It seems to me that psychiatrists focus on the body/brain, and therapists focus on more of the social and environmental things. If only the two parties worked together to help us. I do feel that these things can't really be separated.

Like my psychiatrist always blames my mania on meds, and my therapist more rightly blames stress. I rarely have episodes that aren't preceded by bouts of extreme stress from environmental or social factors. That's what makes me stop sleeping and triggers an episode. I don't think it's ever been just from a med change. It's not that simple.

I don't know about the spiritual stuff though. I'm not a spiritual person, and don't really believe in that stuff. I have to get my "spiritual fix" from the rational/scientific world, which is a little tricky, but still possible in my opinion. I can't deny that I have FAITH in the scientific method (for the most part), and faith is a spiritual concept.