What Psychiatry Measures, and What It Misses: Flourishing as a Blind Spot in Patient-Centered Care.

In psychiatry, judgments are routinely made that extend beyond symptom assessment and reduction to areas such as functioning, agency, responsibility, relationships, and meaning in life. Yet standard outcome measures focus narrowly on symptoms, sometimes implicitly treating these broader dimensions as peripheral or outside the scope of psychiatric care. Thus, there is a mismatch between what psychiatric practice actually influences and what it formally measures. The result is not value-neutral care, but rather value-laden care without explicit acknowledgment. We argue that measures of flourishing do not expand psychiatry's scope so much as make explicit the dimensions of patients' lives psychiatry already shapes. We suggest that incorporating flourishing measures into psychiatry can help align assessment with patient-centered care without requiring clinicians to adopt a comprehensive moral framework or exceed the boundaries of their professional expertise.