Evidence-Based Medicine has little consideration for mechanisms and philosophers of science and medicine have recently made pleas to increase the place of mechanisms in the medical evidence hierarchy. However, in this debate the notions of mechanisms seem to be limited to 'mechanistic processes' and 'complex-systems mechanisms,' understood as 'componential causal systems'. I believe that this will not do full justice to how mechanisms are used in biological, psychological and social sciences and, consequently, in a more biopsychosocial approach to medicine. Here, (...) I propose, following (Kuorikoski, 2009), to pay more attention to 'abstract forms of interaction' mechanisms. The present work scrutinized review articles on depression and medically unexplained pain, which are considered to be of multifactorial pathogenesis, for their use of mechanisms. In review articles on these disorders there seemed to be a range of uses between more 'abstract forms of interaction' and 'componential causal system' mechanisms. I therefore propose to expand the notions of mechanisms considered in medicine to include that of more 'abstract forms of interaction' to better explain and manage biopsychosocial disorders. (shrink)

Contemporary pain literature increasingly acknowledges the need of a multidimensional approach to pain, which accounts for its complex biological, psychological and social components. This is reflected in the recently revised definition of the International Association for the Study of Pain (IASP) and some contemporary philosophical positions. This paper addresses the need to offer a theoretical approach that integrates the biopsychosocial and qualitative multidimensionality of pain by developing the “social grounding view of pain”. My focus is on seeking a multidimensional philosophical (...) approach that accounts not only for its complex biological and psychological aspects but also and specifically does justice to its social dimension. I draw from some of the most recent multidimensional theoretical and methodological approaches that attempt to account for the social component of pain, including enactivism and interpretative phenomenological analysis (IPA), to propose the advancement of the social grounding view, which has a particular focus on socially shared linguistic concepts in relation to the meaning and modulation of pain. More specifically, the social grounding view is based on the argument that the meaning of the experience of pain is determined in part by socially shareable linguistic concepts habitually associated with pain. I test this view against empirical cases drawn from pain neuroscience education (PNE) and try to demonstrate how the modification of the linguistic concepts of pain could be used effectively to modulate its experience. (shrink)

Research in the philosophy of addiction commonly explores how agency is impacted in addiction by focusing on moments of apparent loss of control over addictive behavior and seeking to explain how such moments result from the effects of psychoactive substance use on cognition and volition. Recently, Glackin et al. (2021) have suggested that agency in addiction can be helpfully analyzed using the concept of affordances. They argue that addicted agents experience addiction-related affordances, such as action possibilities relating to drugs, drug (...) paraphernalia, and drug-related activities, as aberrantly salient motivations for action. Building on this approach, we present a novel two-tiered affordance model of addiction. In doing so, we suggest that what is significant about the addicted person’s world is not simply what affordances are experienced as salient, but also the way in which the addicted person’s world is shaped by a dominant concern. It is not only that addiction-related affordances become more prominent as addiction progresses but that one’s plurality of concerns become monopolized by and funneled through addiction. Our model endorses Glackin et al.’s idea that addiction-related affordances become aberrantly salient, while proposing why they become and remain so. This way of viewing agency in addiction also brings to light important implications for recovery and treatment. For, if an addicted person adopts a new, even “socially approved”, dominant concern, there is a risk that the shape of addiction is preserved, even though the content changes, leaving an individual at the risk of addiction substitution or relapse. (shrink)

Discussions concerning the modularity of the pain system have been focused on questions regarding the cognitive penetrability of pain mechanisms. It has been claimed that phenomena such as placebo analgesia demonstrate that the pain system is cognitively penetrated; therefore, it is not encapsulated from central cognition. However, important arguments have been formulated which aim to show that cognitive penetrability does not in fact entail a lack of modularity of the pain system. This paper offers an alternative way to reject the (...) modularity of the pain system, which is independent from, but consistent with, the presence of cognitive penetration. It is proposed that, given the current knowledge regarding the functioning and the structure of the pain system, there are good reasons to accept that certain central cognitive mechanisms are part of the pain system. It is argued that such a ‘cognitive constitution’ of the pain system entails that the pain system is not modular. (shrink)

One of the crucial characteristics of the olfactory modality is that olfactory experiences commonly present odours as pleasant or unpleasant. Indeed, because of the importance of the hedonic aspects of olfactory experience, it has been proposed that the role of olfaction is not to represent the properties of stimuli, but rather to generate a valence-related response. However, despite a growing interest among philosophers in the study of the chemical senses, no dominant theory of sensory pleasure has emerged in the case (...) of human olfaction. The aim of this paper is to develop an argument based on the way in which olfactory valence is neurally encoded; one that demonstrates an advantage of the indicative representational approach to olfactory valence over approaches that characterise valence in terms of desires or commands. The argument shows that it is plausible to understand olfactory valence, at least in part, in terms of indicative representations. (shrink)

This paper aims to provide a theoretical framework for explaining the subjective character of pain experience in terms of what we will call ‘embodied predictive processing’. The predictive processing (PP) theory is a family of views that take perception, action, emotion and cognition to all work together in the service of prediction error minimisation. In this paper we propose an embodied perspective on the PP theory we call the ‘embodied predictive processing (EPP) theory. The EPP theory proposes to explain pain (...) in terms of processes distributed across the whole body. The prediction error minimising system that generates pain experience comprises the immune system, the endocrine system, and the autonomic system in continuous causal interaction with pathways spread across the whole neural axis. We will argue that these systems function in a coordinated and coherent manner as a single complex adaptive system to maintain homeostasis. This system, which we refer to as the neural-endocrine-immune (NEI) system, maintains homeostasis through the process of prediction error minimisation. We go on to propose a view of the NEI ensemble as a multiscale nesting of Markov blankets that integrates the smallest scale of the cell to the largest scale of the embodied person in pain. We set out to show how the EPP theory can make sense of how pain experience could be neurobiologically constituted. We take it to be a constraint on the adequacy of a scientific explanation of subjectivity of pain experience that it makes it intelligible how pain can simultaneously be a local sensing of the body, and, at the same time, a more global, all-encompassing attitude towards the environment. Our aim in what follows is to show how the EPP theory can meet this constraint. (shrink)

As an alternative to linear and unidimensional perspectives focused mainly on either organic or psychological processes, the enactive approach to life and mind—a branch of 4-E cognitive theories—offers an integrative framework to study mental disorders that encompasses and articulates organic, sensorimotor, and intersubjective dimensions of embodiment. These three domains are deeply entangled in a non-trivial manner. A question remains on how this systemic and multi-dimensional approach may be applied to our understanding of mental disorders and symptomatic behavior. Drawing on Gilbert (...) Simondon’s philosophy of individuation, we provide some enactive conceptual tools to better understand the dynamic, interactive, and multi-dimensional nature of human bodies in mental disorders and psychopathological symptoms. One of such tools cursiva is sense-making, a key notion that captures the relational process of generating meaning by interacting with the sociomaterial environment. The article analyzes five aspects related to sense-making: temporality, adaptivity, the multiplicity of normativities it involves, the fundamental role of tension, and its participatory character. On this basis, we draw certain implications for our understanding of mental disorders and diverse symptoms, and suggest their interpretation in terms of difficulties to transform tensions and perform individuation processes, which result in a reduction of the field of potentialities for self-individuation and sense-making. (shrink)

Osteopathy is a person-centred healthcare discipline that emphasizes the body’s structure-function interrelationship—and its self-regulatory mechanisms—to inform a whole-person approach to health and wellbeing. This paper aims to provide a theoretical framework for developing an integrative hypothesis in osteopathy, which is based on the enactivist and active inference accounts. We propose that osteopathic care can be reconceptualised under active inference as a unifying framework. Active inference suggests that action-perception cycles operate to minimize uncertainty and optimize an individual’s internal model of the (...) lived world and, crucially, the consequences of their behaviour. We argue that active inference offers an integrative framework for osteopathy, which can evince the mechanisms underlying dyadic and triadic exchanges and osteopathic care outcomes. We propose that this theoretical framework can underpin osteopathic care across the lifespan, from preterm infants to the elderly and those with persistent pain and other physical symptoms. In situations of chronicity, as an ecological niche, the patient-practitioner dyad provides the osteopath and the patient with a set of affordances, i.e., possibilities for action provided by the environment, that through shared intentionally, can promote adaptations and restoration of productive agency. Through a dyadic therapeutic relationship, as they engage with their ecological niche’s affordances—a structured set of affordances shared by agents—osteopath and patient actively construct a shared sense-making narrative and realise a shared generative model of their relation to the niche. In general, touch plays a critical role in developing a robust therapeutic alliance, mental state alignment, and biobehavioural synchrony between patient and practitioner. However, its role is particularly crucial in the fields of neonatology and paediatrics, where it becomes central in regulating allostasis and restoring homeostasis. We argue that from an active inference standpoint, the dyadic shared ecological niche underwrites a robust therapeutic alliance, which is crucial to the effectiveness of osteopathic care. Considerations and implications of this model—to clinical practice and research, both within- and outside osteopathy—are critically discussed. (shrink)

Pain continues to be one of the most controversial subjects in neurophilosophy. One focus of current debates is the apparent absence of an ideal brain‐based biomarker that could function as a coherent and distinct indicator for pain. One prominent reaction to this in the philosophical literature is scientific pain eliminativism. In this article, I argue for a non‐eliminative alternative that builds on family resemblances and provides a useful heuristic in the tradeoff between the idiosyncrasy of the neural processes corresponding to (...) different pain cases and the demand for generalizability in pain research. (shrink)