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Taking an engineer's view: Implications of network analysis for computational psychiatry
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Borsboom et al. challenge the notion that the brain should occupy a privileged position in mental health nosology and science, contending instead that symptom networks reflect the best units of analysis. However, psychiatry has made great strides in understanding and treating disorders using biology, and it is naïve to assume that because the model does not completely account for the full complexity, it is therefore useless. Because all behavior arises from brain function, neurobiology is obviously critical for understanding psychiatric phenomena and not simply an example of “local reduction” of symptom networks. However, we think that the authors do have an important point that has not been incorporated well into current psychiatric reasoning: namely, that the trajectory of interactions with the external environment contains consequence chains that provide additional access points for treatment. It is important to remember that psychiatric problems are not simply social constructs, but lead to real devastating consequences. For example, a patient with obsessive-compulsive disorder (OCD) unable to stop compulsive hand-washing is damaging their skin, leading to an increased risk of infection (Swedo et al. 1989) – certainly not something one would want anywhere, especially in a plague situation. To help patients overcome their difficulties, we take an engineer's point of view, which asks two questions: (1) What are the failure modes that underlie psychiatric dysfunction? and (2) How can we modify the system? The concept of a failure mode comes from reliability engineering – it recognizes that the structure of a process has specific ways in which it can fail. If we understood how environmental and neurobiological effects lead to behavior, then we could identify how this interaction can fail (MacDonald et al. 2016; Redish 2013; Redish et al. 2008). We agree that it is unrealistic to think that only the brain impacts disease – these...