Toward Systems Psychiatry and Precision Medicine

Why is Psychiatry So Disconnected From Neurology, Physiology, and Biomedical Informatics?

The fragmented conceptual models that constitute much of psychopathological theory–and that inform related discourse about, and treatment of, psychiatric disorders–, seem to prescribe a bounded solution set to a ‘problem’ that the very discourse itself, partly produces.By characterizing these problems in a categorical way, steeped in assumptions about the existence of binaries across and within states called “health” versus “disease,” we fail to recognize the more fundamental biophysical-dynamic mechanisms of co-emergence that may be at play at every level of analysis.

The fundamental nature of our suffering seems anything but clear; however, a trend toward explanatory reductionism (wherever you look in healthcare, be that your mainstream “western medicine”, your “integrative medicine”, your “natural medicine”, people in all camps appear to subscribe to dogmatic certainties) normalizes a discourse that creates this illusion of depth: we mistakenly believe that professionals fully understand a complex mechanism of action by which some structures and processes result in eventual disease . Many people today–practitioners, clients, and the broader public–uncritically accept and conflate these explanatory ‘maps’ with their ‘territories’. But its important to always hold in view that all maps are ‘models’ and “all models are wrong. But some are useful” (EB Box). Maybe people are glad to believe in the idea that somebody–some higher intelligence–understands the nature of their problems; and by association, the format of their “solutions”.

In order to get a sense of whether or not this faith is based in reality, it may be helpful to take a look at some public health patterns. When it comes to matters “of the mind & brain,” we see treatment inefficacy, perpetuation of disease & disorder, attrition and barriers to engagement, power imbalances, risk deflection, blame, rising costs, and other failures that we all bear responsibility for. We do not imply that the scientific knowledge and biopsychosocial technical tools developed thus far are useless; they are deeply valued and utilized by some people in some situations. However, since the 60s, there has been appalling stagnation in this space, particularly with respect to disorders entailing chronic cognitive disorganization, perceptual anomalies, altered states of consciousness, the inability to selectively attend to sensory information, psychosis, etc. (

We speculate that a fundamental part of the problem relates to the socio-structural features of healthcare. The stifling, overwrought, inflexible ecology that we call ‘the mental health system’ renders clients and providers alike unable to easily access potentially useful technologies that do exist in an autonomous & streamlined way. This system design reinforces paternalism, a culture of blame, and administrative risk deflection rather than autonomy, symmetrical risk sharing, and interdisciplinary & interpersonal collaboration, respectively. The failure of the institutional practice of psychiatry and the allied health professions (and really healthcare writ large) warrants immediate attention and action from all stakeholders involved. 

**We focus here on the failure of the practice as opposed to theoretical or explanatory endeavors, though the two are inexorably connected. For the purposes of this discussion, we take the theoretical endeavor to be of value insofar as it has implications for solutions that could be developed (also known as the process of biomedical engineering) in order to address unmet health needs.

 The language and other signaling that we use, implicitly reflects our judgments about, and epistemic orientations toward, the theories to which we subscribe. Much of ‘psychiatry’ as we know it, seems flawed not only in practice, but in many of the conceptual assumptions (and ways of thinking or not thinking about these assumptions) upon which it is inspired.

When we buy into theoretical frameworks with an epistemic attitude of certainty and arrogance, it is likely that we cause more harm than if we were to subscribe to those same theoretical frameworks with an epistemic attitude of openness and skepticism, void of value judgements. This is one of the central features of the value framework within which “doing science” is understood.

So what is a “belief” versus a “theory”? In the latter, we essentially mostly think that an explanatory model is based in sound evidence, follows from reasonable premises, and stands up to the test of time, but we hold this view with a constant awareness of its potential fallibility . We’re not married to our theories. We’re always open and always ready to prioritize or de-prioritize these ideas in lock-step with incoming information.  As professionals’, when we believe something about ideas, or ourselves, or others; when we believe that clients are of “lower” epistemic value in all interactions, not based on the contents of their communications, but based upon a perception of social position and associated intellect, everyone loses.

We are all observers and as such, at any given time and in any given context, we all have the potential to produce some viable ideas, some psychotic ideas, and some ideas that fall somewhere in between.

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