Contemporary psychiatry is increasingly moving beyond rigid categorical diagnosis toward dimensional, transdiagnostic, developmental, and multilevel models of mental disorder. Yet the field still lacks a foundational life-process framework capable of integrating biological regulation, embodied feeling, relational world-making, and the social conditions through which psychiatric suffering is generated, maintained, and relieved. This white paper proposes such a framework by deriving neuropsychiatric disease from disturbances in living coherence across five foundational layers: autopoiesis, structural coupling, emotioning, felt interiority, and emotional sentience. Autopoiesis defines the living organism as a materially open, organizationally closed, self-producing unity. Structural coupling situates this unity within histories of viable or destructive relation with its medium. Emotioning specifies bodily domains of possible action through which organisms meet the world. Felt sense and interoception disclose the organism’s living condition from within. Emotional sentience names the evaluative self-regulatory dimension by which life feels how life is going. Drawing on developments in Research Domain Criteria, the Hierarchical Taxonomy of Psychopathology, enactive psychiatry, interoceptive neuroscience, allostatic-interoceptive overload, neuroimmune psychiatry, phenomenology, and social determinants of mental health, the paper argues that neuropsychiatric disease can be understood as disturbed viability across organismic regulation, relational coupling, affective orientation, embodied self-experience, and meaning-making. In this usage, incoherence is not a personal failing or moral deficit; it is a sign that life conditions, regulatory capacity, or organism-world coupling have become nonviable. The proposed Seven-Primitives Clinical Grammar–Constraint, Margin, State, Disturbance, Perception, Regulation, and Options–offers a disciplined transdiagnostic method for assessing how living coherence breaks down and how it may be restored. The paper concludes by outlining implications for clinical assessment, psychotherapy, psychopharmacology, community care, prevention, research, and life-coherent public policy.
