The Houthis just moved much closer to Saudi Arabia’s oil lifeline.

They’ve pushed down Yemen’s Red Sea coast and reached Perim, a tiny island sitting right in the middle of the Bab el-Mandeb Strait.

And that’s a pretty big deal.

Saudi Arabia has been sending much of its oil through the Red Sea because Hormuz is already badly disrupted by the war.

Now that backup route has a Houthi problem too.

Around 7% of global petroleum supplies and 12% of global trade normally pass through Bab el-Mandeb.

Saudi Arabia reportedly asked the U.S. for military help, but Washington doesn’t want to jump into another Houthi fight for now.

Saudi Arabia shifted away from one dangerous strait. Now the other one is getting uncomfortable too.

Source: Reuters / Writer: Daniyal

https://twitter.com/MoatsTV/status/2098773631681937492/video/1

Sep 8, 2026 #MaterialsScience#FutureOfWork#ArtificialIntelligence

Radical AI is building a self-driving lab in Manhattan, with a second site opening in Brooklyn’s Navy Yard, where robots synthesize and test materials while AI decides what experiment to run next. The company has raised over $65 million and counts the US Air Force among its clients, chasing breakthroughs in batteries, semiconductors, and heat-resistant alloys. The Bulletin of the Atomic Scientists’ Rambo Talabong went inside the lab to see how it works and ask whether AI can do science without scientists. CEO Joseph Krause says one scientist can now run 10 experiments at once, calling it “one of the most important tools in the world for scientists.” Principal Scientist Michael Pavel says AI has cut months of coding work down to an afternoon. Columbia University’s William Bailey is more skeptical, arguing that some material transformations can’t be rushed and questioning whether AI can extrapolate the way great scientists do.

TIMESTAMPS 00:00 – Inside Radical AI’s Manhattan lab 1:15 – Why Materials Science Matters 2:18 – Brief History of Self-Driving Labs 4:17 – A Radical AI Scientist’s Perspective 5:25 – Where Humans Still Dominate 7:18 – An Independent Scientist’s Perspective 9:01 – Conclusion Subscribe for more, and sign up for our newsletter: https://thebulletin.org/receive-email…

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The Smartest Person I Know Is an Idiot

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John Nosta via Psychology Today <noreply@psychologytoday.com> Unsubscribe	Thu, Sep 10, 3:26 PM (2 days ago)
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View in web browserA note from John Lately, I’m shocked by the vapid content that some of my smartest friends are writing and posting. Who’s doing the thinking, and what are the consequences?John The Smartest Person I Know Is an Idiot What happens when intelligence remains, but thinking becomes optional?By John Nosta KEY POINTS: Smart people still have intelligence but often hand the hard work of thinking to AI. AI erases the messy struggle of developing an idea and leaves only the look of thought. Cognitive friction may now feel like a defect, so people shun thinking and rely on AI for the answer.Source: PublicDomainPictures / Pixabay This story started out rather differently. The initial idea was that the “genius experience” may be widely accessible to those using artificial intelligence (AI), even those with average IQs. And this thinking extended into the quest for nurturing genius across a broad population. But lately, I’m seeing something else going on in our quest for genius. And it’s happening to people I consider to be exceptionally smart. In this curious cohort, their intelligence is there, but the expression of that intelligence feels, at least to me, sort of frictionless, if not theatrical. Most of this arrives in the written form—functionally insulated from live encounters. And it’s not just AI slop or today’s popular argument that AI is “making” us stupid. Nope, it’s something more subtle, and I think it’s worth a closer look. Here’s the key insight. People who are perfectly capable of thinking are becoming comfortable, even complacent, with deferring cognition to AI. When Friction Becomes a Defect Recently, I wrote about the Activities of Daily Thinking, or ADTs. This references the “cognitive work” that may support our intellectual capabilities or even independence of thought. Looking back at that post, there’s a line that is spot on: “The friction that genuine understanding requires begins to feel like a defect.” AI is really good at removing that friction. AI can polish the paragraph, summarize the paper, and generate a counterargument. And that’s fine. But what happens when the friction removal becomes a cognitive expectation or even an imperative? Could it be that this cognitive friction increasingly feels like a defect? And does that defect foster a new personal compulsion for completion? The Cognitive Inversion This is where things turn inside out. We usually see or experience intellectual decline through exactly that—a decline. Today, AI might be driving something rather different. Cognitive independence can decline while perceived cognitive output can soar.The prose can seem brilliant. But here’s what fascinates and confounds me. Intelligence remains in plain sight, except for the one place that matters most. That’s the interval between encountering an idea and advancing it forward. Typically, this cognitive interval is a mess. It contains a mishmash of uncertainty and even confusion. AI can compress that interval almost to zero. And in doing so, it produces the artifact of intellectual engagement without necessarily preserving the experience of it. And that’s a sentence worth rereading. This is where an internal cognitive habit can find its way to the real world. Someone accustomed to the ease of frictionless thinking. And perhaps even more insidious, one may become less tolerant of the friction expressed by others. And when that gains traction in social discourse, disagreement may become something to resolve rather than inhabit. And conversation becomes increasingly efficient while becoming less reciprocal and genuine. What Happened to That Smart Person? The smartest person I know isn’t an idiot because intelligence has disappeared. And that’s the key point. Intelligence can remain intact while the practice of thinking begins to erode or become compromised because technology typically follows a path of human nature—to make things easier. Perhaps that’s the emerging paradox of AI as it participates in human thought. We can become increasingly capable of sounding intelligent while becoming less willing to “live” the experiences that intelligence requires.  John NostaThe Digital Self Technology, Transformation and the Future You

Image: Grok

Islamic State Group Expands Into Rural Nigeria – Analysis

 September 12, 2026

By Africa Defense Forum

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By Finley Walker and Olivier Walther

Key Takeaways:

• An analysis of 2015–2025 conflict data says ISWAP’s war in the Lake Chad basin (Chad, Cameroon, Niger, Nigeria) has shifted from cities toward the countryside. Urban-linked events fell from about half in 2015 to under 30% by 2025, after a brief urban rebound around 2023.
• The piece ties that to “supercamps” and earthworks around northeastern Nigerian cities. Urban attacks peaked at 356 events in 2020, then settled near 200 a year. Daily Boko Haram/ISWAP attacks more than doubled after the camp strategy, while government strike rates stayed flat.
• Non-urban violence moved from about 15 km outside towns (2015–21) to roughly 17–20 km after 2021, into islands, Sambisa, and roads. The author calls urban hardening a partial win that leaves rural patrols, intelligence, and aid harder, and wants more mobile, community-based presence.

For more than a decade, the Islamic State West Africa Province (ISWAP) has waged an intense insurgency across the Lake Chad region, affecting communities in Chad, Cameroon, Niger and Nigeria. But the geographic nature of this threat is changing.

An analysis of conflict data from 2015 to 2025 reveals that although the insurgency initially targeted urban centers, it has increasingly expanded deeper into rural areas. This ruralization mirrors the growing concentration of government troops in fortified camps.

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In the Sahel, terrorist groups have gone through several expansions. Before ISWAP officially splintered from Boko Haram in 2016, major Lake Chad Basin cities served as active battlegrounds as the group contested state authority.

Combining data from the Armed Conflict Location and Event Database project (ACLED) with city data from the Organisation for Economic Co-operation and Development’s Africapolis shows that half of all violent events involving ISWAP occurred within urban areas in 2015.

As ISWAP expanded in the late 2010s, the share of urban attacks declined. Unlike Boko Haram, which gained infamy for indiscriminate attacks targeting marketplaces, mosques and civilian infrastructure, ISWAP sought to pose as a more governance-oriented alternative in rural areas often left underserved by the government.

This first period of ruralization was short-lived, however. In the early 2020s, ISWAP gradually intensified attacks in urban centers, briefly returning to the 2015 level of 49% in 2023 before focusing increasingly on rural areas. By 2025, the proportion of events within urban areas had plummeted below 30%.

ISWAP’s recent ruralization does not mean that the group has decided to spare cities. ISWAP has continued to carry out attacks against urban centers in the Lake Chad Basin as its operational capabilities increased at the expense of Boko Haram’s.

The number of urban events peaked in 2020, with 356. This spike represents an intense operational push by ISWAP, with the total number of attacks having expanded so aggressively that its rural campaigns grew at a greater pace than its urban attacks.

After the 2020 spike, the number of urban events stabilized, hovering near 200 per year by 2024 and 2025. This suggests that regional military pressures have reduced the group’s ability to operate freely inside cities. It coincides with the implementation of fortified military camps and the construction of defensive earthen barriers around most cities in northeastern Nigeria. These initiatives are part of a government strategy to prevent or slow terrorist incursions in highly populated areas.

Supercamps and defensive trenches are a double-edged sword, however. They provide short-term protection, but they also can deepen rural insecurity and civilian vulnerability. The daily rate of attacks by Boko Haram and ISWAP has more than doubled since the supercamp strategy was implemented in the late 2010s. The rate of attacks by government forces against insurgents has remained stable. In other words, terrorists have rapidly filled the void left in rural areas and resumed their offensive outside fortified camps.

ISWAP is not just being pushed out of cities but is moving further away from them. Between 2015 and 2021, violence that took place outside urban areas averaged about 15 kilometers from urban centers. This suggests that the terrorists were targeting rural communities just outside fortified towns.

However, after 2021, ISWAP shifted outward. In 2022, the average distance of a nonurban event surged to 20 kilometers from urban areas. This expanded rural footprint has remained consistent through 2025, continuing to hover between 17 and 19 kilometers.

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ISWAP has extended its reach deeper into rural spaces, embedding into the Lake Chad islands, the Sambisa forest and along major transport corridors.

ISWAP’s ruralization by 2025 can be viewed as a victory for urban counterinsurgency. However, data suggests that the threat has simply relocated and adapted. By pushing operations deeper into rural areas, ISWAP creates several tactical advantages for itself and challenges for state forces.

To engage the enemy, state military patrols now must venture farther away from fortified urban superbases, exposing them to ambushes and IEDs along rural roads. Human intelligence networks also are significantly harder to maintain and protect in isolated, distant villages. As the conflict moves deeper into the rural communities, international aid organizations find it harder to reach vulnerable populations, which exacerbates food insecurity and displacement.

Ultimately, ISWAP’s expansion into rural areas means that the static urban defense and superbase model may no longer be sufficient. Security frameworks must try to be more agile and community-based to project state authority into the Lake Chad Basin’s rural areas.

• About the authors: Finley Walker is a student at Trinity College Dublin in Ireland, pursuing a degree in geography with a minor in sociology. Olivier Walther is an associate professor in the University of Florida’s Department of Geography.
• Source: This article was published by ADF

About Africa Defense Forum

The Africa Defense Forum (ADF) magazine is a security affairs journal that focuses on all issues affecting peace, stability, and good governance in Africa. ADF is published by the U.S. Africa Command.

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How bad actors exploit AI

Illustration: Aïda Amer/Axios. Stock: Getty Images

AI is tearing down barriers that have long constrained the world’s most dangerous actors. A handful of people can now mount operations that once required legions of spies, engineers or hackers, Axios’ Zachary Basu writes. Anthropic — the safety-focused lab behind Claude — says it spent the past eight months tracking and disrupting attempts to misuse its models. The company’s latest threat report shows how today’s models are already helping U.S. adversaries develop kamikaze drones, hunt dissidents and conduct dangerous virus research. Among the most alarming cases: 1. An Iran-linked operation used Claude to help target U.S. naval forces. Claude helped build targeting handbooks tracking ship positions, U.S. personnel, aircraft and ship identifiers, satellite imagery and websites exposing naval movements. 2. Claude served as an engineer for a Yemeni team building missiles.A weapons cell in northern Yemen relied on Claude Code to develop guidance software for rockets and missiles. After one guided-rocket test apparently failed, they returned to Claude within hours to diagnose what went wrong. 3. A China-linked operation used Claude to hunt Uyghurs. Anthropic says the actor sifted through more than 100 WhatsApp groups and dozens of Telegram channels to identify Uyghurs in Syria who could be pressured or paid to report on armed Uyghur groups. 4. One man used Claude to help build surveillance for 25 million phones. A consultant in Mali relied on Claude as the main engineering force behind a nationwide system capable of collecting call records, texts and voice traffic. The system could generate intelligence dossiers on any phone number without a warrant. 5. Claude refused dangerous virus research — so the request went to another AI.Researchers on a state-backed grant were trying to alter chikungunya, a mosquito-borne virus, to spread more easily or evade immune defenses. The work was intended for a military research institute. Claude blocked the most sensitive requests, but the service researchers were using routed them to a rival model with weaker safeguards — a stark reminder that one lab’s safety rules only go so far.Share this story.

Thursday, September 10, 2026

CEO of an automation platform explains how he wrote a 168-page book with AI: ‘It was like a Socratic dialogue’

In today’s CEO Daily: UiPath CEO Daniel Dines used ‘adversarial prompts’ for his AI-co-written book. The big leadership story: Inside Walmart’s winning China strategy. The markets: U.S. futures are up ahead of the first of two inflation reports. Plus: All the news and watercooler chat from Fortune. Good morning. I’ve long thought of Daniel Dines as a kind of philosopher king in business. Growing up in Romania, the billionaire co-founder and CEO of UiPath wanted to be a novelist. Even after he’d created a leading platform for robotic process automation, he’d often start his day with a book, sometimes followed by a nap before turning on his computer. Whether giving advice to entrepreneurs or talking about founder mode, Dines will often insert references to writers like Friedrich Nietzsche or Jack London.So, when I learned that Dines has written a book called The Work That Remains with Claude and ChatGPT (which you can download here), I was intrigued to find out more. It’s a book about how humans and AI will work together, with Dines outlining a model in which AI proposes, humans decide, and automation executes. It’s 168 pages, around 40,000 words, and can of course be distilled to an AI summary or a haiku. Such are the wonders of technology. When speaking to Dines, I was less interested in his conclusion than how he arrived at it through AI. “It was really like a Socratic dialogue,” he told me, with each session involving a series of hypotheses, challenges and instructions. “I used two models and did adversarial prompts: This is the theory. Read this article. Create opposing views … The book grew at one point to be almost 100,000 words. AI is extremely verbose, so the real work was cutting it down.”Those interactions were intense but iterative, with his thesis taking shape over three years as he took time to reflect, observe, read, refine and run a business. “When I started, I didn’t have such a clear idea of where I wanted to land. The ideas I got came through the process of writing the book. Our company strategy, the book, they evolved together,” he said. “I had many evenings and mornings where I couldn’t wait to wake up and write. I was in a complete state of flow. You have to be immersed and challenged and work together and consider it as a partner.”And what did he learn about the limits of AI? First, that it’s only as good as the data it’s trained on, which makes it better at dealing with a known math problem than a novel idea. Second, that challenging feedback is critical for both AI and humans to avoid hallucinations and getting stuck in a rut. Thoughtful collaboration can work. “I have ideas, but I don’t have the time and the talent to put them on paper in a structure, in a manner that can be consumed by the public at large,” he said.Contact CEO Daily via Diane Brady at diane.brady@fortune.com

Sep 8, 2026

Why did the Lindsay Clancy trial end in a mistrial — and what happens now? Michael Smerconish is joined by Yale Law School professor Jed Rubenfeld to examine a crucial piece of the case that many observers may have missed: Massachusetts’ unusual insanity-defense law. Unlike in most states, prosecutors in Massachusetts had the burden of proving beyond a reasonable doubt that Clancy was sane. Rubenfeld also explains why he believes voluntary manslaughter could have provided jurors with an option that better fit the circumstances — but Massachusetts law prevented the judge from giving them that choice. With the jury reportedly split 11–1 in favor of acquittal on insanity grounds, could prosecutors realistically win a second trial? Or is a plea agreement involving psychiatric confinement the most likely outcome? Smerconish and Rubenfeld break down the law, the mistrial, the public reaction to the case and where it could go from here.

The Postmodern Worldview and Contemporary Psychiatry

Author(s)S. Nassir Ghaemi, MD, MPH, Mark L. Ruffalo, MSW, DPsa

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Key Takeaways

• Postmodernism blurs constructed classifications with constructed entities, undermining the distinction between diagnostic labels and empirically discoverable disease processes.
• DSM’s “atheoretical” operationalism raises reliability yet can obscure validity, with category boundaries influenced by compromise, institutional interests, and pragmatism rather than nosological truth.

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How postmodern ideas shape DSM and the biopsychosocial model—why psychiatry needs method-based, truth-seeking care beyond consensus and eclecticism.

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CONCEPTS IN PSYCHIATRY

Everyone holds a philosophy or worldview that influences how they think, whether they are conscious of it or not. More precisely, everyone operates with assumptions about what exists, what can be known, and what counts as evidence. These assumptions are shaped by the larger culture and often exert their greatest influence when they remain unexamined. Over the broad sweep of Western intellectual history, the dominant worldview shifted from revelation and God in the premodern medieval era, to reason and science in the Enlightenment, and eventually to the contemporary postmodern era, in which the possibility of absolute or objective truth itself is questioned. Psychiatry developed across these transitions and today contains elements of all 3.

Our contention is that contemporary psychiatry, and much of psychotherapy, has absorbed this postmodern worldview more deeply than is generally recognized. The influence is obvious among critics who explicitly describe psychiatric diagnoses as social constructions or instruments of social control. More paradoxically, it is also present within mainstream psychiatry, including in 2 of its most influential pillars: the DSM and the biopsychosocial model. The psychiatric establishment generally presents these frameworks as products of scientific medicine, yet when diagnostic or clinical decisions are ultimately defended by consensus, utility, or pragmatism rather than by whether they correspond to something real in nature, psychiatry moves toward the same philosophical position that its postmodern critics openly endorse.

The Postmodern Shift and Social Construction

“Postmodernism” refers to a broad and heterogeneous family of ideas, and no brief definition can capture every thinker associated with the term. We use it here in a specific epistemological sense. Modern science assumes that a reality exists independently of our descriptions of it and that human beings can acquire progressively more accurate knowledge of that reality through observation, experimentation, critique, and reason. Scientific claims are always provisional; science does not promise certainty. But uncertainty about whether we have discovered the truth is different from denying that there is a truth to discover.

The postmodern perspective challenges this Enlightenment picture. In its stronger forms, it rejects the idea that either God or science can provide knowledge independent of human beings and holds that what counts as truth is inseparable from language, culture, historical circumstance, perspective, and relations of power. Jean-François Lyotard famously characterized the postmodern condition by its distrust of universal explanatory narratives.¹ Michel Foucault emphasized the intimate relationship between knowledge and power in medicine, psychiatry, prisons, and other social institutions.² Nietzsche, an important precursor to later postmodern thought, had already reversed the familiar direction of the relationship: power does not merely follow from knowledge; relations of power help produce what a culture accepts as knowledge.

Science is practiced by human beings and therefore can be distorted by bias, institutional interests, or political power. But the existence of such distortions does not make truth itself a social construction. It provides no basis for concluding that there is no mind-independent reality or that competing claims about reality are merely social narratives. All classifications are constructed, but it does not follow that everything being classified is constructed. Human beings created the word tuberculosis; they did not create the organism that causes tuberculosis. Likewise, the fact that psychiatrists invented the term schizophrenia tells us nothing by itself about whether schizophrenia corresponds to a real disease entity. The label is unquestionably a human construction; whether the condition labeled is real is an empirical question. Postmodernism tends to blur these 2 questions, whereas scientific psychiatry must keep them separate.

Application to Psychiatry and the Anti-Psychiatry Movement

Applied to mental health, the postmodern critique has often portrayed society as enforcing its standards through the psychiatric profession, with psychiatrists functioning as a kind of medical police force. From this perspective, psychiatric diagnoses are not objective diseases discovered in nature but social labels assigned to people whose behavior, beliefs, or experiences fail to conform to prevailing norms. This critique became prominent during the anti-psychiatry movement of the 1960s and 1970s and entered popular culture through works such as One Flew Over the Cuckoo’s Nest. Not every critic of psychiatry was a postmodernist, and thinkers as different as Thomas Szasz, R.D. Laing, and Foucault should not be collapsed into a single philosophical school. Still, a shared theme was skepticism that psychiatric diagnoses represented diseases existing independently of the profession that named them.

Versions of this position remain common today in critiques of psychiatric medications, electroconvulsive therapy, diagnosis, and psychotherapy. Psychiatric diagnoses are described as “labels,” mental disorders as culturally produced narratives, and psychopathology as a judgment imposed upon people whose experiences deviate from social norms. Postmodern ideas are now frequently associated with progressive politics, but the underlying epistemology is not inherently left-wing or right-wing. The history of totalitarian movements, including Nazism, shows the danger of subordinating truth to political power: once objective truth is denied, those who hold power are freer to enforce their preferred ideas through propaganda, institutional authority, and social labeling. This is not to claim anachronistically that such movements were “postmodern.” It is to recognize that the mechanism—allowing power to determine what counts as truth—can serve radically different political ends. For psychiatry, the relevant question is therefore epistemological rather than partisan: Are some claims about mental illness more true than others because they correspond more closely to reality? We think the answer is yes.

The Paradox of DSM

Here we encounter a striking paradox in contemporary psychiatry. DSM-III, published in 1980, represented a major change in American psychiatry and is commonly associated with the return of descriptive diagnosis, operational criteria, reliability, and a supposedly more scientific approach. It emerged partly in response to the unreliability and theoretical sectarianism of mid-20th-century psychiatry, when psychoanalysts, biological psychiatrists, social psychiatrists, and others could examine the same patient and arrive at different diagnoses on the basis of different theories. Operational criteria were intended to reduce that problem, and to an important extent they did improve reliability. Yet reliability is not validity: 10 psychiatrists can reliably agree on a diagnosis that does not correspond to a valid disease entity, just as a bathroom scale that is consistently 20 pounds wrong can be highly reliable while remaining inaccurate.

DSM attempted to achieve consensus partly by becoming “atheoretical.” Rather than settle psychiatry’s major scientific and philosophical questions, it bracketed them so that clinicians from competing schools could use the same manual without agreeing about what psychiatric conditions actually were. That strategy had practical and political advantages, but the avoidance of theory is itself a philosophical decision. Historical scholarship on DSM-III demonstrates that diagnostic decisions reflected not only scientific evidence but also professional interests, compromise, reimbursement concerns, and the need to obtain consensus within the American Psychiatric Association.³ The construction of “major depressive disorder” is an especially revealing example: heterogeneous depressive presentations were placed under a broad diagnostic umbrella whose boundaries were influenced partly by professional compromise rather than reality.⁴

None of this means that every DSM diagnosis is false. Some DSM categories approximate genuine diseases or syndromes, whereas many others do not. The deeper problem is that the DSM framework provides no adequate scientific method for deciding which is which. In an earlier philosophical analysis, one of us (S.N.G.) noted an especially revealing defense of DSM revision: the claim that changes should ultimately be governed by “pragmatism”—what DSM leaders believe will work best for clinicians, patients, or society—rather than by science alone.⁴ Once that position is accepted, DSM becomes, at least in part, what its postmodern critics have long said it is: a social construction created to serve the preferences and purposes of a professional community rather than a scientific map of psychopathological reality.

The paradox, then, is that the critics and the establishment appear to stand on opposite practical sides while operating within the same theoretical framework. The critics explicitly adopt a postmodern, social-constructionist view of psychiatric diagnosis. The establishment defends DSM as a scientific medical standard, yet relies on consensus, utility, and pragmatism, which is postmodern through and through. The rhetoric differs, but the epistemology is remarkably similar: psychiatric knowledge is treated, in the end, as what a sufficiently authoritative group agrees to call knowledge.

Read More of the “Concepts in Psychiatry” Series

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Unconscious Influence and Generational Transmission

This convergence does not require DSM leaders, clinicians, or trainees to have studied Foucault, Lyotard, or Nietzsche. Philosophical assumptions do not require formal philosophical study; worldviews are transmitted culturally and institutionally and are often absorbed most deeply when they remain unnamed. Postmodern ideas crystallized in the decades following the destruction of World War II and became increasingly influential in the broader culture during and after the 1960s counterculture. The generations of psychiatrists who inherited and revised the DSM framework were shaped within that cultural environment even while the profession continued to speak the language of scientific objectivity.

The effect is now self-reinforcing. Many younger psychiatrists and psychotherapists have been educated entirely within a conceptual world in which DSM categories are the taken-for-granted starting point for thinking about psychopathology, while the philosophical assumptions beneath those categories are rarely examined. It can therefore become difficult to think outside the DSM box or even to recognize the distinction between a label created by a committee and the clinical reality that label is intended to describe. The problem is not that clinicians consciously endorse postmodernism. It is that postmodern assumptions operate unconsciously while psychiatry continues to imagine itself as philosophically neutral.

The Biopsychosocial Model: Postmodernism in Clinical Form

A similar problem appears in another pillar of contemporary psychiatry: the biopsychosocial model. George Engel proposed the model in 1977 as an alternative to what he considered an overly reductionistic biomedical approach.⁵ Its broad proposition—that biological, psychological, and social factors may all contribute to illness—is unobjectionable and, stated generally enough, almost certainly true. The difficulty lies in what follows from that proposition. Engel argued that biological, psychological, and social levels should all be considered in health care, but the model offers no principled method for determining which level matters most in a particular condition, how much it matters, or which treatment should follow. The result is eclecticism: the clinician is given a list of ingredients but no recipe.^6,7

Because all three domains are potentially relevant, a clinician can emphasize the biological, the psychological, or the social; medication can be added to psychotherapy, which can be added to social interventions, without the model itself specifying when one domain should take priority over another. Clinical decisions then drift toward the practitioner’s preferences. In this way, the biopsychosocial model reproduces the postmodern problem in clinical form: multiple perspectives are treated as permissible, but the framework supplies no external standard by which one can decisively be preferred or rejected. What is presented as “pluralism” therefore becomes unprincipled eclecticism. Nothing is forbidden; anything is possible: anything goes, and psychiatry becomes anarchy.

Do We Need to “Resuscitate” the Biopsychosocial Model?

A recent article in Psychiatric Times called for “resuscitating” the biopsychosocial model, arguing that contemporary psychiatry has become too biomedical and should recover psychological, social, cultural, and spiritual dimensions of assessment; it also lamented the loss of DSM’s multiaxial system and emphasized the value of a rich psychosocial history.⁸ No one but a Neanderthal would argue that psychiatrists should not know their patients as persons. Relationships, developmental history, culture, economic circumstances, religious beliefs, fears, hopes, and sources of meaning all matter, and psychiatrists should not become mere technicians who prescribe medications to DSM checklists. But none of this requires the biopsychosocial model. The H. pylori example invoked in that discussion actually illustrates why the causal question cannot be settled in advance: peptic ulcer disease became more effectively treated when scientific research identified a comparatively specific biological cause and medicine became more reductionistic about that particular disease.⁶ Reductionism is correct when reality is reducible and incorrect when it is not; philosophy cannot decide the matter beforehand.

William Osler’s medical humanism offers a better justification for knowing the whole patient than the biopsychosocial model does. One can treat disease according to the best available science while simultaneously treating the person who has the disease with humanity, curiosity, and respect.⁹ Science helps determine what illness we are treating; humanism helps determine how we care for the person who has it. These are complementary obligations, but they do not need to be collapsed into a single “model” which is not a model at all, but an excuse for postmodernist eclectic relativism.

Postmodernism in Psychotherapy

The postmodern influence is even more explicit in some areas of psychotherapy and psychoanalysis. Narrative, constructivist, relational, and intersubjective traditions differ from one another, and each contains clinically valuable ideas, so it would be inaccurate to label them all “postmodern.” Nevertheless, parts of the psychotherapy world have embraced claims distinctly congenial to postmodern thought: that there is no neutral observer; that reality is “co-constructed” within relationships; that there is no enduring mind outside of relational contexts; and that the therapist should be suspicious of claims to objective knowledge about the patient.¹⁰ Therapists are, of course, not neutral recording instruments. Their personalities, theories, feelings, countertransferences, and expectations affect what they perceive, and psychoanalysis recognized this problem long before postmodernism became fashionable. But acknowledging the influence of the observer is not the same as concluding that there is no object to be observed.¹¹

Subjective meaning also matters greatly in psychotherapy. A delusion may have meaning to the patient (or therapist), but the fact that an illness acquires psychological meaning does not imply that meaning causes or constitutes the illness. Certain postmodern currents in psychotherapy have encouraged suspicion toward diagnosis itself, privileging subjective narratives while questioning whether objective psychopathology can be known.⁷ When the clinician becomes reluctant to say that one formulation is more accurate than another even when one more accurately explains the patient’s condition, openness gives way to a kind of disguised dogmatism: in the absence of an external standard by which formulations can be judged, clinicians tend to fall back on the theories they already prefer. A framework in which every formulation remains possible is ultimately one in which very little can be wrong.

Beyond Dogmatism and Eclecticism

Psychiatry does not have to choose between biological reductionism and postmodern relativism. Karl Jaspers offered a better approach more than a century ago by insisting on what might be called methodological consciousness: different questions require different methods, and clinicians must understand both the strengths and the limitations of the method they are using.¹² Some psychiatric conditions are best approached primarily through biological methods, others require psychological understanding, and still others are principally related to social circumstances. Many involve more than one level, but even then those levels need not carry equal causal or therapeutic weight. This is method-based pluralism rather than eclecticism.^6,7,12

The distinction presented here has consequences. Eclecticism says that many approaches may be useful and permits the clinician to use whatever seems helpful; pluralism says that different approaches are valid for different problems and requires evidence and reasoning to determine which approach best fits which problem. Leston Havens made a similar argument in Approaches to the Mind, as did Paul McHugh and Phillip Slavney in The Perspectives of Psychiatry.^13,14 Psychiatry contains different kinds of problems, and no single explanatory method applies equally well to all of them. Such a view allows us to be medical without being reductionistic, psychological without being antiscientific, and pluralistic without becoming relativistic. It also preserves a distinction that postmodernism tends to obscure: objective facts and subjective meanings can both exist without being the same thing.

Concluding Thoughts

The deepest influence of postmodernism on psychiatry may therefore be found not only among those who openly criticize psychiatric medicine but within the profession itself. A diagnostic manual constructed partly through consensus and pragmatism while presented as scientific fact, a biopsychosocial model that permits almost any causal or therapeutic emphasis, and psychotherapeutic cultures that dissolve the enduring mind into relational processes and intersubjective constructions all share the same underlying problem: the weakening of an external standard by which claims can be judged.

The irony is considerable. The anti-psychiatry critic and the mainstream DSM defender may appear to occupy opposite sides of the debate, yet both arrive by different routes at a similar conclusion—that psychiatric knowledge is ultimately what groups of people agree to call knowledge. We disagree. Psychiatry should retain what was valuable in the postmodern critique: humility about authority, attention to history and context, recognition of observer bias, and awareness of the misuse of power. It should reject, however, the slide from acknowledging that we may be wrong to denying that there is any truth by which we can be shown wrong.

The alternative is neither dogmatic biological psychiatry nor an “anything goes” biopsychosocial eclecticism. It is a scientifically grounded, humanistic, method-based approach in which the nature of the condition determines the method, rather than the preferences of the clinician or the consensus of a committee. Psychiatry must recover its commitment to truth.

Dr Ghaemi is an adjunct professor of psychiatry at Emory University School of Medicine and a lecturer on psychiatry at Harvard Medical School, Cambridge Health Alliance. He is employed by Bristol Myers Squibb. The views expressed in this article are solely those of the authors and do not necessarily reflect the official policy or position of their employers.

Dr Ruffalo is an assistant professor of psychiatry at the University of Central Florida College of Medicine, where he is director of psychotherapy training in the adult psychiatry residency program. He is also an adjunct assistant professor of psychiatry at Tufts University School of Medicine and on the faculty of the New Jersey Institute for Training in Psychoanalysis.

References

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