LISBON, PORTUGAL, 5 May 2026 – If a small stroke in one corner of the brain can tip a previously healthy person into mania or set off obsessions and compulsions where none existed before, then the circuit connected to that lesion is telling us something rare in psychiatry. It is telling us about the cause. Gonçalo Cotovio, MD, PhD, a psychiatrist and clinical researcher at the Champalimaud Foundation in Lisbon, has built his early career on that premise and is using it to push the field beyond a century of descriptive diagnosis toward treatments targeting the networks that actually produce symptoms.
A Bet on Causality in a Field Built on Correlation
Psychiatry is a field saturated with associations. Brain region X lights up in depression, connectivity pattern Y differs in schizophrenia, and yet the causal arrows usually remain unresolved. Cotovio approaches that problem by looking at patients in whom the arrow is, in a sense, already drawn. In the Genomic Press interview published this week in Brain Medicine, he frames the logic with unusual clarity.
"If a focal brain lesion can precipitate a syndrome such as mania or obsessive-compulsive symptoms, the connected network may reveal something fundamental about disease mechanisms," he says. The technique at the heart of this work is lesion network mapping, which traces the broader functional circuit linked to each small area of injury. Symptoms that look scattered across the brain when viewed one patient at a time often converge onto a shared network when viewed across many.
The method has produced striking findings in mania and, more recently, in lesional obsessive-compulsive disorder, two syndromes Cotovio has worked on directly. He is now extending the strategy to disordered feeding behaviour. His ambition is modest in tone and immodest in substance: to identify the networks that are not merely correlated with psychiatric symptoms but capable of producing them, and to use those networks as targets for intervention.
Dinner-Table Conversations, Then a Lifetime of Them
Born in Lisbon and still working there, Cotovio traces his interest in the brain to a household where the adult conversation rarely strayed from behaviour and emotion. His father is a psychiatrist. The questions that surface at a family dinner when one parent treats psychiatric illness for a living tend to shape a child, and in this case they shaped a career. Medicine drew him in because it sits where human stories meet biology and decision-making. Psychiatry held him because it demanded all of those at once.
He earned his medical degree at NOVA Medical School in 2014, joined the Champalimaud Foundation as a research intern in 2015, completed his PhD in Biomedicine in 2023, and finished his psychiatry residency in 2024. Under the mentorship of Albino J. Oliveira-Maia, head of the Neuropsychiatry Unit, he trained across clinical psychiatry, neuroimaging, and translational neuroscience, with further periods at Harvard Medical School alongside Alvaro Pascual-Leone, Michael D. Fox and Daniel Press. That combination, he says, taught him how to move between the clinic and the laboratory. It also explains why he refuses to let one displace the other.
From Causal Maps to Personalised Stimulation
The second strand of Cotovio's work picks up where the first leaves off. Once a causal circuit has been identified, how should it be engaged? His answer, in practice, is magnetic resonance imaging and connectivity-informed transcranial magnetic stimulation. Rather than applying a standard coil position to every patient, Cotovio aims to explore the use each person's own connectivity profile to individualise targeting. A third strand studies cortical excitability and functional connectivity as candidate biomarkers that might one day help clinicians decide which patient should receive which intervention.
Cotovio is careful about the gap between promise and proof. "The most interesting questions usually demand patience, nuance, and a willingness to revise one's assumptions," he says, a line that reads as both scientific temperament and something like a working motto. He levels the same demand at the field itself: "Elegant methods are not enough. The field should stay accountable for whether our research helps explain suffering and improve people's lives."
The Part That Does Not Fit on a CV
Asked about his greatest pride, he does not name a paper. He names his family. Asked which living person he most admires, he names his father. His motto, given in Portuguese and translated almost apologetically into English, is concentração, descontração e vamos para a frente, which he renders as focus, calmness, and keep moving forward. Running is where he thinks most clearly. Long meals and quiet evenings at home are where he refuels. For a clinician-scientist whose subject is the circuitry that produces human suffering, the balance seems less like a luxury than a professional tool.
What Cotovio is building in Lisbon is, in the end, a quiet argument. It says that psychiatry can be mechanistic without being reductive, that causality can be pursued in human beings and not only in mice, and that non-invasive stimulation guided by the right map has a chance to do something that symptom-based prescribing cannot. The work is early. The bet is not.
Gonçalo Cotovio's Genomic Press interview is part of a larger series called Innovators and Ideas that highlights the people behind today's most influential scientific breakthroughs. Each interview in the series offers a blend of cutting-edge research and personal reflections, providing readers with a comprehensive view of the scientists shaping the future. By combining a focus on professional achievements with personal insights, this interview style invites a richer narrative that both engages and educates readers. This format provides an ideal starting point for profiles that explore the scientist's impact on the field, while also touching on broader human themes. More information on the research leaders and rising stars featured in our Innovators and Ideas – Genomic Press Interview series can be found on our interview website: https://interviews.genomicpress.com/ .
The Genomic Press Interview in Brain Medicine titled "Gonçalo Cotovio: Mapping causal brain circuits to personalize neuromodulation in psychiatry," is freely available via Open Access, starting on 5 May 2026 in Brain Medicine at the following hyperlink: https://doi.org/10.61373/bm026k.0033 .
About Brain Medicine: Brain Medicine (ISSN: 2997-2639, online and 2997-2647, print) is a peer-reviewed medical research journal published by Genomic Press, New York. Brain Medicine is a new home for the cross-disciplinary pathway from innovation in fundamental neuroscience to translational initiatives in brain medicine. The journal's scope includes the underlying science, causes, outcomes, treatments, and societal impact of brain disorders, across all clinical disciplines and their interface.
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