In this episode I introduce what I call process-based formulation, a way of understanding difficult, “treatment-resistant” presentations by mapping causal loops and feedback processes, rather than hunting for a single diagnosis or cause. I contrast the classic medical model (differential diagnosis → one primary etiology → one treatment) with situations where suffering is maintained by self-perpetuating systems, like the simple loop of caffeine → insomnia → fatigue → more caffeine. I illustrate this with a real case of “treatment-resistant depression” that finally remitted when I stopped thinking in terms of labels and instead targeted a specific feedback loop, leading to an unconventional treatment.
