The Spiritual Determinants of Health and Mental Health

SECOND THOUGHTS

This week, I am attending the “Ministry of Hope Conference,” sponsored by the International Catholic Forum on Mental Wellbeing and the Pontifical Academy for Life in Rome, Italy and the Vatican, November 5-7, 2025. This is the prepared text for my invited Plenary Session – Sharing Pastoral Practices, Clinical-Integrated & Institutional Models.

Against a World of Facts Without Faith, Data Without Value

British writer and philosopher Aldous Huxley followed his dystopian novel, Brave New World with Science, Liberty and Peace¹ just after WWII. In this, he described a world of supposed facts without faith, filled with “nothing-but” thinking—reduced only to those things than can be measured “rather than of purpose, intention and values”:

"A highly organized and regimented society, whose members exhibit a minimum of personal peculiarities, and whose collective behaviour is governed by a single master plan imposed above, is felt by the planners and … by the plannees … to be more “scientific,” and therefore better, than a society of independent, freely cooperating and self-governing individuals.

The first step in this simplification of reality … is a process of abstraction. Confronted by the data of experience, men of science begin by leaving out of account all those aspects of the facts which do not lend themselves to measurement and to explanation in terms of antecedent causes rather than of purpose, intention and values.

…

Because of the prestige of science as a source of power, and because of the general neglect of philosophy, the popular Weltanschauung of our times contains a large element of what may be called “nothing-but” thinking. Human beings … are nothing but bodies, animals, even machines; the only real elements of reality are matter and energy in their measurable aspects; values are nothing but illusions that have somehow got themselves mixed up with our experience of the world; mental happenings are nothing but epiphenomena, produced by and entirely dependent upon physiology; spirituality is nothing but wish fulfilment and misdirected sex … (emphasis added)"

Social Determinants of Health and Mental Health and Their Relevance for Pastoral Work

In recent years, world psychiatry has been informed by the World Health Organization’s (WHO) Commission on the Social Determinants of Health.² This work, conducted by Sir Michael Marmot, the world’s pre-eminent epidemiologist, represents nothing less than the most robust and relevant aspects of populational health ever done.³ A related study in the US by Felitti and Anda,⁴ called the Adverse Childhood Experiences (ACE) Study shows that early childhood adversity is strongly associated with negative health outcomes throughout life. This was not done by psychologist or psychiatrists or even pediatricians but by specialists in internal medicine and epidemiology.⁴

The Global Mental Movement (GMH) Movement has adopted this research as its foundational science with the slogan, “No health without mental health.”⁴ One of the key findings and a cornerstone of this research is the treatment gap, which identified the gap between the known burden of disease and access to care in a given population.²

What this approach has achieved is to finally expand our view of health and forced us to acknowledge its social determinants. Some people would go so far as to call them structural determinants, meaning things that are built into the very fabric of society.⁶ Furthermore, there is a call to move beyond illness and disease to define health and mental health rather than their pathologies.⁷

How Encompassing is Social Context?

When I was a youth growing up in the Catholic Church, we called the broad social context “horizontal theology”—but is “social” large enough to encompass all that matters in our lives?

I have already called for enlarging the SDH/MH framework to include family, psychosocial, and cultural determinants of health.^8,9

Does even this more embracing framework allow for meaning, for the search for identity, and for the spiritual yearnings of our times?¹⁰ It depends on the community of practice in which we find ourselves. And I would like to make this more explicitly and openly recognized.

Even the WHO has addressed the question of what a “spiritual dimension” of health looks like, and “how it might enrich the health policies advocated by their organization”¹¹ And the WHO has now developed a strategy to address it.¹²

This is why I am now calling for the recognition of the spiritual determinants of health and mental health.

And indeed, there is an emerging recognition of spirituality as an “intermediary determinant of health”¹³:

Spiritual health potentially is an intermediary determinant of children's health in some Western countries, but not in Eastern countries. The universality of social determinants of health models and the measures used in their evaluation require careful assessment across cultures, political contexts, and health outcomes.

Amid a so-called epidemic of loneliness and lack of social connectedness,^14,15 we need to recenter our lives, to find sense and meaning beyond the material world, beyond the world of achievement and prestige, beyond even the safety and security at the base of Abraham Maslow’s hierarchy of needs.¹⁶ Sometimes, the need for meaning, for preserving dignity and our core values, trumps even the desire to stay alive. After all, these are the themes of the lives of saints and martyrs.

Sociologists have warned us about “bowling alone” in Robert Putnam’s metaphor of loss of communal life¹⁷ and “the hidden injuries of class,”¹⁸ “the homeless mind”¹⁹ and “the family besieged,”²⁰ the complexity of modern life²¹ and “liquid modernity”²²—all highlighting how the shifting anchors of contemporary life have created injuries, rootlessness, a lack of belonging, and perhaps worse, a void of meaning.

The decline of religious affiliation in the West is associated with social instability, relational fracture, and personal fragility which compromises health and mental health.

Those of us who have a clinical or a pastoral mission need now to expand the received notion of health and mental health. The Global Mental Health movement has given us the mantra, “No health without mental health.”⁵ As President of the World Association of Social Psychiatry (WASP) I have enlarged this to say, “There is no mental health without a healthy body in a healthy society.” Now, we need to go further to say that the SDH/MH framework also needs to embrace the spiritual determinants of health.

A Psychiatry of Meaning, A Psychiatry of Faith

Can a psychiatry of meaning, or faith, be construed? Canadian philosopher Charles Taylor²³ writes about the “Sense of awe at the miracle of nature and the cosmic order generally and human evolution from lower forms of nature in particular: that evolution, while undeniably miraculous, remains at a natural, immanent level,” describing it as:

a kind of punctual hole blown in the regular order of things from the outside, that is from the transcendent. Whatever is higher must thus come about through the holes pierced in the regular, natural order, within whose normal operation there is no mystery.²³

I am calling for a psychiatry that embraces these themes a psychiatry of meaning for all practitioners and for those of us who are believers and for pastoral workers, I would call for a psychiatry of faith.

This is not the first time that we have heard such calls, within the Catholic Church and beyond. Viktor Frankl, a Jewish neuropsychiatrist who survived Auschwitz, wrote of Man’s Search for Meaning.²⁴ Against Freud’s famous derision of faith as an illusion,^25,26 great Catholic anthropologists²⁷ and philosophers of religion^23,28 have criticized a society that has lost faith with its attendant moral, communal, and social consequences.

How Do We Translate This Into Pastoral Care?

We have heard much about person-centered care.²⁹ Those who reach for a kind of secular faith insist on humane treatment, human rights, and humanistic psychology, psychiatry, and psychotherapy.³⁰ They can be allies in pastoral care.

But we need more: an acknowledgement of the spiritual determinants³¹—or better, the spiritual dimension—of health and mental so that we may also speak of spiritual health.

The endless reaching into ourselves for a “haven in a heartless world,”³²in a world without an anchor, is a vain search. This ceaseless interrogation of human nature, with an understanding of its meaning based on natural philosophy, reaching for narrowly scientific explanatory models leaves us unsatisfied and unfulfilled—patients and practitioners alike. We have explored in turn the psychoanalytic unconscious, later rejected by behaviorism, replaced in turn by cognitive therapy, and again by emotion-focused therapy later recast as attachment therapy, and mostly recently as evolutionary psychology and psychiatry and social neuroscience. This last double-barreled shot focusing on genes and brains is even more reductive and empty than the others.

Practice points:

1. Meaning is expressed in narratives: listen to people’s stories. And they often come to us traumatized. How do we listen to the trauma story?

Practice tip: Avoid early closure, premature understanding, and the reach for transcendence. Have the courage to listen to and be affected by other people’s pain and trauma. Healing takes time, don’t be in a rush.³³

2. Fear, regret, bitterness, anguished suffering, mental pain, relational crises, social stigma, a sense of loss and disorientation are all signs of a tragic dislocation from our chosen images or the frustrating search for an identity, a sense of belonging in the world.

Practice tip: “[M]ental health providers should ask patients about the [spiritual or religious concerns] that are important in their lives to provide holistic and patient-centered care.”³⁴ Yet, that may not be enough; we need to listen to the search behind the symptoms, the search for meaning, for faith.

3. Beyond the clinical encounter, there are “promising approaches for strengthening … public health by integrating spiritual considerations to inform person- and community-centered policy and practice.”³⁵

Practice tip: Just as their public health measures for health and mental health, we need to identify how to promote spiritual health as well.

A key study by Long and associates offers a five-point plan with this hope³⁵:

This analysis, while respecting the spiritual and religious diversity of the US population, identifies promising approaches for strengthening US public health by integrating spiritual considerations to inform person- and community-centered policy and practice.

We may adapt some aspects of the plan by Long and associated to promote the spiritual determinants of health and mental health:

1. “Foster basic spiritual and religious literacy in public health training and continuing education.”
2. “Strengthen communication, relationships, and trust building between leaders from public health and spiritual communities, which should, in turn, lead to collaboration focused on common goals (for example, the well-being of patients and communities, new forms of peer support, and adopting whole-person health frameworks).”
3. “Improve national coordination between academic and faith-based groups to better understand and measure public health efforts (for example, through common databases, coordinated research initiatives, dedicated focus in academic journals, and national leadership).”
4. Support research that “maps activities, documents best practices, and evaluates the impact of spirituality and faith-based interventions on health.”

Their call for public financial support for “chaplains, medical care providers, and faith-based services that provide appropriate spiritual care and other essential public health services for diverse populations” may prove more controversial due to competing interests in the public sphere.

Coda: Still Searching for Meaning

Some years ago, I stumbled into a brief spiritual retreat in the Order of Carthusians in southern Brazil.³⁶ I was taken by the motto of their order:

Stat crux dum volvitur orbis.

The Cross is steady while the world turns.³⁷

The world is still churning—and some of us are still turning to faith, for a safe haven, for an anchor, and a sense of meaning in psychiatry.

Dr Di Nicola is a child psychiatrist, family psychotherapist, and philosopher in Montreal, Quebec, Canada, where he is professor of psychiatry & addictology at the University of Montreal. He is also clinical professor of psychiatry & behavioral health at The George Washington University and president of the World Association of Social Psychiatry (WASP). Dr Di Nicola has received numerous national and international awards, honorary professorships, and fellowships. Of note, Dr Di Nicola was elected a Fellow of the Canadian Academy of Health Sciences (FCAHS), given the Distinguished Service Award of the American Psychiatric Association (APA), and is a Fellow of the American College of Psychiatrists (FACPsych) and Fellow of the Royal Society of Canada (FRSC). His work straddles psychiatry and psychotherapy on one side and philosophy and poetry on the other. Dr Di Nicola’s publications include: A Stranger in the Family: Culture, Families and Therapy (WW Norton, 1997), Letters to a Young Therapist (Atropos Press, 2011), and Psychiatry in Crisis: At the Crossroads of Social Sciences, the Humanities, and Neuroscience (with D. Stoyanov; Springer Nature, 2021).

Acknowledgements

I am grateful to the organizers and participants of the Ministry of Hope Conference from around the world, sponsored by the International Catholic Forum on Mental Wellbeing and the Pontifical Academy for Life in Rome, Italy and the Vatican, for their fellowship and hope. John Farnsworth, PhD, my writing partner, offered valuable comments that improved my essay.

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