Abstract
AbstractPsychiatry is the only branch of medicine that still diagnoses without reference to the organ it treats. Psychiatry: The Case for Starting Over argues that this is a structural failure rather than a temporary gap. The descriptive nosology inherited from Kraepelin and formalized in the DSM achieved diagnostic reliability at the cost of validity. Its categories were assembled by committee consensus rather than grounded in mechanism, and so it cannot guide the circuit-targeted therapies now reshaping the field.The book traces this problem historically and then builds an alternative from three converging lines of work. The first is computational neural-network modeling of psychopathology, from Hopfield and Hinton through Hoffman's simulations of schizophrenia and the author's own work. The second is systems neuroscience, including large-scale networks, global workspace and integrated information theories, attractor dynamics, and small-world connectivity. The third is Friston's Free Energy Principle and predictive processing.From this synthesis the book introduces Neuroanalysis and its clinical instrument, Clinical Brain Profiling (CBP). CBP treats mental disorders as disturbances of dynamic brain-network organization and organizes them across four timescales of plasticity:•Cognizance plasticity (milliseconds) is centered on the central executive network and linked to psychosis and negative signs.•Reactive plasticity (minutes to hours) is centered on the salience network and linked to anxiety.•Adaptive plasticity (days to weeks) sits at the salience–default mode interface and is linked to depression and mania.•Developmental plasticity (lifetime) is centered on the default mode network and linked to personality disorder patterns.The book reviews the neuromodulation toolkit: ECT, DBS, TMS, tDCS/tACS, psychedelic-assisted therapy, and focused ultrasound. It then proposes an entity-matched "grammar of plasticity" for selecting, combining, and sequencing these interventions. Guiding principles include strengthening prefrontal regulation before driving motivation, opening plasticity windows before directing them, and continuous biomarker monitoring.Throughout, the author separates established science from theoretical proposal and untested hypothesis. He outlines what validation would require: prospective outcome trials, clinically feasible network measures, and a cultural shift from single-label diagnosis to multidimensional profiling. The result is a case for rebuilding psychiatry as a measurement-based, mechanism-guided clinical neuroscience.
