Counseling Beyond the “Medical Model”

People occasionally ask about the name of my therapy practice: Five Bodies Counseling. Some want to know if there are five therapists in the room. (No, unless I’m co-facilitating a workshop, it’s just me.) Almost uniformly, unless they are well-schooled in yoga or familiar with Eastern philosophy, people have no idea what “five bodies” I might be referring to — which begs the question. That’s fine by me, because I genuinely want people to ask.

“Five bodies” is a more robust way of conceptualizing the human being, both as a physical entity and as an experience of consciousness, than is common in most Western counseling approaches. I’m a psychotherapist with a decidedly Eastern outlook, operating with a necessary Western pragmatism. I view clients through a holistic frame, understanding mental health as affecting five bodies, which you might imagine as lampshades through which the spark of consciousness shines. These are: the physical body, the energetic body, the mental-emotional-psychological body, the body of personal narrative, meaning and belief systems, and the body of spiritual or subtle connections. These bodies are described in the Vedic texts, ancient writings dating back to about 1,500 BC and which ultimately gave rise to much of modern Eastern philosophy and spiritual practices, including Buddhism, yoga and Hinduism.

How does something so ancient have relevance today? How does using this framework differ from what you might encounter in traditional Western counseling, with its increasing adoration of the “medical model” of psychotherapy? How does this go beyond the more simplistic view of mind-body dualism? Allow me to explain:

The First Body: My Brain, Myself

Part of what ails Western society these days — particularly in the fragmented health care system that dominates the United States — is a reductionistic mindset about the human experience. Among the purely scientific, including many in psychology who embrace neuroscience to the exclusion of other perspectives, biology reigns supreme. In this view, everything we do, including consciousness itself, emerges from the brain, and the brain alone. Many scientists debate even the existence of a “mind,” noting we cannot “prove” it exists because current technology can neither see nor measure it.

Despite the important discoveries being made in neuroscience, especially around traumatic brain injuries and minimally conscious states (what we’ve long called “persistent vegetative states”), when it comes to treatment of psychological concerns, an exclusively biological perspective is short-sighted, incomplete, and I will dare to say, harmful as well.

After years of practicing in a clinical environment among people — both clients and colleagues — who bought into this reductionistic “medical model,” time and again I witnessed an insidious helplessness emerge when it came to a person’s ability to recover from mental illness and to live a life of well-being, particularly without the use of medication. Far too many people have been persuaded by corporate pharmaceutical advertising that their brain “isn’t wired right” or that their troubles stem from “brain chemistry” and that the only means of remedy is to take psychiatric meds. Many of these medications have terrible side effects, such as liver damage, profound weight gain, constipation, tremors and the like — and commonly result in long-term users developing diabetes, inflammation and other chronic health conditions.

I admit I am no fan of psych meds. I have certainly worked with many people who they have helped dramatically, including those struggling with profound depression or altered states commonly called psychosis, and by way calming neurological storms in brains that have experienced significant damage, such as traumatic brain injuries. But on the whole, I have repeatedly observed that psychiatric medications are used too broadly and freely, usually without first making even simple attempts to change lifestyle or environmental factors that contribute to and maintain the cycle we call “mental illness.”

For example, it’s not uncommon to meet clients suffering “anxiety” or sleep disturbances and taking medications like lorazepam (Ativan) or alprazolam (Xanax) to treat these troubles without first eliminating the excessive amount of caffeine consumed in the form of sodas, coffee and chocolate. (I know! No one wants to give up chocolate, least of all me, but when you’re having anxiety or sleep troubles, reducing or eliminating caffeine consumption is the place to start, as opposed to medication.) The problem with this lifestyle approach is that too many entrenched corporate entities, from the pharmaceutical industry to the manufacturers of corn syrup, want you to buy their products. A simple fix is usually not a money-maker and thus is not promoted or given research funding to support it as an “evidence-based practice.”

But even without these social and cultural influences, the medical model, with its narrow focus on biology, often only takes one body into account: the physical body. Recognizing the physical body’s role in mental health is crucial, particularly as a bearer of symptoms including muscular and joint pain, tremors, shortness of breath, digestion problems and accelerated heart rate. But it’s only one-fifth of the story, and if you medicate away these symptoms too quickly, you don’t get to the root of the problem. You just cover it up for a while — until the problem shows up somewhere else.

The Third Body: My Ego, Myself

The broader-minded within the medical model usually acknowledge the presence of a mind, even if it can’t be definitively mapped on a functional MRI. Most of us sense there is an “I” to us, an ego, that is unique and separate from others, and many are also able to observe thoughts and emotions without being utterly lost in them. If we are only our brains, who is the one observing the brain’s behavior?

For example, we might notice our thoughts spinning out of control — engaging in morbid fantasies or talking to (and about!) us in a critical voice. As these thoughts gather like thunderheads building over the plains and stir the storms of our emotions, we may start to feel anxious or depressed. Just one small thought, about something like a pimple on a chin or a poor grade on an exam or why our boss wasn’t friendly toward us, can carry us right into the eye of a psychological hurricane, in which we batter and bruise ourselves with condemnation. Once we become aware we’re doing this, many of us have learned how to step away from this streaming diatribe for at least a moment and say: Hey, wait a second, that’s not true! Why am I being so mean to myself today?!

With a bit of distance, we can often intercept the stream of thought, argue with it, tell ourselves something kinder and give ourselves shelter from the emotional storm that has arisen.

That is an example of the mind, our third body, at work: the mental-emotional-psychological body. And within the medical model, this is the core of a lot of therapy. It’s what counselors who say they practice Cognitive Behavioral Therapy are doing: teaching awareness of thought processes and how they affect the emotions, then helping clients learn how to argue effectively with such “hot thoughts” to reduce their emotional impact. For many clients, this is necessary education and very good stuff.

But, again, it’s only part of the picture.

The Second Body: The Reservoir of Energy

So what of the second body, you ask? Why did I skip that?

The fact is, in a cultural climate like the Western medical model, the energetic, or pranic, body is abstract and esoteric. I wanted to address the points of contact the medical model makes with the five bodies before getting into the big differences. And if you’re someone who thinks “mind” doesn’t exist, you’re unlikely to embrace the notion of an energetic body.

Within Eastern philosophies and medicine, however, the energetic body is undeniable. Prana is the bridge that connects the first body — this physical bag of bones, blood and flesh — to the unmeasurable mind and higher states of consciousness. Prana is a universal force, like light, and moves in human beings on the breath. It is the energetic field that is being tampered with when you get acupuncture or when you meditate. It is at the heart of our sense of vitality, whether we feel energetic or lethargic, agitated or at peace.

Strong pranic flow keeps us healthy, and when it wanes, we become vulnerable to disease. But like all forces, it must be kept in balance and harmony. Too much uncontrolled, free-flowing energy can give rise to anxiety; too little prana, or stagnation that blocks its movement (as one often experiences when injured), can result in depression or illness. Learning how to observe and wisely alter the energetic body is essential to well-being. A person with strong prana who lacks the wisdom to channel it is likely to be a fearless dare-devil and find trouble more often than not. Perhaps this is part of what we see in some children who get labeled as “hyperactive” — free-flowing second-body energy without the knowledge of how to handle it effectively. (Of course one problem with Western culture is evident here: If we don’t acknowledge this body exists, we can’t teach children how to tame it. So we give them pills instead.)

Counseling professionals who use “mindfulness” approaches in their work — such as changing the pace and depth of one’s breath — are doing second-body work, helping raise awareness of pranic energy and learning how to move and adjust it for a greater sense of well-being.

So that covers, in admittedly minimal fashion, the first three bodies, and brings us to the two remaining: the bodies of meaning and connection. (For the record, this five bodies approach does not deny the nuances of other Eastern schools of thought, such as informs kundalini yoga, which suggest there are 10 bodies. This higher number represents subtle distinctions that the average Westerner is unlikely to grasp, so I stick with the core five described in Vedanta. If you delve deeply into Eastern practices, you may develop a sensibility that allows you to detect these nuances.)

The Fourth Body: The Home of Stories

The fourth body is commonly referred to as the “wisdom” body. I prefer to describe it as the body of belief systems, the narrative body or the meaning-making body. This distinction from “wisdom” is purposeful because many of us Westerners assume “wisdom” is always good. But the fourth body can be a source of tremendous illness, because not all the meaning or belief systems we maintain — which are a form of personal wisdom — are healthy or useful. Thus I like to describe it in terms of personal narrative or story, the beliefs we have about ourselves, life and “the way things are supposed to be.”

Our fourth body is healthy when it helps us navigate the world and our relationships with an openness that inspires a sense of harmony and well-being. It is out of balance, and a source of illness, when it is full of stories that beat us up, demoralize us, take away our sense of agency, or leave us feeling helpless, hopeless, powerless.

One might understand both trauma and existential crises as troubles afflicting the fourth body. Events that bring significant and surprising harm to us — be it a physical assault, a sudden and accidental death of a loved one, the terrorist attack on what so many Americans remember “started out as a beautiful blue September day” or anything else that was “not supposed to happen” — represent ruptures in the fabric of our belief systems. Our lives and the way we view the world can be dramatically up-ended, our belief systems collapsing like a house of cards. This sets off an emotional storm like no other and can create what Victor Frankl liked to call “an existential vacuum.” Always, something rushes in to fill the void. Within the wake of trauma in particular, it is usually not a good “something.”

For example, the beliefs that allowed us to take the subway to work or to make vows of commitment in marriage, when suddenly disrupted by unforeseen and painful events, can give way to stories that “the world is too dangerous” to venture out in, or that “other people can’t be trusted.” Such narratives embedded as new beliefs often lead to isolation, loneliness, pain, anger and even rage — toward other people and toward life itself. Living like this begets an emotional and physical cascade from which suffering and illness tend to emerge.

Almost all clients presenting for psychotherapy need some help with the fourth body, which involves building awareness of personal narratives and beliefs and determining which ones are adaptive, useful and healthy versus which ones can be chucked or rewritten. The great thing about the fourth body is that all of us, even when we dip in and out of existential angst in the face of life’s inherent disappointments, have the capacity to live with a greater sense of meaning and fulfillment. But you need a therapist who is skilled at hearing the larger stories at play and bringing them to light. Cognitive therapy, this isn’t. It’s depth and narrative work.

The Fifth Body: The Open, Connected Heart

The fifth and final body is perhaps the most difficult for Western minds to grasp, even more so than the energetic body. On the latter, most of us have overt experiences of having too much or too little energy at some point, so we can relate. But the fifth body is hard to describe, and you will often notice in my writings, lectures, workshops and therapy sessions that I use many terms interchangeably: the spiritual body, the body of subtle connections, the body of the connected heart.

In the original sanskrit, it is anandamaya kosha, which means, more or less, “the body of bliss.” Many dictionaries define bliss as “a state of perfect happiness,” often to the point of being oblivious to anything else. It is, suffice it to say, an uncommon state. This body is regarded in some spiritual practices to be the seat of the soul, the home of karma and the only part of the embodied “Self” that transfers from lifetime to lifetime during the process of reincarnation. However you envision it, the fifth body is something we yearn to feel, the pursuit of which can drive us to ruin, especially when we confuse the high from a drug or the welling emotions of falling in love as the source of true bliss. We may also mistakenly believe we need the presence of a guru or spiritual leader to give us access to this body. I say this is a mistaken belief because each of us has a fifth body, and it is there for us to discover and feel — with or without a teacher to guide us. There is no “right” spiritual practice or philosophy.

Our connection to it may come spontaneously, or it may be the result of an intentional effort to bring our other bodies into harmonious alignment through diet, exercise, meditation, yoga and mindful practices such as ecstatic dance. I like to refer to this body as the “body of the open heart” because when the heart is truly open and flowing, we experience the deep connection with others and with life itself, including the awe-inspiring power of natural environments, that marks a fifth body experience.

On the other hand, when we can’t access the fifth body, we are likely to feel disconnected and isolated, like we’re somehow not part of the larger picture. In illness, we may not be able to feel empathy or compassion; we may be able to visit the grandest landscapes on earth without so much as a hint of awe. Nothing will impress us; nothing will help us feel connected.

Odd as it may sound, it’s also possible to be overly connected to the fifth body — and when this happens, it becomes difficult to function in the day-to-day world. When one is in a constant state of “bliss,” one is less likely to do the grocery shopping or attend to other practical matters. It may be, too, that some prolonged states of psychosis are the result of being overwhelmed by a fifth-body experience and unable to ground again in the mutually agreed upon “reality” in which the vast majority of society functions.

But for most of us, transient connection to the fifth body is more common. We may experience it in dreams while sleeping; we may know it only through dedicated spiritual practices; we may be faced with extraordinary events that throw our hearts open; or we may find it in our connection to the natural world. Indeed, there are many possibilities. And once having felt it, we often yearn for it again. We can become despondent when it feels out of reach.

No therapy can guarantee access to the fifth body. But one thing is certain: without acknowledging the importance of this unique state — which in its awe and sense of deep connection surpasses any experience of simple “emotion” — it’s impossible to address the whole of a person’s well-being.


Ultimately, what I like about the five bodies is the way in which they provide a map to individual experience. It is a valuable tool in a health and wellness model, creating a simple framework through which to achieve and maintain physical, emotional, psychological and spiritual balance and harmony. At the same time, every mental illness described in psychiatry’s bible, the Diagnostic and Statistical Manual, or DSM, can be broken down onto the five bodies framework. In this way, a five bodies approach to counseling creates the opportunity for an individual in psychological and emotional suffering to ask: Where am I hurting? Where do I start healing?

In identifying which body is suffering the most, we create what I think of as a topographical relief map, a three-dimensional rendering of experience that says “You Are Here” and gives a starting point for therapy and wellness practices. I’ll discuss this more in future blog posts by illustrating some common mental health concerns on such a five bodies map.