She remembers it well. While working as a research assistant on MRI research into the brains of people with addictions and obsessive behaviour, Nina de Boer found herself reading an article about a systemic approach to mental disorders. “The network theory described in the article really grabbed me,” she says, looking back. “Everything in it made intuitive sense, but I couldn't put my finger on what it was exactly.” She decided to explore this further and went on to read more about it during her studies. Then a PhD position became available at Radboud University to conduct research on this theory from a philosophical perspective. “I seized that opportunity. I wanted to figure out why this approach felt so fitting.”
Mental health problems as a network
Network theory states that mental disorders do not have a single cause, but are networks of causally interacting symptoms. “Take rumination,” explains De Boer. “That can interfere with your sleep. Sleep deprivation causes concentration problems, which in turn can lead to more rumination. In this way, thoughts and feelings reinforce one another, and you can get caught up in a pattern.”
According to De Boer, this view is at odds with the biomedical approach, which has been dominant in psychiatry since the 1980s. “That approach assumes that the symptoms of a mental disorder, such as low mood, feelings of worthlessness, and sleep problems in cases of depression, stem from a single underlying biological cause. Since the 1980s, psychiatric diagnosis has focused more on symptoms. This made it easier to measure mental health problems, allowing research into their biological foundations in our genes or brains.”
Different thinking tools
Because the biomedical approach has not led to the aspired breakthroughs in our understanding of mental suffering, criticism of this approach has grown in recent years. “Also in academic hospitals,” says De Boer. Therefore, in her research, she tried to move beyond from the idea that mental dysregulation always has a single clear cause. “Instead, I explored how to look at mental suffering in a systemic way: how thoughts and feelings influence one another, in conjunction with biological and environmental factors. So, seeing the system as a whole.”
She started her research with a clear hypothesis. “My intuition was that the systemic approach was right, and the biomedical approach was not.” But her conclusion became more nuanced. “One approach is not necessarily better than the other. We should think of them as different thinking tools. The usefulness of an approach in research or treatment depends on the context.” That also means: don't write off approaches too soon. “We should never completely abandon an approach just because it turns out to have limitations, because we will never find a perfect approach.”
De Boer sees a recurring pattern. “When embracing new psychiatric approaches, people often think: now we will really understand mental suffering. This is where philosophical research becomes relevant: it can help tease out what a specific approach entails exactly, and whether its claims hold up. Philosophy can help us get a better grip on such approaches.”
As an extension of this work, since 2025, De Boer and her colleagues have been studying another acclaimed development: the use of experiential knowledge in psychiatry. “People with lived experience are increasingly involved in mental healthcare and research. Experts-by-experience can be sensitive to factors that others do not observe. This makes their experience important, both ethically and in terms of the information they provide . Here too, philosophy can help us to tease out what experiential knowledge entails.”
New perspectives
According to De Boer, there is added value in looking at psychiatry from a philosophical perspective. “Psychiatry is full of philosophical questions: what is mental suffering? What is a disorder? Where is the line between normality and abnormality? There are values hidden in definitions. These are things we can discuss with each other. In the process, underlying assumptions are revealed, so that clients, practitioners, and researchers can check with themselves what they implyn.”
Thinking about these questions creates space, De Boer argues. “It gives you freedom to decide how you want to relate to and talk about mental health problems. This, in turn, opens up new perspectives, making it possible, for example, to relate differently to a diagnosis. Philosophy can help us think more precisely and act more carefully.”
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