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

Despite substantial advances in clinical neuroimaging, its impact on defining and treating psychiatric disorders remains limited. Current approaches in clinical brain imaging frame psychiatric disorders as dysfunctions of brain-based information processing. Here, we propose a shift in this explanatory focus, from how aberrant neural processes generate maladaptive behavior to the brain's participation in the dynamics of the patient-environment system. Drawing on organism-environment approaches, we conceptualize behavior as emerging from context-dependent coordinated interactions among brain, body, and environment. Within this framework, we conceptualize psychiatric disorders as excessive stability or flexibility in patient-environment dynamics that impair the patient's capacity to adapt to changing situations. After examining the ontological commitments of current clinical neuroimaging and recasting psychiatric disorders in terms of patient-environment dynamics, we outline concrete strategies for operationalizing this framework. These progress from combining ecological momentary assessment with neuroimaging, to naturalistic brain and body imaging that jointly tracks neural, bodily, and environmental dynamics, and finally to explicit dynamical models of the patient-environment system in which maladaptive stability or flexibility can be formally defined and identified. By making these dynamics measurable, we aim to turn a conceptual reframing into a concrete empirical program, recasting the brain not as the seat of psychiatric disorders but as one participant in the patient-environment dynamics.