As someone with a broad set of life experiences— navigating supporting a child with schizophrenia, having another child who has had multiple diagnoses of cancer from birth until now, and holding a MSc psychology, I am so incredibly thankful that this conversation is happening.
There are many things we can attribute to medical science— my daughters would not be here without it. But so much of their growth and development has come from the deep understanding and nurturing we’ve developed with them over the years.
I firmly believe that support circles for people going through mental crises can be taught to improve outcomes.
What the medical model does well is identify and treat the agent causing the problem. If you get sick and test positive for strep, the doctor treats the bacteria. Eliminate the agent, and the symptoms resolve. That model works beautifully when the cause is identifiable and direct.
Psychology is often working in a very different lane.
Most of the time, we are not treating a single, clear agent that is causing the experience. We are working with the experience itself — the person’s thoughts, emotions, behaviors, and the meaning they’re making of what’s happening. Sometimes biology is part of the equation, yes. But often there is no single “bacteria” to target.
If a physician tried to treat only the experience of strep, such as the fatigue, the sore throat, the irritability, without addressing the infection, it would be inefficient and inconsistent. They can standardize care because they can target the cause.
Now take depression. In many cases, we don’t have a single, identifiable cause to eliminate. If it’s situational — loss, death, betrayal, major transition — we may understand the context. But we cannot remove the loss the way we remove a virus. Even if the depression is biological, we are often managing vulnerability rather than curing a discrete invader.
So we treat the experience. We work with how someone is living through it. We address patterns. We build coping. We help them metabolize grief. We help them make meaning.
That is much harder to standardize.
We can identify symptom clusters. We can track trends. We can study what tends to help. But we are not curing people of emotional responses to being human. We are helping them navigate those responses.
If we move away from a strict “cure it” framework and toward a “support and integrate” framework, we may make more progress. Emotional experiences are not infections. They are responses — to life, to biology, to relationships, to change.
And this is why, over and over, the research shows that the therapeutic relationship matters so much. It is in relationship with a person who is attuned, consistent, and showing up specifically for us, that change becomes possible.
That does not dismiss severe mental illness or the role of psychotropics and neuroscience. In many cases, brain-based interventions are essential. But even there, medication often stabilizes the system so that relational and psychological work can actually take hold.
Medicine can often remove the agent.
Psychology helps people live through what cannot be removed.
The therapeutic alliance point is the sharpest argument in this piece — if the best predictor of outcomes is relational rather than modality-specific, that's essentially empirical evidence against over-standardization, coming from within the research tradition itself. It undermines the medical model on its own terms.
The tension you're describing between phenomenological approaches and what's easily measurable also has real implications for criminal and forensic psychology, where standardized risk assessment tools often flatten the very individual complexity that determines outcomes. The soul, as you put it, doesn't fit neatly into actuarial tables either.
Thanks for reading and providing this comment. If you haven’t seen it yet, I have an older post from early January when I break down psychiatric diagnostics and some of the troubles there. Gives more context to my emphasis on the soul here. I’m glad this resonated with you
As someone with a broad set of life experiences— navigating supporting a child with schizophrenia, having another child who has had multiple diagnoses of cancer from birth until now, and holding a MSc psychology, I am so incredibly thankful that this conversation is happening.
There are many things we can attribute to medical science— my daughters would not be here without it. But so much of their growth and development has come from the deep understanding and nurturing we’ve developed with them over the years.
I firmly believe that support circles for people going through mental crises can be taught to improve outcomes.
Cheers.
Well said. Thanks for reading and sharing your insight
What the medical model does well is identify and treat the agent causing the problem. If you get sick and test positive for strep, the doctor treats the bacteria. Eliminate the agent, and the symptoms resolve. That model works beautifully when the cause is identifiable and direct.
Psychology is often working in a very different lane.
Most of the time, we are not treating a single, clear agent that is causing the experience. We are working with the experience itself — the person’s thoughts, emotions, behaviors, and the meaning they’re making of what’s happening. Sometimes biology is part of the equation, yes. But often there is no single “bacteria” to target.
If a physician tried to treat only the experience of strep, such as the fatigue, the sore throat, the irritability, without addressing the infection, it would be inefficient and inconsistent. They can standardize care because they can target the cause.
Now take depression. In many cases, we don’t have a single, identifiable cause to eliminate. If it’s situational — loss, death, betrayal, major transition — we may understand the context. But we cannot remove the loss the way we remove a virus. Even if the depression is biological, we are often managing vulnerability rather than curing a discrete invader.
So we treat the experience. We work with how someone is living through it. We address patterns. We build coping. We help them metabolize grief. We help them make meaning.
That is much harder to standardize.
We can identify symptom clusters. We can track trends. We can study what tends to help. But we are not curing people of emotional responses to being human. We are helping them navigate those responses.
If we move away from a strict “cure it” framework and toward a “support and integrate” framework, we may make more progress. Emotional experiences are not infections. They are responses — to life, to biology, to relationships, to change.
And this is why, over and over, the research shows that the therapeutic relationship matters so much. It is in relationship with a person who is attuned, consistent, and showing up specifically for us, that change becomes possible.
That does not dismiss severe mental illness or the role of psychotropics and neuroscience. In many cases, brain-based interventions are essential. But even there, medication often stabilizes the system so that relational and psychological work can actually take hold.
Medicine can often remove the agent.
Psychology helps people live through what cannot be removed.
Thanks for tackling this topic, Luke!
Very well put. Thanks for sharing this
The therapeutic alliance point is the sharpest argument in this piece — if the best predictor of outcomes is relational rather than modality-specific, that's essentially empirical evidence against over-standardization, coming from within the research tradition itself. It undermines the medical model on its own terms.
The tension you're describing between phenomenological approaches and what's easily measurable also has real implications for criminal and forensic psychology, where standardized risk assessment tools often flatten the very individual complexity that determines outcomes. The soul, as you put it, doesn't fit neatly into actuarial tables either.
Looking forward to reading more from this series.
Thanks for reading and providing this comment. If you haven’t seen it yet, I have an older post from early January when I break down psychiatric diagnostics and some of the troubles there. Gives more context to my emphasis on the soul here. I’m glad this resonated with you