At a time when exciting new ideas and theories are emerging to better understand and manage complex systems, it is difficult to appreciate Hinshelwood's view as useful or relevant. For example, the science of complex adaptive systems (CAS) has been applied to a wide range of human endeavors, and it would be a worthwhile effort to consider psychiatric institutions through this lens. The Institute of Medicine, in a recent report on health care in America (1), includes an appendix on applying the CAS framework to health care system reform. The ideas are compelling and at once simple and powerful. The institute makes it clear that our entire health care system is in urgent need of reform and suggests that the CAS framework might be a powerful tool for understanding and facilitating change. Our institutions need a new paradigm, not a reworking of outdated and misapplied theories.