The way psychiatry treats those who deviate from the norm is akin to the outdated and unhelpful way that industry used to understand the assembly line—something that manufacturing started moving away from by the mid-20th century.
It was W. Edwards Deming, an American quality guru, who was pivotal in transforming manufacturing and quality management at that time.
When Deming came upon the American manufacturing scene, quality management basically amounted to one guy standing at the end of a production line sorting out good product from bad product. Good product was shipped. Bad product was either reworked to meet requirements or, if it couldn’t be reworked, it was discarded. At the time, it was common for management to blame the operators. Or the machines. Or the materials.
Deming responded, in so many words, “That’s not very clever. Look at the costs incurred each time nonconforming product is discovered only here at the end of the line. To produce this nonconforming product, you incurred the costs of labor, materials, and operating overhead. You will sink more labor, materials and operating overhead either reworking parts to bring them into conformity, or producing good product to replace the nonconforming product. And what of the opportunity cost? How much more product could we have produced if we weren’t playing catch-up? In a sense, you’ve lost three times every time you find nonconforming product at the end of the line.”
Deming’s suggestion was to move quality into the process. Focus upon the process itself to ensure product conformity. To ensure quality, don’t focus so much on product at the end of the line, but focus upon the processes that create the product, making them as effective and efficient as possible, ever improving them. Control the process to control the product.
Nonconformity is a systemic result. It’s not the fault of the operators, nor is it the fault of the parts themselves. When nonconforming product is discovered, its cause lies somewhere in the system. It’s the system itself that’s flawed.
“Every system is perfectly designed for its outputs.” Although these exact words may not have been uttered by Deming, this quote is often attributed to him because it so clearly sums up part of his teachings.
If a system produces nonconforming parts, the system didn’t merely allow the nonconformities to arise, it was effectively designed to produce those very results. The root cause exists somewhere in the system. By adjusting the system to account for and control the impacts of these causes, the system becomes more robust—now no longer susceptible to that particular source of variation or error.
Psychiatry, in its treatment of nonconforming human behavior, often mirrors the outdated manufacturing mindset. Behaviors that deviate from societal norms are frequently pathologized, framed as disorders to be fixed rather than expressions to be understood. By applying principles from quality management, psychiatry can learn to approach nonconformity in a more constructive and nuanced way.
In psychiatry, we find a strikingly similar issue to that of early manufacturing: the treatment of nonconformity. Nonconforming behaviors are treated by psychiatry like early manufacturing treated nonconforming product. Just as nonconforming products were reworked without understanding the root cause, individuals exhibiting distressed behaviors are often treated in isolation, with little attention paid to the broader, systemic factors that shape and cause these behaviors.
Psychiatry, much like early manufacturing, too often focuses on reworking (treating) the individual to conform (fit into societal norms)—norms that have been shaped by human-made political, economic, social, and religious systems.
Much of the psychiatric field operates on the premise that individual behavior is a biological phenomenon. When a person exhibits distressed or “nonconforming” behaviors, they are often treated with medications, therapy, or other interventions aimed at alleviating symptoms and reworking the person into a state of conformity. This treatment approach mirrors the early manufacturing mindset—fixing the product without addressing the underlying systems that created the nonconformity in the first place.
While understanding a person’s biology and life experiences is crucial to an understanding of their behavior, this knowledge is elusive, never complete, and of little value in effectively addressing the root causes of the problems they face. Psychiatry tends to focus on the individual, assuming that the issue is with the person, and by treating the person, they are treating the problem—rather than looking to the person’s orbit, community, and beyond to the systems that shaped their development and behavior.
This approach is like simply reworking a nonconforming part without fully considering its root cause, satisfied merely with identifying and treating the observed nonconforming condition at hand.
In a competitive world, improvement isn’t just nice, it’s necessary. The moment we quit improving our processes and products, there will be competitors who take market share with improved processes and products. Improvement is necessary for survival. Learning is necessary for improvement. Which brings up another gem from Dr. Deming: “Learning is not compulsory. Neither is survival.”
Though psychiatrists naturally want to improve, their improvement efforts seem focused on improving the ability to “diagnose and treat mental illness.” Accordingly, they strive to improve their ability to interact with individuals and understand the “symptoms” of the “mental illness” that need to be “treated.”
Psychiatry’s reliance on symptom-based classifications, as seen in the Diagnostic and Statistical Manual of Mental Disorders (DSM), parallels early manufacturing’s narrow focus on outputs rather than processes. In manufacturing, a nonconforming condition consists of a disparity between actual features of the manufactured part versus the specified requirements pertaining to that part. The specified requirements often appear on blueprints describing a conforming part. By applying tolerances for variation around the stated requirement, blueprints also identify conditions that would be considered nonconforming.
A part that is nonconforming can be made to conform to requirements by eliminating the nonconforming condition. For example, if requirements specify a part to be one inch long, with a tolerance of a quarter inch, and the actual part measures one and a half inches, the part is nonconforming. It can be reworked to meet those requirements by cutting off somewhere between a quarter inch and three quarters of an inch of material from one end. If it’s too short, then it gets relegated to the recycle bin. It can’t be reworked.
The DSM to psychiatrists is like the blueprint to manufacturers. It provides a basis for identifying nonconformity. Improvements to diagnostic capabilities would result in new, improved versions of the DSM—a tool that’s ever improving the ability to diagnose.
When it comes to treatment, the focus is on the nonconforming condition, eliminating that condition, thereby bringing the nonconforming part into conformity. Accordingly, they attempt to treat (rework) the person displaying that condition to where they no longer meet requirements to be classified as displaying symptoms (per the DSM). But this often fails, and people end up in “treatment” for the rest of their lives with no meaningful improvement—as if they are a manufactured part slated for perpetual rework.
Psychiatry tends to focus on the individual, assuming that the issue is with the person, and by treating the person, they are treating the problem—rather than looking to the person’s orbit, community, and systems that shaped their development and behavior. This approach is like simply reworking a nonconforming part without fully considering its cause, satisfied merely with identifying and treating the observed nonconforming condition at hand.
Improving treatments is like improving how we rework product. As if we are resigned to systemic nonconformity. We can get really good at reworking, ever improving our rework methods, but that approach will never address, fix, or even touch the systemic causes. Improvement efforts need to be applied to the broader systems of governance, not to the rework systems of psychiatry.
The real wisdom that Deming’s principles offer psychiatry is the understanding that nonconforming behaviors are not isolated accidents but are the direct results of systemic causes. These causes are not resident in, or inherent within the individual; they are resident in the systems that surround and shape them. Just like nonconforming parts are the product of a flawed manufacturing system, distressed behaviors are the product of a flawed societal system (or collection of governing systems).
One might object that this approach is based on nonconforming parts—objects lacking brains—so these objects are understandably completely the result of their processing. In contrast, humans have brains, so we carry responsibility for our behavior. But human brains are objects, too, objects that are developed by biological processes and exposures to external forces over which an individual has no control.
ACE (Adverse Childhood Experiences) research underscores this conclusion. Exposure to enough adverse experiences during childhood can physically impact development of a person’s brain. People with high ACE scores encounter many troubles those unfamiliar with the research still attribute to the individual instead of the life experiences the person was exposed to. Nobody chose their trauma, yet a distressed person is often viewed as the cause of their own troubles. A distress person has a “mental illness” that must be “diagnosed” so it can be properly “treated.” Once cause is attributed to the person, so is treatment focused merely on the individual.
The societal systems that influence individuals—political, economic, social, and religious structures—are deeply ingrained and often oppressive. No longer is human development shaped by exposure to nature and natural systems, but increasingly by a human-made environment and systems. These human-made systems shape people’s biology, psychology, and behavior in ways that are often harmful, leading to the distress and dysfunction that psychiatry seeks to address.
When psychiatrists treat an individual’s behavior without addressing the systems that have shaped it, they are merely trying to rework the person to fit into a machine that’s inherently broken. They’re focusing on “symptom” management rather than systemic change. This approach, though it may offer temporary relief, does not address the root causes of the distress, just as merely reworking a nonconforming part doesn’t address the flaws in a production process.
The lesson from Deming is clear: to truly address nonconformity, we look to the system producing it. In psychiatry, this means recognizing that distressed behaviors are not the caused by the individual, but they are natural reactions to the oppressive circumstances they endure and the adverse conditions they developed under. The real long-term solution lies not in reworking the individual to fit into a flawed society but in transforming the broken systems that drive these reactions in the first place.
By shifting the focus from the individual to the person’s orbit, community, and the larger societal systems, psychiatry can move toward a more holistic and effective approach.