The whole community approach to mental health begins with an understanding of the inner experience of distress and despair. Using examples of suicidality, substance use, and overdoses, the descent from distress into despair is illustrated and explained. Biological and psychological “bottom-up,” and social—relational “top-down” processes that create a person’s experience are explored. The effect of both bottom-up interventions such as medications and top-down processes such as psychotherapy and social support are examined. The authors also draw on examples from their personal experience to help put a human face on distress and despair.