The mental status exam (MSE) remains the core element of psychiatric assessment, forming the basis for our diagnoses and documentation of the patient’s presentation at a moment in time. It is now now largely out of step with a modern understanding of the brain as a dynamic information-processing and energy-regulating system.

Here I argue for a functional mental status exam, a first-principles-oriented approach to assessing the integrity of a dynamic nervous system, and suggest a few guideposts to frame this new approach to patient evaluation.

As organizations confront accelerating social disruption and technological overload, new frameworks are needed to understand leadership and mental resilience. This blog explores Managerial Allostasis, the Extended Mind, and the science of cognition and emotional regulation—offering insights into how leaders and institutions can adapt, regulate, and thrive in rapidly changing social and technological systems.

Leadership in an allostatic organization is less about command and more about calibration. It means noticing early signals of overload, shaping culture as a feedback mechanism, and building structures that can flex without fracturing.