Shaping Suffering & Meaning-making in Mental Disorder: the Role of Narratives, Metaphors, and Interpretive Frameworks
Kate FInley, PhD, Hope College
According to one recent compelling account, suffering "is the experience of a gap between how things are and how things ought to be" (Tate, 2025, p. 1). However, our understanding of both parts of this gap is inevitably shaped not only by the reality of how things are and how they ought to be - but also by the interpretive frameworks we bring to bear, which shape our beliefs about and understanding of 'how things are' as well as our beliefs and understanding of 'how things ought to be'. Thus, suffering may result from the gap itself as well as discrepancies between our beliefs and reality on either dimension. This means that we can potentially address suffering by attending to what shapes our understanding of 'how things are' and 'how things ought to be'.
Mental disorder provides a particularly challenging and complex case to consider on this framework. For many, religion and/or spirituality is central to how they understand and experience mental disorder. While psychology and psychiatry are increasingly addressing this intersection of mental disorder and religion, nuanced philosophical and theological inquiry remains limited, resulting in an underdeveloped understanding of the conceptual frameworks that (often unconsciously) shape how individuals experience mental disorder, and psychological suffering more generally, and reconcile it with their religious/spiritual identity. This is especially fraught because the very capacities for sense- and meaning-making can be altered or undermined in experiences of mental disorder.
Metaphors and narratives shaped by surrounding secular and religious culture do more than simply reflect or help us interpret our experiences—they can actually shape them, filter what we attend to, and potentially constrain the futures we can imagine or hope for. Biogenetic and dysfunction-centered models dominate mental healthcare—often scaffolded by underlying mechanistic metaphors (e.g. 'broken brain', 'brain circuits', etc.). While these models can be powerful in guiding psychiatric research and practice and can be helpful for some dimensions of patient self-understanding (e.g. encouraging seeking out treatment, diminishing a sense of blame), they can also lead to problematic effects. Empirical research indicates that these models are associated with prognostic pessimism, decreased sense of agency, and increased stigma. Additionally, my own research reveals their association with decreased meaning-making and diminished ability to integrate one's experiences into their self-narrative (2023, 2024, forthcoming). This research also speaks to the power of metaphors and the models they underlie — they don't merely describe neural and psychological processes; in a sense they 'scaffold' our cognition, shaping how we understand 'what is' (reducing mental disorder to malfunctioning mechanisms) and 'what ought to be' (constraining our vision of healing to the restoration of proper function, leaving little room for transformation or integration).
However, over-spiritualization poses its own risks, distorting "how things are" by reducing mental disorder entirely to spiritual causes (e.g., "it's not depression, it's spiritual warfare"). My research reveals a more promising middle path: those who understood their experiences through frameworks that acknowledged spiritual or religious dimensions — while not denying biological and psychological factors—were more open to and ultimately more likely to derive meaning from their suffering (2024, forthcoming). Narratives played a key role in this, shaping participants' meaning-making processes. A subsequent narrative intervention study demonstrated that balanced frameworks—emphasizing the multidimensional, biopsychosocial nature of mental disorder — enabled participants to integrate their mental disorder more positively into their self-narrative while avoiding over-spiritualization and enabling spiritual meaning-making (forthcoming). Notably, this meaning-making did not eradicate or outweigh the suffering they experienced—rather, their suffering and how they understood it played an integral role in it.
Religious traditions offer resources for addressing both our understanding of 'how things are' and 'how things ought to be'. These can often be best understood and integrated for patients through metaphorical and narrative frameworks (e.g. organic growth, journeying, wayfaring (see Kinghorn, 2024), wandering (see Coblentz, 2022)) that resist mechanistic reductionism while remaining compatible with underlying biological reality and enabling meaning-making. They can help us see a different vision of 'how things ought to be' which does not require the elimination or fixing of disorder as a prerequisite for flourishing, but rather makes space for growth, transformation, and meaning-making through rather than despite experiences of mental disorder. Importantly, this is not about replacing medical intervention with religious re-framing—nor is it about assuming that such re-framing will eliminate suffering. Rather, it is about recovering and reimagining conceptual resources that have often been squeezed out by the dominance of mechanistic frameworks.
Mental disorder provides a particularly challenging and complex case to consider on this framework. For many, religion and/or spirituality is central to how they understand and experience mental disorder. While psychology and psychiatry are increasingly addressing this intersection of mental disorder and religion, nuanced philosophical and theological inquiry remains limited, resulting in an underdeveloped understanding of the conceptual frameworks that (often unconsciously) shape how individuals experience mental disorder, and psychological suffering more generally, and reconcile it with their religious/spiritual identity. This is especially fraught because the very capacities for sense- and meaning-making can be altered or undermined in experiences of mental disorder.
Metaphors and narratives shaped by surrounding secular and religious culture do more than simply reflect or help us interpret our experiences—they can actually shape them, filter what we attend to, and potentially constrain the futures we can imagine or hope for. Biogenetic and dysfunction-centered models dominate mental healthcare—often scaffolded by underlying mechanistic metaphors (e.g. 'broken brain', 'brain circuits', etc.). While these models can be powerful in guiding psychiatric research and practice and can be helpful for some dimensions of patient self-understanding (e.g. encouraging seeking out treatment, diminishing a sense of blame), they can also lead to problematic effects. Empirical research indicates that these models are associated with prognostic pessimism, decreased sense of agency, and increased stigma. Additionally, my own research reveals their association with decreased meaning-making and diminished ability to integrate one's experiences into their self-narrative (2023, 2024, forthcoming). This research also speaks to the power of metaphors and the models they underlie — they don't merely describe neural and psychological processes; in a sense they 'scaffold' our cognition, shaping how we understand 'what is' (reducing mental disorder to malfunctioning mechanisms) and 'what ought to be' (constraining our vision of healing to the restoration of proper function, leaving little room for transformation or integration).
However, over-spiritualization poses its own risks, distorting "how things are" by reducing mental disorder entirely to spiritual causes (e.g., "it's not depression, it's spiritual warfare"). My research reveals a more promising middle path: those who understood their experiences through frameworks that acknowledged spiritual or religious dimensions — while not denying biological and psychological factors—were more open to and ultimately more likely to derive meaning from their suffering (2024, forthcoming). Narratives played a key role in this, shaping participants' meaning-making processes. A subsequent narrative intervention study demonstrated that balanced frameworks—emphasizing the multidimensional, biopsychosocial nature of mental disorder — enabled participants to integrate their mental disorder more positively into their self-narrative while avoiding over-spiritualization and enabling spiritual meaning-making (forthcoming). Notably, this meaning-making did not eradicate or outweigh the suffering they experienced—rather, their suffering and how they understood it played an integral role in it.
Religious traditions offer resources for addressing both our understanding of 'how things are' and 'how things ought to be'. These can often be best understood and integrated for patients through metaphorical and narrative frameworks (e.g. organic growth, journeying, wayfaring (see Kinghorn, 2024), wandering (see Coblentz, 2022)) that resist mechanistic reductionism while remaining compatible with underlying biological reality and enabling meaning-making. They can help us see a different vision of 'how things ought to be' which does not require the elimination or fixing of disorder as a prerequisite for flourishing, but rather makes space for growth, transformation, and meaning-making through rather than despite experiences of mental disorder. Importantly, this is not about replacing medical intervention with religious re-framing—nor is it about assuming that such re-framing will eliminate suffering. Rather, it is about recovering and reimagining conceptual resources that have often been squeezed out by the dominance of mechanistic frameworks.