Artist reflection

When I painted Look Again, I was not thinking about deprescribing. Yet when I read the editorial, I felt an immediate sense of recognition. It seemed to be describing many of the same ideas that had already found their way into the painting.

The work is built around the act of reconsideration.

The title itself is an instruction. Look. Again. Return to what you think you have already understood. Examine it from another angle. Notice what was overlooked. Be willing to change your mind.

The gold running through the painting is central. Gold suggests value, authority, excellence and something fixed and dependable. In medicine we often hear about ‘gold-standard’ treatments. Yet the painting asks a different question: who decides what the gold standard is, and under what circumstances should that judgement be revisited?

Two gold bands traverse the work. These can be read as benchmarks, thresholds or bars against which decisions are measured. They raise questions about where we set the bar, whether a single standard can apply equally to everyone and how standards change over time. The editorial repeatedly reminds us that what is appropriate for one person may not be appropriate for another, and that decisions regarding prescribing and deprescribing are rarely universal. The appropriateness of a treatment depends not only on the medication itself, but on the individual, the circumstances and the outcomes it produces.

The branching forms began as botanical structures but gradually became something else. To me they now resemble dendrites and neural pathways. They suggest connections, communication and the movement of information through complex systems. The forms move among landscape, plant structure and neural architecture, resisting a single fixed interpretation.

The gradual shift in tonal contrast across the surface is also significant. Moving between lighter and darker passages, it reflects fluctuations in mood and emotional experience, introducing another layer of interpretation beneath the work’s cognitive themes.

What struck me most after reading the editorial were the parallels between the text in the article and the text already dispersed throughout the artwork. Words such as insight, hindsight, review, renew, discern, detect, correct, overturn, rewrite and predict are not specific to either psychiatry or art. They are cognitive terms that operate across both domains, describing acts of reconsideration, revision and meaning-making. They describe exactly what happens when assumptions are revisited, when interpretations change and when understanding evolves. They form a vocabulary of inference.

Competing interpretations

One aspect of the painting that resonates strongly with the editorial is the presence of competing interpretations. The branching forms resist a single explanation. They can be read as roots, dendrites, pathways, river systems, botanical structures or neural networks. None of these interpretations is entirely correct or entirely incorrect. Instead, meaning emerges through a process of weighing possibilities, testing assumptions and revising conclusions as additional information becomes available.

This mirrors a central theme within the editorial. Clinical decision-making often involves distinguishing between competing explanations rather than identifying a single obvious answer. Symptoms may have multiple possible causes. Benefits and harms may coexist. Changes in functioning may reflect illness, treatment effects, recovery, adaptation or entirely different factors. Good judgement requires the capacity to hold several interpretations simultaneously while remaining open to new evidence. In this sense, the viewer of the painting undertakes a process remarkably similar to that described within the editorial.

Predict and revise

A second point of overlap concerns prediction and revision. Many of the embedded words within the painting are only partially visible at first glance. The viewer often anticipates a word before it has been fully identified, making an initial prediction that is then either confirmed or revised through closer observation. This process echoes the cognitive sequence already embedded within the work itself: predict, detect, correct. Understanding develops not through immediate certainty but through an ongoing cycle of expectation, observation and adjustment.

The editorial describes a comparable process within clinical practice. Decisions regarding prescribing and deprescribing are rarely made under conditions of complete certainty. ^{Reference Looi, Bell, Kisely, Szymaniak, Shivakumar and Naylor1,Reference Goldberg, McIntyre, Swartz, Freeman, Mago and Citrome2} Instead, clinicians and patients generate working hypotheses, observe outcomes, detect discrepancies between expectation and reality and revise decisions accordingly. ^{Reference Malhi, Bell, Stavdal, Wu, Naylor and Kumari3} Understanding evolves through repeated cycles of observation and correction.

Perhaps the deepest connection between the painting and the editorial is that neither is ultimately about its apparent subject matter. The editorial appears to be about medication, while the painting appears to be about neural pathways and perception. Yet both are fundamentally concerned with how humans construct understanding when certainty is unavailable. Both acknowledge that knowledge is provisional, that interpretation evolves and that good judgement depends upon remaining open to revision.

This is also reflected in the hidden words themselves. They are discovered rather than presented. The viewer is not simply given meaning; meaning emerges through engagement with the work. In a similar way, the editorial suggests that understanding often develops through a process of ongoing review rather than through immediate answers. Both works propose that insight is rarely a single moment of revelation. More often, it emerges gradually through observation, reflection and the willingness to reconsider what we think we know.

My broader practice is concerned with cognition, metacognition and meaning-making. I am interested in how people construct understanding from fragments, partial information and ambiguity. We rarely possess complete information. Instead, we infer, predict, interpret and revise (Fig. 1).

The editorial describes a similar process within clinical decision-making. Treatment decisions are made under uncertainty. New information emerges. Assumptions are tested. Outcomes are observed. Decisions are reconsidered.

For me, the overlap is not primarily related to prescribing, deprescribing or medication. It is about how humans make sense of complex situations when certainty is unavailable.

Both the painting and the editorial recognise that understanding is provisional. Both acknowledge that good decisions require ongoing attention. Both suggest that wisdom lies not in clinging to certainty but in remaining open to revision.

The painting ultimately proposes a simple idea, one that sits at the core of my practice.

We encounter fragments.

We construct meaning.

The rest is inference.

In art, in psychiatry and in decisions regarding prescribing and deprescribing, the most important thing may not be deciding.

It may be the willingness to reconsider what we think we know. To look. And then to look again.