A Primer on Integral Theory and Its Application to Mental Health Care
journals.sagepub.com/doi/full/10.1177/2164956120952733Abstract
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.
Keywords
integral, mental health care, paradigm, wisdom
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
This definition is somewhat helpful in describing the operational characteristics of integrative medicine and does have some heuristic value. However, it fails to address the key challenge facing any “integrative team,” that is, “what is your perspective, what is my perspective, and do they relate to one another.” Unfortunately, this inability to define and respect various perspectives has meant that most integrative health-care systems are driven by the idiosyncrasies of a particular clinician, typically an allopath.
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