From Listening to Prescribing: Pharmacological Reductionism, Temporality, And the Loss of Complexity in Contemporary Psychiatry

Abstract

Pharmacotherapy has transformed prognosis and broadened the possibilities of care across different mental disorders. This recognition, however, does not eliminate the problem of pharmacological reductionism, understood in this article as the conversion of medication from a therapeutic resource into the organizing principle of diagnosis, of the explanation of suffering, and of psychiatric practice itself. This critical review of restricted scope examines the literature published between 2021 and 2026 on the mechanisms that favor this reduction, its clinical and epistemological consequences, and the alternatives proposed to reintegrate the biological, psychopathological, relational, social, and existential dimensions. The analysis is organized around eight problems: the symptom–diagnosis–drug circuit; the reification of diagnostic categories; the gap between acute response and long-term recovery; polypharmacy and prescribing cascades; economic and organizational incentives; the limits of a merely protocol-driven deprescribing; shared decision-making; and biopsychosocial and recovery-oriented models of care. The general psychiatric syndrome hypothesis is discussed as a possible challenge to nosographic fragmentation, but also as a construct that demands caution so that it does not become a new reified entity.

The synthesis showed that pharmacocentrism does not stem from a single cause. It emerges from the combination of diagnostic reification, the predominance of short-term outcomes, the invisibility of harms and preferences, cumulative polypharmacy, commercial influence, and services with few psychosocial alternatives. At the same time, studies of efficacy and effectiveness confirm relevant pharmacological benefits, which precludes an anti-psychopharmacological conclusion. The data support a distinction between rational use of medicines and pharmacocentric organization of care. Overcoming the latter depends on a causal and revisable clinical formulation, shared decision-making, longitudinal follow-up, family involvement when appropriate, and effective access to non-pharmacological interventions. We argue that criticizing pharmacocentrism does not mean denying psychopharmacology, but rather restoring medication to a proportionate position within a broad, longitudinal clinical formulation that is sensitive to the person's experience.