From brain networks to the patient-environment system in clinical neuroimaging

Despite substantial advances in clinical neuroimaging, its impact on defining and treatingpsychiatric disorders remains limited. Current approaches in clinical brain imaging framepsychiatric disorders as dysfunctions of brain-based information processing. Here, wepropose a shift in this explanatory focus, from how aberrant neural processes generatemaladaptive behavior to the brain's participation in the dynamics of the patient–environment system. Drawing on organism-environment approaches, we conceptualizebehavior as emerging from context-dependent coordinated interactions among brain,body, and environment. Within this framework, we conceptualize psychiatric disordersas excessive stability or flexibility in patient-environment dynamics that impair thepatient's capacity to adapt to changing situations. After examining the ontologicalcommitments of current clinical neuroimaging and recasting psychiatric disorders interms of patient–environment dynamics, we outline concrete strategies foroperationalizing this framework. These progress from combining ecological momentaryassessment with neuroimaging, to naturalistic brain and body imaging that jointly tracksneural, bodily, and environmental dynamics, and finally to explicit dynamical models ofthe patient–environment system in which maladaptive stability or flexibility can beformally defined and identified. By making these dynamics measurable, we aim to turn aconceptual reframing into a concrete empirical program, recasting the brain not as theseat of psychiatric disorders but as one participant in the patient–environment dynamics.