental
health.
6
Complementary (ie, nonallopathic) approaches are gaining
increased acceptance among the community.
7
Health-care professionals are experiencing escalating levels
of burnout that is not understood or effectively treated by the
current mental health-care model.
8
Communities are not prepared to meet the societal upheavals
that are inevitable with the emerging dominance of artificial
intelligence technologies. Recent advances in genetics will provide scientists with the
ability to potentially radically reshape the human genome and
current models of bioethics are simply inadequate to contain this
emerging “god-like” capacity.
Limitations of the Biopsychosocial Model
It is reasonable to question whether the Integral model simply represents a
repackaging of the biopsychosocial model (BPS) first proposed by George Engel in
1977 as alternative to reductionist biomedical models. The BPS has certainly gained
widespread acceptance and has been helpful in supporting more eclectic and holistic
approaches to understanding the pathogenesis and treatment of mental illness. There
are, however, several limitations to the model, specifically the BPS model as
follows: Describes domains of function and intervention rather than
perspective or etiology. This makes the model vulnerable to being shaped
by the dominant biological reductionism that attempts to describe all
domains in objective metrics, for example, social neuroscience rather
sociology. Does not provide any insights into how each domain relates to one
another. Does not provide any common language for different professionals
to communicate effectively across disciplines. Does not provide any descriptions of the different stages, states,
and lines of human experience. Rather than replacing the BPS model, Integral theory (as described
later) extends and deepens the BPS model to include a deeper
appreciation of the importance of promoting human flourishing and not
simply combating human pathology.
Limitations of Integrative Medicine Model
“The limits of my language mean the limits of my world”—Ludwig Wittgenstein (1889–1951).
It is important to distinguish between the Integral theory model and
“integrative medicine.” Although there has been an increasing interest
in the so-called “integrative” approaches to health care, the
definition of integrative medicine remains unclear. The Academic Consortium of
Academic Medical Centers in Integrative medicine states: Integrative medicine and health reaffirms the importance of the relationship
between practitioner and patient, focuses on the whole person, is informed
by evidence, and makes use of all appropriate therapeutic and lifestyle
approaches, healthcare professionals and disciplines to achieve optimal
health and healing.
9
The Origins of Integral Theory
The intellectual lineage of contemporary Integral Theory includes philosophers, psychologists, and sociologists dating back more than 2 centuries.
Georg Hegel (1770–1831)
Georg Hegel can justifiably considered the first “integral philosopher.” Contrary to Kant, Hegel described knowledge and consciousness as creating a persistent dynamic dialectic tension that impels consciousness to evolve across distinct stages. He suggested that the evolution of human consciousness mirrored the larger impulse of the universe to move toward the absolute. Hegel suggested that each evolutionary stage incorporated, and did not destroy, the previous stages. He wrote, “every era’s world view was both a valid truth unto itself and also an imperfect stage in the larger process of absolute truth’s unfolding.” 10 Through his description of an inclusive model of evolutionary consciousness, Hegel can rightfully considered the first “Integral Philosopher.”
Sri Aurobindo (1872–1950)
The term integral was first used in the context of psychology in 1914 by the Indian sage Sri Aurobindo when he described integral yoga as the process of the uniting of all the parts of one’s being with the Divine, and the transformation of all the developmental states of consciousness, emotions, intellect, and physical states into ultimate harmony. 11 Indra Shen (1903–1994) reframed Aurobindo’s ideas into an “Integral Psychology” model that he proposed in contrast to the reductionist behavioral and psychoanalytic paradigms that dominated Western psychology at that time. 12
Jean Gebser (1905–1973)
The Swiss phenomenologist and interdisciplinary scholar Jean Gebser independently introduced the term integral to describe his model of the evolution of human consciousness. In his influential book, The Ever-Present Origin, 13 Gebser described history as the punctuated evolution of human consciousness along 5 distinct structures of consciousness such as archaic, magic, mythical, mental, and integral.
James Mark Baldwin (1861–1934)
Baldwin was one of the first psychologists to study the intellectual and emotional development of children. He refined the constructs of human development by describing the dialectic development of human consciousness along distinct stages, that is, the prelogical, logical, extra-logical, and hyper-logical stages. Other developmental psychologists including Piaget, Kohlberg, Loevinger, Gilligan, Gardner, and Kegan expanded Baldwin’s insights. 14
Abraham Maslow (1908–1970)
Abraham Maslow exerted a powerful influence in several areas of psychology. He described a hierarchy of humans beginning with survival and culminating in self-actualization. Maslow coined the term “positive psychology” and highlighted the importance of recognizing and supporting each person’s drive toward their innate potential. In this way, he was an intellectual progenitor to Integral theory. This focus is captured in his statement: “It is as if Freud supplied us the sick half of psychology and we must now fill it out with the healthy half.” 15
Clare Graves (1914–1986)
Clare W Graves was a professor of psychology at Union College in Schenectady, New
York. He developed an epistemology of human psychology based on his study of
undergraduate students at the university. Graves described a hierarchy of human
development that described the emergence of human consciousness across specific stages. The psychology of the adult human being is an unfolding, ever-emergent
process marked by subordination of older behavior systems to new, higher
order systems. The mature person tends to change his psychology
continuously as the conditions of his existence change. Each successive
stage or level of existence is a state through which people may pass on
the way to other states of equilibrium. When a person is centralized in
one of the states of equilibrium, he has a psychology, which is
particular to that state. His emotions, ethics and values, biochemistry,
state of neurological activation, learning systems, preference for
education, management, and psychotherapy are all appropriate to that
state. 16
Ken Wilber (1949–)
Ken Wilber is an independent philosopher who has surveyed and integrated many of
the world’s philosophic and religious traditions to develop a
comprehensive Integral model. Integral theory is a meta-theory that attempts to
integrate all human wisdom into a new, emergent worldview that is able to
accommodate the perspectives of all previous worldviews, including those that
may appear to be in contradiction to one another. The Integral model continues
to expand in complexity and has been applied to many areas such as business,
politics, ethics, religion, psychology, and philosophy. Wilber states: I therefore sought to outline a philosophy of universal integralism. Put
differently, I sought a world philosophy—an integral
philosophy—that would believably weave together the many
pluralistic contexts of science, morals, aesthetics, Eastern as well as
Western philosophy, and the world’s great wisdom traditions. Not
on the level of details—that is finitely impossible; but on the
level of orienting generalizations: a way to suggest that the world
really is one, undivided, whole, and related to itself in every way: a
holistic philosophy for a holistic Kosmos, a plausible Theory of
Everything.
17
A Brief Overview Wilber’s Integral Model
This section provides a brief overview of the Integral model. Ken Wilber has described an integral model that includes 5 elements that describe the organizing patterns of all reality.
Wilber’s Integral model is often referred to as the “AQAL” model that stands for all quadrants, all levels, all lines, all states, and all types. These 5 elements represent all the aspects through which we can describe individual and group manifestations and experiences. This 5 element framework organizes all potential ways of understanding and responding to any particular life circumstance and therefore enables one to select the most relevant and effective strategies for responding to that life circumstance. 1
Here is brief description of each the 5 elements of the AQAL model.
All Quadrants: The Basic Dimension Perspectives
Integral theory describes that all life conditions are filtered through 4 irreducible
perspectives that come from one of “inside versus outside” (ie,
subjective, intersubjective, objective, and interobjective perspectives) and
“singular versus plural” perspectives. This describes 4 quadrants from
which to perceive any life circumstance at any particular moment. You cannot
understand one of these realities through the lens of any of the others and all 4
perspectives offer a partial and complementary perspective (rather than
contradictory perspectives). It is interesting to note that these perspectives are
included in almost all most languages, suggesting that they have universal
applicability to human experience. According to Wilber, the 4 quadrants are as
follows: The “I” perspective—The
upper left quadrant (LUQ). This represents the individual’s
first-person subjective experience (characterized as aesthetics and
experiential consciousness). This quadrant contains all first-person
experience of the inner stream of consciousness from bodily sensations,
thoughts, soul, and spirit. The “We” perspective—The
lower left quadrant (LLQ). This represents the social
perspective—the inside of the collective intersubjective realm
(characterized by shared values and cultural
perspectives). The “It” perspective—The
right upper quadrant (RUQ). This represents the third-person perspective
(characterized by scientific objective third-person
data). The “Its” perspective—The
right lower quadrant (RLQ). This represents external (ecological)
structures (characterized by social, regulatory, and political systems;
Figure 1).
The Four Perspective Quadrants Described in Integral Theory.
Wilber suggests that modern western society (and Western allopathic medicine) has become blinkered on the RUQ (the exterior objective perspective). This perspective only values facts that can be generated through the scientific method and marginalizes, devalues, or even denies the validity of first-person experience. This blinkered perspective clearly has very significant implications for psychiatry and psychology that attempt to understand the human psyche. Fortunately, the recent emergence of contemplative neuroscience (as the application of scientific method to studying the first-person phenomenology of contemplative practices) represents a major step toward linking interior and exterior domains.
Levels
The levels of development represent stages of organization (or complexity) within a quadrant. The levels in each quadrant demonstrate part (a Holon) of the whole (holarchy), much like a “Russian doll” with each new level transcending the limitations of the previous levels while still including the essential aspects of each prior level.
Rather than replacing previous levels, each emergent level expands the complexity and capacity. This describes the emergence of “holons within a holarchy,” each one distinct but still part of a whole. This suggests that systems evolve in a punctuated way , for example, atoms to molecules to organisms.
Integral theory describes between 8 and 10 levels, depending upon the quadrant being described. The anthropologist, Jean Gebser, described 5 levels (ie, archaic, magic, mythic, rational, and integral) while Robert Kegan, Clare Graves, Jane Loevinger, and Erik Erikson have proposed other models. Each of these has validity depending upon which line they are describing and within which particular domain.
Spiral Dynamics (SD) theory of levels has found increasing recognition as a practical model for understanding the perspectives experienced at different levels of development. SD has grown out of the initial work by Clare W Graves that has been elaborated by Don Beck. 18 The amalgam of Integral theory and SD theories is referred to Spiral Dynamics Integral (SDI). This model expands our understanding of the “values line” and how this can be understood in individuals and communities. In SD, the term “meme” refers to these core value systems. SDI describes how people think, and not what they think about. Our values describe the lens through which individuals or groups experience what is important, and therefore what motivates their actions. These value systems are shaped by the local conditions and individuals and groups can manifest different values (and responses) under different circumstances (eg, when faced with a situation that challenges their survival vs a situation that is less threatening). Any group is likely to manifest the value system of its majority. However, individuals may still possess their own values within the larger group—albeit typically under pressure to conform to the group values.
Levels of Values Development Described by the SD Model
SD describes 6 “first-tier” levels (describing survival or reactive levels of being) and the 2 “second tier” value levels (describing flourishing or reflective levels of being). In an attempt to avoid any hierarchical implications, and to facilitate communication, specific colors have been assigned to each of the levels.
First-Tier Value Levels
The Archaic-Instinctual Level (Beige): The primary values at this level are organized around basic survival such as food, sex, and housing.
Manifested in the following: earliest hunter–gatherer groups,
newborn infants, patients with advanced dementia, individuals experiencing
severe deprivation, and social disconnection (eg, some people with serious
mental illness who are living on the streets). 2. Magical-Animistic (Purple): Values are
organized around magical spirits and thinking. The
“spirits” exist in ancestors who bond the group
together.
Manifested in the following: tribal groups, gangs, some corporate
“tribes,” and individuals experiencing psychosis. 3. Power Oriented (Red): Values are organized
around a drive to manifest personal authority in a world perceived
as threatening and where there can be only one winner. The person at
this stage seeks dominance and the total submission of others to
their will. They do not experience remorse or concern for others
perceived to be weaker than them.
Manifested in the following: dictators, gang leaders, malignant sociopaths,
children at the “terrible twos” stage. 4. Mythic Order (Blue): Values organized
around belief in a benign and all-powerful higher authority that
requires their rigid adherence to dualistic morality. This is often
manifested in monotheistic religious structures that prescribe
strict rules of conduct and subservience to an anointed hierarchical
system.
Manifested in the following: Monotheistic religious fundamentalism, totalitarian
societies, organizations, or societies with strict codes of ethics (such as
certain professional groups and patriotic groups). 5. Rational Achievement (Orange): Seeks
self-expression through their overt material accomplishments. Does
not subjugate their opinions to a higher authority and often
utilizes objective truths and scientific approaches as a vehicle for
their accomplishments. Typically display little idealism and places
personal success against the welfare of the group or the
ecology.
Manifested in the following: capitalist entrepreneurs and corporate leaders.
6. Sensitive Self (Green): Seeks diverse and
egalitarian nonhierarchical communities that acknowledge and value
all perspectives above any single authority. Willing to subjugate
their authority to others and has a strong sense of justice and
attempts to reach consensus rather than subjugation. Concerned about
ecological systems. Have high empathy skills and often values
emotions above cognitive reasoning.
Manifested in the following: Postmodernism, nonprofits such as Greenpeace, animal rights groups, environmental activists, and human rights organizations.
Second-Tier Value Lines
Clare Graves described second-tier values as indicating a quantum shift in human
consciousness. Operating out of the second-tier level, the individual is able to
recognize that each preceding level addresses some aspect of reality that is
necessary to the development of human consciousness. In fact, any one of the
first-tier levels may need to be activated in certain life conditions. Unlike
each of the first-tier values that experience the world only through their
blinkered perspective, the second tier includes and transcends the first-tier
levels and do not experience a need to belong to any particular group. Rather
than scarcity, individuals experience the universe and their own potential as
abundant and limitless. Second tier signifies higher developmental stages of
consciousness and is not to be confused with a particular state of
consciousness. 7. The Integrative Level (Yellow): This is
characterized by flexibility, creativity, and spontaneity. Focuses
on functionality rather than dogma and encourages the emergence of
systems with increasing complexity. 8. The Holistic Level (Turquoise): This is
characterized by the motivation to support novel complex systems
that support the emergence of compassionate and harmonious
unification of the entire spectrum of human consciousness. This
perspective is both idealistic and realistic and recognizes the
specific needs of all previous levels.
Manifested in the following: Second-tier consciousness represents the leading edge of human consciousness and remains quite rare. Examples can be found in individuals such as Nelson Mandela, Gandhi, and Martin Luther King who midwifed profound cultural transformations.
It is very important to appreciate that the levels (stages) describe progressive and permanent landmarks along an evolutionary path that is manifesting the emergence of a more inclusive and complex unfolding of our potential. In this regard, integral theory offers a model for understanding the emergence of human flourishing. This is helpful to healers who should skillfully apply appropriate interventions suitable for a particular stage. For example, an individual who is experiencing values that are organized at a mythic (blue) level will be likely to accept interpretations and treatments that are framed in the context of receiving the blessing of a higher authority (eg, their appointed religious authority).
Figure 2 describes the levels of development within each quadrant as proposed by Wilber.
The Four Quadrants—Methodology and Clinical Applications in Mental Health.
Lines (of Development)
The lines of development describe the capacities (“intelligences”) within each of the levels that manifest in each of the 4 quadrants. Each line has emerged in response to the challenges posed by life within different quadrants. Each person (and collective) demonstrates their own signature strengths and weakness in particular lines that can be plotted on a “psychograph.” Howard Gardner has developed the concept of “multiple intelligences” that include musical-rhythmic, visual-spatial, verbal-linguistic, logical mathematical, bodily-kinesthetic, interpersonal, intrapersonal, and naturalistic intelligences. An individual may demonstrate high intelligence in one line while also demonstrating significant weaknesses in another (eg, a sociopathic dictator who demonstrates high cognitive intelligence but low moral development). 19
Stated in more practical terms, the lines can be described as follows: Cognitive line: The complexity of one’s
thinking. Moral line: The ability to discern how things should
be. Emotional line: The capacity to experience and regulate
emotions. Interpersonal line: The ability to relate to others in social
situations. Self-identity line: The capacity to maintain a stable sense of
personal identity. Aesthetic line: The capacity for experiencing and manifesting
beauty. Spiritual line: The capacity to manifest one’s spiritual
development. Values line: The capacity to experience increasingly prosocial
values that shape one’s decisions. (The values line has been
further developed into the SDI model—see later).
Clinicians can assess their clients’ development across each line and develop a “psychograph” that enables them to identify and work skillfully with the individual’s (or groups) strengths and challenges (see Figure 3). Figure 4 is an example of a clinical “psychograph” that can be used to characterize an individual's strengths within different lines of development. For example, when working with an individual who has experienced significant developmental trauma it may be more effective to work within their somatosensory experience than focus on cognitive approaches.
Levels within the four quadrants.1
Example of a Psychograph.
States (of Consciousness)
States are temporary states of consciousness such as waking, dreaming and sleeping, bodily sensations, and drug-induced and meditation-induced states. In contrast, structures are somewhat permanent patterns of consciousness and behavior. Levels and lines are representative of these structures of consciousness. The states describe vertical (spiritual) development, while the stages describe (psychological) horizontal development. Wilber has described this as “waking up” (state development) versus “growing up” (stage development).
The states manifested in each quadrant include the following:
LUQ States First-person feeling states (eg, such as elevated and depressed
moods, insights, and intuitions). The natural states of waking, dreaming, and deep sleep, and
nondual states. Meditative states induced by contemplative practices. These have
been extensively explored by Eastern contemplative traditions. With
sustained training they can move from being a state to a stable trait.
Based on his thorough study of contemplative traditions, Wilber
describes 4 types of consciousness, that is, gross, subtle, causal, and
nondual. Drug induces “altered” states.
RUQ States—These are states that can be observed by a third party: 5. Physical brain states (alpha, beta, theta, and delta waves) and
hormonal states. 6. Behavioral states such as crying and smiling. 7. Physical states (eg, normal vs pathological, water versus
ice)
LLQ States—These are consensus intersubjective states experienced by a group of individuals (mass hysteria, shared religious ecstasy, and the so-called “group think”) such as shared ecstasy and bliss or a communal experience of the divine.
LRQ States—These are states manifest by an ecological system. This notion of equilibrium is illustrative of various ecological states such as entropy (increased disorder) or eutrophy (being well-nourished).
Types
Within the Integral model, the “Types” describe the stable patterns that manifest regardless of the developmental level of an individual or group. Examples of Types include one’s personality type, gender, or genotype. Since these Types are stable and resilient patterns, recognizing the characteristics of working within a specific Type is important when attempting to initiate sustainable change within an individual or collective. For example, rigidly attempting to employ monotheistic symbols within an atheistic culture will inevitably fail.
Here are some type characteristics that are distinguishing factors within the 4
domains as follows: LUQ types: examples include personality and gender. LLQ types: examples include different religious system (eg, monotheism,
polytheism, and pantheism) and kinship systems (eg, Eskimo, Hawaiian, Lakota
Sioux, and so on.). RUQ types: examples include objectively measured types such as blood types,
body types, and genotypes. RLQ types: examples include types of governing (eg, democracy, dictatorship,
oligarchies, and so on.)
Practical Implications of an Integral Psychiatry Model for Mental Health Care
The Integral psychiatry model (IPM) provides a heuristic framework that has very practical clinical applications that can address the challenges facing the current mental health-care system. An integral clinical practitioner addresses these complex challenges by combining first-person, second-person, and third-person assessments, diagnostic formulation and methods, practices, and techniques in a given situation. Through this Integral approach, Integral practitioners are often able to identify vitally important insights into understanding and more effectively responding to the myriad factors that can influence the well-being of an individual or group.
The IPM addresses current deficiencies in contemporary psychiatry by the following:
Expanding the paradigm beyond the current focus on the
neurobiological domain. As discussed earlier, the IPM
recognizes the power and importance of third-person scientific
discoveries (ie, “scientific truth”). However, it also
recognizes the limitations of this monocular view and even its potential
for harm when pursued in a vacuum that is blind to the experiential,
social, and ecological determinants of human suffering. The IPM
distinguishes between “curing” that occurs in the domain
of scientific objectivity, and “healing” that manifests as
enhanced coherence and development across and between each of the
Integral elements. When necessary and appropriate, the IPM will
certainly utilize biological treatments such as medications and
interventional technologies. However, the IPM also values other
therapeutic tools in the “Integral clinical toolbox” (eg,
psychotherapies, contemplative practices, nutrition, environmental
modifications, and social and regulatory changes) that offer the patient
and their community a wider range of therapeutic
options. Supporting an interdisciplinary team approach.
The Integral clinician should be proficient at identifying the multiple
factors that influence their patient’s well-being. However, the
integral clinician working within an IPM has the humility to recognize
that they do not have the skills to effectively understand and address
all of these factors. The Integral psychiatrist therefore works within a
respectful nonhierarchical clinical team that possesses the skills and
experience to develop and implement a treatment plan that will be most
effective in addressing the patient’s suffering. Recognizing patterns, and not just the details.
The IPM assumes a wide perspective whose horizon is not blinkered by
objective data points derived from psychometric tools and
neurodiagnostic studies. The IPM does not disregard or minimize these
objective data but places it in the broader context that supports
insights into the relational patterns generated by the multiple
interactions between psychological, experiential, and ecological factors
that shape behavior. From this integral perspective, human behavior is
recognized to be a manifestation of resonant patterns within ecological
systems at both the micro and macro level. Promoting self-assessment, humility, and
self-cultivation. The Integral clinician is not held
captive to a single dominating paradigm that characterizes a hierachical
system. Rather, the Integral clinician recognizes the strengths and
limitations of each paradigm in the context of their patient’s
subjective experience and objective behavioral metrics. In this way, the
IPM seeks to constantly assess and optimize a particular perspective and
is motivated by compassion. Recognizing the importance of community
engagement. The IPM recognizes the importance of
identifying the ecological factors that influence the well-being of
their patients. This ecological perspective includes regulatory and
legislative issues as well as the impact of the environmental factors
(such as pollution). The Integral clinician will therefore recognize the
vital importance of working beyond the walls of the clinic and engaging
in positive community and legislative activism to improve the health of
their community. Actively supporting human flourishing, rather than
focusing on pathology. Rather than simply attempting to
“combat disease,” the Integral clinician is motivated by
compassion to improve the flourishing of their patient. The IPM will
therefore utilize positive psychology approaches that enhance optimism,
gratitude, awe, and loving-kindness that enhance their patient’s
inherent capacity for flourishing. Furthermore, the IPM attempts to
identify and optimize each person’s particular strengths, rather
than only focusing on their challenges. The IPM therefore empowers each
individual to assume authority over their lives, rather than abdicating
responsibility to medications or health-care delivery systems. IPM
maintains an optimistic perspective at all times and recognizes that the
evolutionary impulse is ultimately aligned toward wider and more
coherent systems that support coherence and flourishing. Acknowledges and fosters individual and cultural
diversity. The IPM recognizes the first person and
interpersonal frameworks shape the expression of neurobiology. With this
insight, the IPM recognizes that diseases occur within the physical form
of the body, but the meaning that persons and communities ascribe to
this physical process becomes their subjective illness. A deep respect
for the uniqueness of the individual and their culture are therefore
central to the Integral clinician’s relationship to their work as
healers. In this respect, the IPM fosters collaborative relationships
with patients and their communities that are aligned with their
patients’ values. This respectful collaboration is more likely to
foster effective therapeutic approaches that will be accepted by that
community. Recognizing the importance of first-person
experience. Rather than viewing first-person reports as
qualitative data with limited scientific utility, the IPM actively seeks
and respects the patient’s first-person experience as a vital
information that should be incorporated into any diagnostic formulation
and treatment plan. In this regard, the IPM recognizes that listening to
and respecting the patient’s personal narrative is a crucial
aspect of healing. Self-Cultivation. The IPM recognizes the healer
can only support healing to the level of their own personal development.
Given this attitude, the integral clinician recognizes the importance of
both self-cultivation as well as the acquisition of technical
competence. The 4 pillars of an Integral healer are as follows: (1)
Compassion, (2) Wisdom, (3) Competence, and (4)
Self-cultivation.
20
The Integral model
provides a template for supporting a wisdom that transcends the
limitations of dogma and prejudice. However, it also recognizes that
this wisdom must be motivated by a compassionate intention that
motivates the healer to acquire competence in their healing tradition.
Given this attitude, the integral clinician recognizes the importance of
both self-cultivation as well as the acquisition of technical
competence. Through self-cultivation techniques such as contemplative
practices, physical self-care, nutrition, and environmental supports,
the Integral healer enhances their resilience and reduces the likelihood
of experiencing burnout.
Limitations of Integral Theory
Although Integral theory has found acceptance across many arenas (including business, education, and politics), it has garnered detractors who criticize it for simply being a model and not describing a practical method for supporting positive evolutionary change. This argument in itself is not a criticism of Integral theory but does highlight the challenges inherent to supporting change within any system. The SDI model has however addressed this challenge by providing practical approaches for understanding how to understand facilitate change. 18
The Integral theory model has also been criticized for failing to recognize that biological systems are not static but exhibit evolutionary changes that will influence the so-called “scientific truth” of the neuroscientific method. This is illustrated by the finding that sustained contemplative practices produce measurable structural and connectivity changes in meta-relational structures such as the insular cortex. 21 These changes will in turn influence the individual’s response to changes in the internal and external environment.
Concluding Remarks
The IPM provides an elegant and comprehensive map for understanding and responding to
the enormous challenges facing contemporary psychiatry in the 21st century.
Utilizing this model, integral mental health care values the importance of the
biomedical model but also recognizes that it is not sufficient to understanding and
supporting human flourishing. It also provides a template for the development of a
more effective and compassionate integrative approach to mental health care that is
vital to navigating the challenges manifesting in the early 21st century. However,
although it strives to describe the myriad factors that shape behavior, the IPM
appreciates that its ultimate goal is to support the manifestation of coherent
wholeness that supports human flourishing. Wiliam James captures this perspective
when he wrote, The
Footnotes
Declaration of Conflicting Interests
The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
Funding
The author(s) received no financial support for the research, authorship, and/or publication of this article.
