We start from the systemic autoreferential epistemology that A. Pichot and J. Varela have applied to Biology, to describe some properties of living matter. Pichot broadens the approach to describe the cerebral functions with convincing results. We show how the same logic can be applied to a description of the human mind. This allows a description that takes into account the different therapeutic levels without reducing one to the other, and makes it possible to articulate them logically better than the usual psychiatric theories do. This leads to a much more coherent picture of the clinical psychiatric symptoms and of the therapeutic procedures.
Dansby R. A. & Whiting J. B. (2019) Second-order change in couple and family therapy. In: Lebow J., Chambers A. & Breunlin D. C. (eds.) Encyclopedia of couple and family therapy. Springer, Cham: 2596–2599. https://cepa.info/6620
Excerpt: In the 1950s and 1960s, the Mental Research Institute (MRI) in Palo Alto, California, hosted a variety of professionals from multiple disciplines, including human communication research, psychiatry, and anthropology. This was before “couple, marriage, and family therapy” was a distinct discipline. Several original members of the MRI team shared their understandings of change, specifically second-order change, with the broader community of helping professionals in 1974, through their book, Change: Principles of Problem Formation and Problem Resolution. There, they describe second-order change in relation to another type of change, first-order change.
de Haan S. (2017) The existential dimension in psychiatry: An enactive framework. Mental Health. Religion and Culture 20(6): 528–535. https://cepa.info/6917
In his paper Psychiatry and religion: Consensus reached!, Verhagen advocates the relevance of spirituality and religion for the “origins, understanding, and treatment of psychiatric disorders”. In this comment, I argue for the broader claim that the existential dimension is important for understanding psychiatric disorders – of which religion can, but must not necessarily be, part. The existential dimension refers to our ability to relate to ourselves, our experiences, and our situation. This evaluative relation can play an important role in psychiatry: it can co-constitute the disorder, be affected by the disorder, and/or modulate the course of the disorder. Given this importance, it makes sense to explicitly recognize the existential dimension in our explanatory model of psychiatric disorders. The biopsychosocial model goes a long way in providing an integrative model, but there is room for improvement, especially when it comes to integration of its aspects, and acknowledging the existential aspect. I briefly introduce the research paradigm of enactivism, and suggest that an enactive framework is well-suited to incorporate this existential dimension – along with the traditional dimensions of the biopsychosocial model.
de Haan S. (2022) Book Author’s Response: Continuity, not Conservatism: Why We Can Be Existential and Enactive. Constructivist Foundations 17(2): 173–178. https://cepa.info/7788
Abstract: García’s and Oblak’s reviews of my book Enactive Psychiatry open up some fundamental debates with regard to my use of the term “enactive” for the kind of approach that I develop. Is my account still properly “enactive” (García) and how does my approach compare to the extended mind theory on the one hand and to constructivism on the other hand (Oblak? In this response, I argue that (a) adding an existential dimension to enactivism is necessary to do justice to our way of being in the world and our specific sense-making and its problems; and (b) that this dimension can be incorporated within enactivism without giving up on either enactivism’s commitment to naturalism or the enactive life-mind continuity thesis. My “existentialized” enactivism is very much enactive in that it adopts the thoroughly relational perspective that forms the core of enactivism. This relational perspective is also what distinguishes enactive theory from both extended mind theory and constructivism. Erratum: In §1, the name of the first commentator is misspelled: Her name is “Enara García” rather than “Elena García.”
Fuchs T. & Schlimme J. E. (2009) Embodiment and psychopathology: a phenomenological perspective. Current opinion in psychiatry 22: 570–575. https://cepa.info/2275
Purpose of review To survey recent developments in phenomenological psychopathology. Recent findings We present the concept of embodiment as a key paradigm of recent interdisciplinary approaches from the areas of philosophy, psychology, psychiatry and neuroscience. This requires a short overview on the phenomenological concept of embodiment; in particular, on the distinction of subject and object body. A psychopathology of embodiment may be based on these and other distinctions, in particular on a polarity of disembodiment and hyperembodiment, which is illustrated by the examples of schizophrenia and depression. Recent contributions to phenomenological accounts of these disorders are presented. Finally, the study discusses the relationship of phenomenological and neuropsychiatric perspectives on embodiment. Summary A phenomenology of embodiment may be combined with enactive approaches to cognitive neuroscience in order to overcome dualist concepts of the mind as an inner realm of representations that mirror the outside world. Phenomenological and ecological concepts of embodiment should also be conjoined to enable a new, advanced understanding of mental illness.
Abstract: In Enactive Psychiatry, de Haan puts forward the enactive approach as a promising theory to solve the integration problem in psychiatry by articulating the physiological, socio-cultural, experiential, and existential dimensions of human sense-making. The author provides a valuable and accessible introduction to the enactive theory, a rich analysis of the classical descriptivist-normativist debate, and a guideline for personalized diagnosis. However, the addition of the existential dimension to the enactive theory adds (ad hoc) tensions with regard to the life-mind approach.
Gipps R. G. T. (2020) Disturbance of ego-boundary enaction in schizophrenia. Philosophy, Psychiatry. & Psychology 27(1): 91–106.
The psychopathology of schizophrenic conditions is today often characterized merely in diverse and disjunctive symptomatic terms. Classically, however, what was understood to underpin and unify such diverse symptoms was a disturbance to the ‘self’ or ‘ego, ’ especially in that ego’s boundaries. As psychoanalytic and phenomenological theories have become less influential in psychiatry, concepts like ‘self’ or ‘ego, ’ ‘self-other distinction’ or ‘ego boundary, ’ have become less popular as psychopathological organizers, with the result that the very idea of distinctively ‘schizophrenic’ conditions has itself also appeared to want for validity. Yet within the philosophy of psychology, enactivism provides a new naturalistic framework for understanding the emergence and maintenance of the self-other distinction. This framework considers the distinction neither as something constituted a priori, nor as something showing up within experience, but rather as a continuously enacted achievement. The contention of this article is that an enactivist perspective provides us with the apparatus to retheorize the conception of ego boundaries, contribute to the reunification of the ‘schizophrenia’ concept, and inform the provision of therapies targeted at the schizophrenic diathesis itself.
Heims S. P. (1977) Gregory Bateson and the mathematicians: From interdisciplinary interaction to societal functions. Journal of the History of the Behavioral Sciences 13(2): 141–159.
An instance of fruitful cross-disciplinary contacts is examined in detail. The ideas involved include (1) the double-bind hypothesis for schizophrenia, (2) the critique of game theory from the viewpoint of anthropology and psychiatry, and (3) the application of concepts of communication theory and theory of logical types to an interpretation of psychoanalytic practice. The protagonists of the interchange are Gregory Bateson and the two mathematicians Norbert Wiener and John von Neuman; the date, March 1946. This interchange and its sequels are described. While the interchanges between Bateson and Wiener were fruitful, those between Bateson and von Neumann were much less so. The latter two held conflicting premises concerning what is significant in science; Bateson’s and Wiener’s were compatible. In 1946, Wiener suggested that information and communication might be appropriate central concepts for psychoanalytic theory – a vague general idea which Bateson (with Ruesch) related to contemporary clinical practice. For Bateson, Wiener, and von Neumann, the cross-disciplinary interactions foreshadowed a shift in activities and new roles in society, to which the post-World War II period was conducive. Von Neumann became a high-level government advisor; Wiener, an interpreter of science and technology for the general public; and Bateson, a counter-culture figure.
Kirmayer L. J. & Ramstead M. J. D. (2017) Embodiment and enactment in cultural psychiatry. In: Durt C., Fuchs T. & Tewes C. (eds.) Embodiment, enaction, and culture: Investigating the constitution of the shared world. MIT Press, Cambridge MA: 397–422. https://cepa.info/5082
Excerpt: Recent work has begun to apply embodied and enactivist approaches to understanding mental disorders (Colombetti 2013; Fuchs 2009; Fuchs and Schlimme 2009; Zatti and Zarbo 2015). We believe that cultural psychiatry stands to gain a great deal from these new paradigms. This chapter will outline an approach to the cultural neurophenomenology of mental disorders that focuses on the interplay of culturally shaped developmental processes and modes of neural information processing that are reflected in embodied experience, narrative practices that are structured by ideologies of personhood, culturally shared ontologies or expectations, and situated modes of enactment that reflect social positioning and selffashioning. Research on metaphor theory suggests ways to connect the approaches to embodiment and enactment in cognitive science with the rich literature on the cultural shaping of illness experience in current medical and psychological anthropology. The resulting view of cultural enactment has broad implications for psychiatric theory, research, and practice, which we will illustrate with examples from the study of the phenomenology of delusions.
Maiese M. (2021) An enactivist reconceptualization of the medical model. Philosophical Psychology Online first.
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.