I would like to offer a response that challenges some of the underlying premises of your project—particularly the insistence that psychiatry must ground itself in a scientifically validated methodology to reclaim its epistemic legitimacy. While your call for rigor and your critique of reductive evidence-based medicine are well taken, I worry that the POP model may still be operating within the very paradigm it seeks to refine: one that assumes that mental suffering can—or must—be contained, explained, and resolved within the logic of scientific reasoning.
This assumption raises several concerns.
First, the attempt to codify clinical reasoning into a systematized methodology risks reproducing the same reductive tendencies that have long plagued the field. Psychiatry’s preoccupation with being seen as a “science” has often come at the expense of other vital forms of understanding—narrative, relational, historical, spiritual, communal. As Thomas Insel himself conceded in reflecting on the National Institute of Mental Health’s heavy investment in biological psychiatry: scientific progress did not translate into healing. A model that seeks to refine psychiatry’s clinical judgment may be necessary, but one that seeks to rescue it through scientific legitimacy alone may miss the deeper shift that patients, practitioners, and communities are increasingly demanding.
Namely: a redefinition of what knowledge is, and what kinds of knowing matter.
Rather than continuing psychiatry’s long-standing effort to secure its place as a “real science,” perhaps we should embrace the fact that psychiatry is, at its best, an integrative and interpretive practice—one that necessarily draws from disciplines outside traditional science: the arts, the humanities, the spiritual and the communal, the ecological and the historical. This isn’t a rejection of science, but a refusal to allow science—particularly narrowly conceived biomedical science—to be the only arbiter of what is valid.
Your POP model gestures toward individualization, collaboration, and the centrality of patient goals, which is deeply commendable. But even in its commitment to pragmatism and prediction, it still frames mental life through a lens of modeling and intervention, assuming that the clinician’s task is to generate testable hypotheses about the patient’s condition. What if, instead, the clinician’s task is not just to “model” but to witness, to accompany, to inquire alongside the patient without needing to resolve or contain their experience in a way that can be objectively mapped?
Mental suffering is often shaped by structural violence, intergenerational trauma, colonization, land displacement, and spiritual alienation—none of which are easily modeled, and none of which are easily addressed through interventions within the clinical frame. To truly engage these complexities, psychiatry must move beyond the clinic and see itself as one node in a network of healing traditions, rather than the apex of expertise.
This would mean not just acknowledging the value of alternative knowledge systems—community-based, Indigenous, faith-based, relational—but actually reconfiguring psychiatry’s own epistemology to make space for them. Not just science plus culture or spirituality, but a new orientation altogether: one in which science becomes humble, and psychiatry rejoins the world as a participant, not its analyst.
In that light, the future of psychiatric training may lie not only in better models but in better conversations—across disciplines, communities, and traditions of meaning. Psychiatry might then not just improve its predictions, but deepen its capacity for presence, humility, and transformation—qualities often found less in maps than in stories, rituals, and relationships.
Thank you again for this essential contribution. I hope it opens the door to even broader and more radical conversations about what psychiatry can become.
I would like to offer a response that challenges some of the underlying premises of your project—particularly the insistence that psychiatry must ground itself in a scientifically validated methodology to reclaim its epistemic legitimacy. While your call for rigor and your critique of reductive evidence-based medicine are well taken, I worry that the POP model may still be operating within the very paradigm it seeks to refine: one that assumes that mental suffering can—or must—be contained, explained, and resolved within the logic of scientific reasoning.
This assumption raises several concerns.
First, the attempt to codify clinical reasoning into a systematized methodology risks reproducing the same reductive tendencies that have long plagued the field. Psychiatry’s preoccupation with being seen as a “science” has often come at the expense of other vital forms of understanding—narrative, relational, historical, spiritual, communal. As Thomas Insel himself conceded in reflecting on the National Institute of Mental Health’s heavy investment in biological psychiatry: scientific progress did not translate into healing. A model that seeks to refine psychiatry’s clinical judgment may be necessary, but one that seeks to rescue it through scientific legitimacy alone may miss the deeper shift that patients, practitioners, and communities are increasingly demanding.
Namely: a redefinition of what knowledge is, and what kinds of knowing matter.
Rather than continuing psychiatry’s long-standing effort to secure its place as a “real science,” perhaps we should embrace the fact that psychiatry is, at its best, an integrative and interpretive practice—one that necessarily draws from disciplines outside traditional science: the arts, the humanities, the spiritual and the communal, the ecological and the historical. This isn’t a rejection of science, but a refusal to allow science—particularly narrowly conceived biomedical science—to be the only arbiter of what is valid.
Your POP model gestures toward individualization, collaboration, and the centrality of patient goals, which is deeply commendable. But even in its commitment to pragmatism and prediction, it still frames mental life through a lens of modeling and intervention, assuming that the clinician’s task is to generate testable hypotheses about the patient’s condition. What if, instead, the clinician’s task is not just to “model” but to witness, to accompany, to inquire alongside the patient without needing to resolve or contain their experience in a way that can be objectively mapped?
Mental suffering is often shaped by structural violence, intergenerational trauma, colonization, land displacement, and spiritual alienation—none of which are easily modeled, and none of which are easily addressed through interventions within the clinical frame. To truly engage these complexities, psychiatry must move beyond the clinic and see itself as one node in a network of healing traditions, rather than the apex of expertise.
This would mean not just acknowledging the value of alternative knowledge systems—community-based, Indigenous, faith-based, relational—but actually reconfiguring psychiatry’s own epistemology to make space for them. Not just science plus culture or spirituality, but a new orientation altogether: one in which science becomes humble, and psychiatry rejoins the world as a participant, not its analyst.
In that light, the future of psychiatric training may lie not only in better models but in better conversations—across disciplines, communities, and traditions of meaning. Psychiatry might then not just improve its predictions, but deepen its capacity for presence, humility, and transformation—qualities often found less in maps than in stories, rituals, and relationships.
Thank you again for this essential contribution. I hope it opens the door to even broader and more radical conversations about what psychiatry can become.