THE BIOPSYCHOSOCIAL-SPIRITUAL MODEL IN PSYCHIATRIC DIAGNOSIS AND TREATMENT: A CRITICAL NARRATIVE REVIEW

Abstract

Psychiatric disorders emerge from interactions among biological vulnerability, psychological processes, social context, and systems of meaning. The biopsychosocial model broadened clinical formulation beyond biomedical reductionism, while contemporary research has increasingly examined religion and spirituality as clinically relevant dimensions of mental health. This critical narrative review examines how a biopsychosocial-spiritual formulation may contribute to psychiatric diagnosis and treatment without replacing established biological, psychological, or social approaches. Foundational publications were combined with contemporary systematic reviews, meta-analyses, professional guidelines, and key clinical studies, with emphasis on literature published from 2020 through September 2026. The most consistent clinical contributions concern spiritual history taking, religious coping, culturally informed differential diagnosis of unusual experiences, treatment adherence, recovery, suicidality, and patient-centered psychotherapy. Positive religious coping, meaning, and community support may be protective in selected contexts, whereas spiritual struggle, guilt, perceived divine punishment, discrimination, and rigid explanatory models may intensify distress or delay care. In psychosis and bipolar disorder, religious content alone does not establish psychopathology; diagnosis requires assessment of disorganization, functional impairment, mood syndrome, negative symptoms, insight, longitudinal change, and cultural congruence. The model is most defensible as a framework for formulation and culturally competent care rather than as a universal etiological theory. Spirituality should therefore be assessed when clinically relevant, integrated according to patient preferences, and kept distinct from untestable metaphysical claims.