This opinion piece presents insights derived from research conducted in a radiology department in the United States. For several weeks I followed the head of department while making notes and occasionally discussing them with him. The main objective of this research visit was to study strategies of embodied cognition and the intersubjective ground for individual intentions in the process of image-based diagnosis in order to reveal the essential regularities and personalizations of diagnostic practices as performed by radiologists. I argue that my observation reveals how at least certain aspects of the diagnostic cognition focused on medical imaging are structured and may be improved.

Key words: phenomenology, ethnography, radiology, embodied cognition, enactivism, intersubjectivity

In recent years, the societal and personal impacts of pain, and the fact that we still lack an effective method of treatment, has motivated researchers from diverse disciplines to try to think in new ways about pain and its management. In this paper, we aim to develop an enactive approach to pain and the transition to chronicity. Two aspects are central to this project. First, the paper conceptualizes differences between acute and chronic pain, as well as the dynamic process of pain chronification, in terms of changes in the field of affordances. This is, in terms of the possibilities for action perceived by subjects in pain. As such, we aim to do justice to the lived experience of patients as well as the dynamic role of behavioral learning, neural reorganization, and socio-cultural practices in the generation and maintenance of pain. Second, we aim to show in which manners such an enactive approach may contribute to a comprehensive understanding of pain that avoids conceptual and methodological issues of reductionist and fragmented approaches. It proves particularly beneficial as a heuristic in pain therapy addressing the heterogenous yet dynamically intertwined aspects that may contribute to pain and its chronification.

Little has been done yet to study the synchronization properties of the sources estimated from the MEG/EEG inverse problem, despite the growing interest in the role of phase relations in brain functions. In order to achieve this aim, we propose a novel approach to the MEG/EEG inverse problem based on some regularization using spectral priors: The MEG/EEG raw data are filtered in a frequency band of interest and blurred with some specific “regularization noise” prior to the inversion process. This formalism uses non quadratic regularization and a deterministic optimization algorithm. We proceed to Monte Carlo simulations using the chaotic Rössler oscillators to model the neural generators. Our results demonstate that it is possible to reveal some phase-locking between brain sources with great accuracy following the computation of the inverse problem based on scalp MEG/EEG measurements.

Excerpt: The singularity of micro-phenomenological explicitation as an interview technique consists of referring to a “specific” moment that corresponds to a unique situation, experienced at a given place and time. The mode of access to this hic and nunc moment is also specific: it is not a voluntary remembrance but a process of “evocation” (the french term is “évocation”) which appeals to our unvoluntary concrete organic memory. By “contacting” this moment again, we are led to “relive” it by restoring all of the concrete flesh of our feeling. This singular moment is initially unrecognized, that is to say, pre-reflective or immediately unavailable. We must immerse ourselves again in this lived situation in order for the palpable flesh of this moment to return and so that, as an interviewed subject, we can find features of this moment that we thought we did not know. Some of its aspects then appear to us as new, fresh, and unprecedented, under the open and indirect guidance of the interviewer. Footnote

In the present study we have analyzed the changes in the expressed antibody repertoire and in temporal fluctuations of antibody levels in serum that followed infusion of normal IgG (IVIg) in a patient with autoimmune thyroiditis. Administration of IVIg resulted in the stimulation of IgM production, in alterations of expressed antibody activity in serum that could not merely be accounted for by the passive transfer of antibody specificities contained in IVIg, in transient down-regulation of B cells clones expressing a specific disease-related idiotype and in the increase in serum in recipient’s autoantibodies specifically reactive with F(ab′)2 fragments of IVIg. In addition, infusion of IVIg shifted the pattern of spontaneous fluctuations of autoantibody activities in the patient’s serum from a pattern indicative of disconnected events in the immune network to a pattern similar to that which is consistently observed in healthy controls. These results suggest that normal IgG may modulate autoreactivity by selecting expressed antibody repertoire through V region-dependent interactions with antibodies.

Key words: autoimmunity, IgG, intravenous immunoglobulin (IVIg), immune networks

From 22 January 2019 to 24 January 2019, the 4E Cognition Group held the “Second Workshop on Enactive Approaches to Mind in Health and Disease” at Instituto de Investigaciones en Matemáticas Aplicadas y en Sistemas (IIMAS) in Mexico City, Mexico. The aim of the workshop was to discuss different kinds of mental impairments from an enactive stance, potentially contrasted with the basis of healthy mental processes and with other views of cognition.

Key words: enactivism, mental health, mental disease, social cognition, affordances, sense-making

The degree of interdependence between intracranial electroencephalographic (EEG) channels was investigated in epileptic patients with temporal lobe seizures during interictal (between seizures) periods.With a novelmethod to characterize nonlinear cross-predictability, that is, the predictability of one channel using another channel as data base, we demonstrated here a possibility to extract information on the spatio-temporal organization of interactions between multichannel recording sites. This method determines whether two channels contain common activity, and often, whether one channel contains activity induced by the activity of the other channel. In particular, the technique and the comparison with surrogate data demonstrated that transient large-scale nonlinear entrainments by the epileptogenic region can be identified, this with or without epileptic activity. Furthermore, these recurrent activities related with the epileptic foci occurred in well-defined spatio-temporal patterns. This suggests that the epileptogenic region can exhibit very subtle influences on other brain regions during an interictal period and raises the possibility that the cross-predictability analysis of interictal data may be used as a significant aid in locating epileptogenic foci.

Key words: Temporal lobe epilepsy, Intracranial EEG, Epileptogenic focus, Nonlinear cross-prediction, Surrogate data

According to the medical model that prevails in the Western world, mental disorder is a form of illness, parallel to bodily illness, which can be diagnosed by a doctor on the basis of symptoms and administered treatments designed to “cure” it. However, it seems clear that how we understand “disorder” is influenced by cultural norms and values. Theorists associated with the so-called anti-psychiatry movement have gone so far as to claim that ‘mental illness’ simply is the accepted term for behaviors and experiences that are problematic or do not fit the cultural norm. In my view, however, this social-constructionist view downplays and obscures the very real difficulties encountered by subjects with mental disorder. I argue that rather than rejecting the medical model altogether, we should revise the model by utilizing insights from the enactivist approach in philosophy of mind. An appeal to the enactivist notions of autonomy, sense-making, and adaptivity, I propose, can help us to (a) account for mental disorder’s normative aspect, so that we can navigate a middle way between the medical model and an anti-psychiatry stance; and (b) understand the way in which the neurobiological, social, and existential dimensions of mental disorder are integrated.

Key words: enactivism, psychiatry, medical model, sense-making, affordance

Epileptic seizures are a principal brain dysfunction with important public health implications, as they affect 0.8% of humans. Many of these patients (20%) are resistant to treatment with drugs. The ability to anticipate the onset of seizures in such cases would permit clinical interventions. The view of chronic focal epilepsy now is that abnormally discharging neurons act as pacemakers to recruit and entrain other normal neurons by loss of inhibition and synchronization into a critical mass. Thus, preictal changes should be detectable during the stages of recruitment. Traditional signal analyses, such as the count of focal spike density, the frequency coherence or spectral analyses are not reliable predictors. Non-linear indicators may undergo consistent changes around seizure onset. Our objective was to follow the transition into seizure by reconstructing intracranial recordings in implanted patients as trajectories in a phase space and then introduce non-linear indicators to characterize them. These indicators take into account the extended spatio-temporal nature of the epileptic recruitment processes and the corresponding physiological events governed by short-term causalities in the time series. We demonstrate that in most cases (17 of 19), seizure onset could be anticipated well in advance (between 2–6 minutes beforehand), and that all subjects seemed to share a similar “route” towards seizure.

This article applies Maturana’s theory of ‘bringing forth’ reality to the clinical domain. Many common features of therapy are redefined including the notions of ‘psychopathology’, languaging and conversations, the family, and cognition. New concepts are introduced, notably those of the multiversa and the placing of objectivity in parenthesis. The rôle of the socially sanctioned specialist (expert) is examined and criticised for pretending to have a privileged access to an objectively existing reality. The authors propose a radical change in epistemology, premised upon the changes in understanding which they propose in relation to the ontology of the phenomenon of cognition. Particular attention is given to the orthogonality of the therapist’s approach to interacting with families.