Takeaway
Consider adding an ecological lens to your practice—screen for environmental health risks while also prescribing nature itself as medicine.
Passion in the medical profession | September 29, 2026 | 5 min read
By David Kopacz, MD, University of Illinois College of Medicine
If we’re truly going to address illness and promote health, we need to not only look inside the human organism (bio- and psycho-), the interpersonal (social), the context of meaning, purpose, and transcendence (spiritual), but also at the physical environment where we live and breathe every day. To this end, an eco-biopsychosocial-spiritual model of health is proposed.
The world around us is burning, flooding, blowing, shaking—the climate is unstable and even if we aren’t personally threatened by the four classical Greek elements of life—fire, earth, water, air—we’re acutely aware that the elements meant to sustain us could flip from nurturing to threatening. Even if our lives and health aren’t directly threatened, we have a proliferation of new pathologies that attempt to name our feelings of unsafety and insecurity in the world—climate despair, eco-anxiety, climate anxiety, ecological grief, solastalgia, eco-angst, environmental distress, and ecological trauma. But what can we do when the world is burning?
Technological environment
It’s not just our physical environment that feels unsafe, but the technological environment, as well. AI—which also has a physical impact by consuming massive amounts of electricity, depleting water resources, accelerating raw mineral mining, generating electronic waste, and causing noise pollution—is sometimes proposed as a new panacea and at other times as the latest threat to our health, well-being, and employment.
Social media environment
The social media environment has proved to be addicting and pulls us in with increasingly negative and disturbing content through active manipulation of algorithms that make us feel less safe. Our “smart” phones connect us to the world, but they also affect our nervous systems, sleep, psychological outlook, and even how we view our fellow citizens.
Feeling unsafe
The threats of climate crisis and technology are new but our psychology and feelings of being unsafe and insecure in our environment are part of the existential nature of being alive and conscious. Roughly 2,500 years ago, the Buddha gave his Fire Sermon: “. . . all is burning . . . eye is burning . . . ear is burning . . . nose is burning . . . tongue is burning . . . body is burning . . . mind is burning.” Psychiatrist Mark Epstein quotes this in his book “The Trauma of Everyday Life.” Epstein summarizes, “Everyday life is trauma, the Buddha proclaimed. It is as if everything was burning. He spoke of trauma as if it were a fire.” When faced with the burning pain of everyday life, it can be helpful to remember that while the details are new, the existential struggles we face are also part of what it means to be alive.
An Eco-Biopsychosocial-Spiritual Model
We’ve had the biopsychosocial model of health and illness since Dr. George Engel introduced it in 1977. In 2002, Dr. Daniel Sulmasy proposed an expansion of this to the Biopsychosocial-Spiritual Model of Health, to take into account the spiritual elements of health and illness, particularly at the end of life.
The environment—physical, social, technological, and political—affects our health and can cause illness when out of balance. That which can promote healing can also cause illness. This awareness goes back to the ancient Greeks who described pharmakon as a healing medicine as well as a deadly poison—all depending on how it was used. If we’re truly going to address illness and promote health, we need to not only look inside the human organism (bio- and psycho-), the interpersonal (social), the context of meaning, purpose, and transcendence (spiritual), but also at the physical environment where we live and breathe every day. To this end, an Eco-Biopsychosocial-Spiritual Model of health is proposed.
What would this look like in clinical practice?
First we could screen for the negative effects of the environment on health—these include direct effects of fire, water, air, and earth on the human organism. However, we don’t want to focus only on the negative, we also want to empower patients to tap into the health-promoting effects of our shared ecosystem.
An Eco-Biopsychosocial-Spiritual Model reminds us that we aren’t isolated individuals, but interconnected organisms whose health depends, not only on ourselves, but also on the health of our physical, social, technological, political, and spiritual environments.
In 2020, writer and naturalist Barry Lopez wrote an essay entitled “Love in a Time of Terror,” in which he wrote about how to develop a sense of intimacy and connectedness with the world and its forms of life. While he recognizes all the ways that we and the world are suffering, he closes the essay by asking if we can enter into this ecological intimacy.
“In this trembling moment . . . is it still possible to face the gathering darkness and say to the physical Earth, and to all its creatures, including ourselves, fiercely and without embarrassment, I love you, and to embrace fearlessly the burning world?”
Practical applications:
1. Ask patients about their daily lived experience at home, in their neighborhood, in the country, and the world—give space for the unarticulated, and time for what they may only partially be aware of. If needed, prompt about how safe, secure, nurtured, and protected they feel in the world.
2. Screen for health risks from the air, water, fire, and earth where the patient lives.
3. Empower patients to tap into the healing powers of nature as well, bringing in the health promoting aspects of nature and ecology. Two ideas include:
a) Spend time in nature, even the micro-nature of the backyard, the grass and trees on the curb, or a city park—stop, look, listen, engage the senses, breathe.
b) Spend time with plants—either outdoors or by bringing a houseplant indoors. A simple meditation is to sit with a plant, relax the mind, eyes, and heart, and imagine the interconnectedness of the oxygen the plant gives off, you breathing that in to sustain and nurture you, and then exhaling carbon dioxide, which the plant “breathes” in—completing a cycle of what Barry Lopez might describe as love, or E. O. Wilson called biophilia—the love of the natural world.
This piece expresses the views solely of the author. It does not necessarily represent the views of any organization, including Johns Hopkins Medicine.