The Art of Undoing: The Need for Exit Strategies in Psychiatry

The recovery movement has challenged long-standing professional pessimism about psychiatric prognoses. Yet, despite strong empirical evidence for the possibility of recovery from mental illness, the psychiatric profession has shown little change in attitude. Drawing on complexity thinking, the authors describe how diagnostic and therapeutic practices can create feedback loops that sustain perceptions of chronicity. Psychiatry's emphasis on rapid diagnosis and treatment initiation, coupled with neglect of dediagnosing and deprescribing, may inadvertently reinforce the belief that mental disorders are lifelong. They propose that the "art of undoing," such as deprescribing and revising diagnostic assessments, should be recognized as a core clinical skill and research target to break professional pessimism.