Below is a clinically grounded way to apply the network approach to psychopharmacologic practice—without collapsing it into mere “symptom suppression,” and without pretending medication targets a single cause.
1. Core reframing: medication does
not
treat disorders
→ it perturbs networks
Classical psychopharmacology assumes:
Drug → Neurotransmitter → Disorder → Symptom relief
The network approach replaces this with:
Drug → specific nodes & edges → network reconfiguration → downstream changes
So a medication:
- does not “treat depression”
- does not “fix serotonin”
- does alter connectivity, activation thresholds, and feedback loops
Medication becomes a system-level intervention, not a cure.
2. Think in terms of
node categories
, not diagnoses
In practice, psychotropic drugs tend to act on certain classes of nodes, regardless of DSM labels.
Common node types medications affect
|
Node type |
Examples |
Typical pharmacologic leverage |
|
Arousal / energy nodes |
fatigue, psychomotor retardation |
activating agents |
|
Sleep-wake nodes |
insomnia, hypersomnia |
sedative or circadian-modulating agents |
|
Affective intensity nodes |
anxiety, panic, irritability |
dampening agents |
|
Cognitive loop nodes |
rumination, obsessionality |
loop-weakening agents |
|
Impulse threshold nodes |
suicidality, aggression |
containment agents |
Key point:
Medication rarely targets meaningful content
It targets dynamical properties of nodes
That’s why drugs feel:
- blunt but powerful
- nonspecific yet effective
3. Central nodes vs “deep causes” (your earlier concern)
The network approach does not deny centrality.
It reframes it.
In psychopharmacology:
- Central nodes = nodes with high betweenness or degree
- These are often:
- sleep
- anxiety
- psychomotor agitation
- severe rumination
Clinically, this explains a familiar truth:
Treating sleep sometimes “treats” the depression
Treating anxiety sometimes “treats” everything
Not because sleep/anxiety is the cause
—but because it is a structural bottleneck
Medication is often best used there, not everywhere.
4. Why polypharmacy makes more sense (and more danger)
In linear thinking:
- Polypharmacy = bad practice
In network thinking:
- Polypharmacy = multi-node intervention
But with a crucial caveat.
Two types of polypharmacy
A. Coherent (network-aware)
- Each drug targets a different node
- Effects are complementary
- Network becomes more flexible
B. Incoherent (network-blind)
- Multiple drugs hit the same node
- Redundancy, side effects
- Network becomes rigid or fragile
The network model gives a rational basis for judging this difference—beyond rules of thumb.
5. Treatment-resistant depression (TRD) reinterpreted
From a network view, TRD is not:
- “biologically severe depression”
- “failure of the right drug”
It is often:
- a hyper-stable network
- with strong self-reinforcing loops
- and high resistance to perturbation
Medication fails when:
- it perturbs peripheral nodes
- while core loops remain intact
This explains why:
- tiny changes sometimes suddenly work
- dramatic pharmacologic efforts often don’t
Change occurs at phase transitions, not by accumulation.
6. The ethical position of medication (important)
The network approach supports a non-reductionist ethics:
Medication is not a truth-revealer
Medication is not a lie
Medication is a prosthetic intervention in suffering
It:
- creates room for psychotherapy
- lowers thresholds for change
- but does not replace meaning, history, or choice
In your language:
Medication is not the Ereignis
It may make the Ereignis possible
7. Clinician stance: prescriber as
network tactician
This subtly changes the role of the psychiatrist.
Instead of:
- “Which diagnosis?”
- “Which guideline?”
We ask:
- “Which node is maintaining the loop now?”
- “Where is the least violent intervention?”
- “What change would cascade?”
This is closer to:
- strategic thinking
- systems ethics
- clinical humility
8. Final synthesis (very close to your position)
You could formulate it this way:
Psychopharmacology does not heal the wound.
It alters the terrain around the wound
so that the subject may endure, move, or speak.
Or more sharply:
Drugs do not give freedom.
They sometimes reduce the cost of freedom.
If you want, next we can:
- Map TRD pharmacologically as a network diagram
- Compare psychopharmacology vs psychotherapy as different perturbation styles
- Or articulate a network-informed ethics of prescribing for your 自體的心理學 project
Just point to the next node.
