Definition
Tunneling Molecular Psychiatry (TMP) is a mechanism-first approach to evaluation and management of psychiatric cases that prioritizes CNS protection, patient safety science, patient-centered care, diagnostic rigor, developmental attunement, longitudinal surveillance, epistemic humility, evidence-based practice, trauma & dissociation science, patient advocacy, bioethics, integrative care, clinician accountability, child protection and much more. It is a correction to legacy psychiatry, which is the status quo.
Thought Experiment
Psychiatrists should not be treating symptom clusters alone. Consider the following example. If a child has fever, cough and tachypnea, we have no idea if the child has bacterial/viral/atypical pneumonia, bronchiolitis obliterans, bronchiolitis, myocarditis of any etiology, asthma, croup, pertussis, cystic fibrosis, primary ciliary dyskinesia, retropharyngeal abscess, metabolic acidosis of any etiology, anemia of any etiology, MIS-C, vasculitides, toxic exposures, EVALI, etc.
Treating symptom clusters without proper testing causes plenty of harm in every area of medicine, and psychiatry is no different. It is past time to eliminate the outdated practice of treating only symptom clusters in psychiatry. Unfortunately it will take years for psychiatry to catch up to other specialties but the wheels are already in motion. There are known and predictable failure modes of the CNS, and those are exactly what TMP evaluates with appropriate medical testing.
Symptom clusters are the starting point of medical reasoning, not the endpoint – yet psychiatry has inverted that logic for decades.
Symptomatology ≠ Etiology
Phenomenology ≠ Etiology
The brain is a complex biological engine that requires specific, mechanism-based inquiry to prevent and treat its failure modes.
Restore psychiatry to medicine.