Causality or etiology in psychiatry is marked by standard biomedical, reductionistic models (symptoms reflect the construct involved) that inform approaches to nosology, or classification, such as in the DSM-5 [Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition; ( 1 )]. However, network approaches to symptom interaction [i.e., symptoms are formative of the construct; e.g., ( 2 ), for posttraumatic stress disorder (PTSD)] are being developed that speak to bottom-up processes in mental disorder, in contrast to the typical top-down psychological construct approach. The present article presents a hybrid top-down, bottom-up model of the relationship between symptoms and mental disorder, viewing symptom expression and their causal complex as a reciprocally dynamic system with multiple levels, from lower-order symptoms in interaction to higher-order constructs affecting them. The hybrid model hinges on good understanding of systems theory in which it is embedded, so that the article reviews in depth non-linear dynamical systems theory (NLDST). The article applies the concept of emergent circular causality ( 3 ) to symptom development, as well. Conclusions consider that symptoms vary over several dimensions, including: subjectivity; objectivity; conscious motivation effort; and unconscious influences, and the degree to which individual (e.g., meaning) and universal (e.g., causal) processes are involved. The opposition between science and skepticism is a complex one that the article addresses in final comments.
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