In this article, we sketch how theoretical neuroethics can clarify the concept of autonomy. We hope that this can both serve as a model for the conceptual clarification of other components of PIAAAS and contribute to the development of the empirical measures that Gilbert and colleagues [1] propose.

In this article, we sketch how theoretical neuroethics can clarify the concept of autonomy. We hope that this can both serve as a model for the conceptual clarification of other components of PIAAAS and contribute to the development of the empirical measures that Gilbert and colleagues [1] propose.

The aims of this paper are to: (1) identify the best framework for comprehending multidimensional impact of deep brain stimulation on the self; (2) identify weaknesses of this framework; (3) propose refinements to it; (4) in pursuing (3), show why and how this framework should be extended with additional moral aspects and demonstrate their interrelations; (5) define how moral aspects relate to the framework; (6) show the potential consequences of including moral aspects on evaluating DBS’s impact on patients’ selves. Regarding (...) (1), I argue that the pattern theory of self can be regarded as such a framework. In realizing (2) and (3), I indicate that most relevant issues concerning PTS that require resolutions are ontological issues, including the persistence question, the “specificity problem”, and finding lacking relevant aspects of the self. In realizing (4), I identify aspects of the self not included in PTS which are desperately needed to investigate the full range of potentially relevant DBS-induced changes—authenticity, autonomy, and responsibility, and conclude that how we define authenticity will have implications for our concept of autonomy, which in turn will determine how we think about responsibility. Concerning (5), I discuss a complex relation between moral aspects and PTS—on one hand, they serve as the lens through which a particular self-pattern can be evaluated; on the other, they are, themselves, products of dynamical interactions of various self-aspects. Finally, I discuss (6), demonstrating novel way of understanding the effects of DBS on patients’ selves. (shrink)

Deep Brain Stimulation (DBS) is an invasive therapeutic method involving the implantation of electrodes and the electrical stimulation of specific areas of the brain to modulate their activity. DBS brings therapeutic benefits, but can also have adverse side effects. Recently, neuroethicists have recognized that DBS poses a threat to the very fabric of human existence, namely, to the selves of patients. This article provides a review of the neuroethical literature examining this issue, and identifies the crucial dimensions related to the (...) self which DBS may endanger—personal identity, authenticity, and autonomy. The most influential theories accounting for these dimensions are analyzed herein, and it is argued that most of these theories require further refinement. This paper also demonstrates the interrelation between personal identity, authenticity, and autonomy, and concludes that one can only fully understand the impact of DBS on the self when all of these factors are taken into account. (shrink)

This paper aims to offer an account of affective experiences within Predictive Processing, a novel framework that considers the brain to be a dynamical, hierarchical, Bayesian hypothesis-testing mechanism. We begin by outlining a set of common features of affective experiences that a PP-theory should aim to explain: feelings are conscious, they have valence, they motivate behaviour, and they are intentional states with particular and formal objects. We then review existing theories of affective experiences within Predictive Processing and delineate two families (...) of theories: Interoceptive Inference Theories and Error Dynamics Theories. We highlight the strengths and shortcomings of each family of theories and develop a synthesis: the Affective Inference Theory. Affective Inference Theory claims that valence corresponds to the expected rate of prediction error reduction. In turn, the particular object of a feeling is the object predicted to be the most likely cause of expected changes in prediction error rate, and the formal object of a feeling is a predictive model of the expected changes in prediction error rate caused by a given particular object. Finally, our theory shows how affective experiences bias action selection, directing the organism towards allostasis and towards optimal levels of uncertainty in order to minimise prediction error over time. (shrink)

Despite technological innovations, clinical expertise remains the cornerstone of psychiatry. A clinical expert does not only have general textbook knowledge, but is sensitive to what is demanded for the individual patient in a particular situation. A method that can do justice to the subjective and situation-specific nature of clinical expertise is ethnography. Effective deep brain stimulation (DBS) for obsessive-compulsive disorder (OCD) involves an interpretive, evaluative process of optimizing stimulation parameters, which makes it an interesting case to study clinical expertise. The (...) aim of this study is to explore the role of clinical expertise through an ethnography of the particular case of DBS optimization in OCD. In line with the topic of the special issue this article is a part of, we will also use our findings to reflect on ethnography as a method to study complex phenomena like clinical expertise. This ethnography of DBS optimization is based on 18 months of participant observation and nine in-depth interviews with a team of expert clinicians who have been treating over 80 OCD patients since 2005. By repeatedly observing particular situations for an extended period of time, we found that there are recurrent patterns in the ways clinicians interact with patients. These patterns of clinical practice shape the possibilities clinicians have for making sense of DBS-induced changes in patients’ lived experience and behavior. Collective established patterns of clinical practice are dynamic and change under the influence of individual learning experiences in particular situations, opening up new possibilities and challenges. We conclude that patterns of clinical practice and particular situations are mutually constitutive. Ethnography is ideally suited to bring this relation into view thanks to its broad temporal scope and focus on the life-world. Based on our findings, we argue that clinical expertise not only implies skillful engagement with a concrete situation but also with the patterns of clinical practice that shape what is possible in this specific situation. Given this constraining and enabling role of practices, it is important to investigate them in order to find ways to improve diagnostic and therapeutic possibilities. (shrink)

Deep brain stimulation interventions are novel devices being investigated for the management of severe treatment-resistant psychiatric illnesses. These interventions require the invasive implantation of high-frequency neurostimulatory probes intracranially aiming to provide symptom relief in treatment-resistant disorders including obsessive-compulsive disorder and anorexia nervosa. In the scientific literature, these neurostimulatory interventions are commonly described as reversible and to be used as a last resort option for psychiatric patients. However, the ‘last resort’ status of these interventions is rarely expanded upon. Contrastingly, usages of (...) DBS devices for neurological symptoms have paved the way for established safety and efficacy standards when used earlier in a disease’s timeline. As DBS treatments for these neurological diseases progress to have earlier indications, there is a parallel ethical concern that early implementation may one day become prescribed for psychiatric illnesses. The purpose of this article is to build off contemporary understandings of reversible neurostimulatory interventions to examine and provide clarifications on the ‘last resort’ status of DBS to better address its ethically charged use in psychiatric neurosurgery. To do this, evaluative differences between DBS treatments will be discussed to demonstrate how patient autonomy would be a paramount guiding principle when one day implementing these devices at various points along a psychiatric disease’s timeline. In presenting the clarification of ‘last resort’ status, the ethical tensions of early DBS interventions will be better understood to assist in providing psychiatric patients with more quality of life years in line with their values. (shrink)

Gilbert et al. argue that the concerns about the influence of Deep Brain Stimulation on – as they lump together – personality, identity, agency, autonomy, authenticity and the self are due to an ethics hype. They argue that there is only a small empirical base for an extended ethics debate. We will critically examine their claims and argue that Gilbert and colleagues do not show that the identity debate in DBS is a bubble, they in fact give very little evidence (...) for that. Rather they show the challenges of doing research in a field that is stretched out over multiple disciplines. In that sense their paper is an important starting point for a discussion on methodology and offers valuable lessons for a future research agenda. (shrink)

An oft misattributed piece of folk-wisdom goes: “Insanity is doing the same thing, over and over again, but expecting different results.” In many cases, we don’t just do things repeatedly but think over the same topics repeatedly. People who ruminate are not often diagnosed as insane—most of us ruminate at some point in our lives—but it is a common behaviour underlying both depression and anxiety :504, 2000). If rumination is something we all do at some time, what is it about (...) ruminative thought that makes it ‘sticky’ and difficult to stop for the worst sufferers? In order to answer this question, I will present a plausible account of how ruminative behaviour becomes entrenched to the point where sufferers of anxiety and depression simply cannot make meaning from the world except in terms of the kinds of behaviours, actions and thoughts they have become reliant on. I develop my account from Barrett’s theory of constructed emotion using the work of Merleau-Ponty, ProQuest Ebook Central, 2012. https://ebookcentral.proquest.com/lib/ed/detail.action?docID=1433878. Accessed 29 Dec 2020) in order to bridge the gap between the explicit thought we experience—an important part of the lived experience of rumination. To conclude, I will apply my account to Wu and Dunning’s :25–35, 2018; Hypocognitive mind: How lack of conceptual knowledge confines what people see and remember, 2019. https://doi.org/10.31234/osf.io/29ryz) theory of hypocognition to further illuminate the particular cognitive qualities that can be experienced by ruminators, i.e. a prohibited access to particular emotion concepts. (shrink)

We introduce two concepts—social certainty and social doubt—that help to articulate a variety of experiences of the social world, such as shyness, self-consciousness, culture shock, and anxiety. Following Carel's (2013) analysis of bodily doubt, which explores how a person's tacit confidence in the workings of their body can be disrupted and undermined in illness, we consider how an individual's faith in themselves as a social agent, too, can be compromised or lost, thus altering their experience of what is afforded by (...) the social environment. We highlight how a loss of bodily or social certainty can be shaped and sustained by the environments in which one finds oneself. As such, we show how certain individuals might be more vulnerable to experiences of bodily and social doubt than others. (shrink)

In this article we move beyond the problematic distinction between ‘higher’ and ‘lower’ cognition by accounting for so-called ‘higher’ cognitive capacities in terms of skillful activities in practices, and in terms of the affordances exploited in those practices. Through ethnographic research we aim to further develop the new notion of skilled intentionality by turning to the phenomenon of the tendency towards an optimal grip on a situation in real-life situations in the field of architecture. Tending towards an optimal grip is (...) an inherently affective and dynamic phenomenon. It has been under explored in philosophy, despite its central place in Merleau-Ponty’s phenomenology. When the architects experience discontent, attention is typically solicited by the affordances through which possible ways of continuing the improvement of the design can be explored. In various ways this tension or disequilibrium - fueling a tendency towards an optimal grip - is encountered in the complex architectural design practices that we observed. Based on our field material we distinguish between: a) grip in visual perception, b) grip on the design, and c) grip on ‘how to design’. The move towards an optimal grip takes shape by joining forces with a landscape of affordances. This landscape includes, for instance, affordances for grasping a cup of coffee, affordances provided by a cardboard model to improve it, as well as for engaging with a person who is not physically present. Because they are skilled, the architects can be responsive to these different affordances in similar ways. Furthermore, in practice the architects are responsive to multiple affordances simultaneously. Through our analysis of the tendency towards an optimal grip we show that our surroundings contribute to skillful action and cognition in a far more complex way than is currently acknowledged in philosophy and cognitive science. (shrink)

Most philosophical discussions of psychopathy have centered around its significance in relation to empathy, moral cognition, or moral responsibility. However, related questions about the extent to...

A number of reports have suggested that patients who undergo deep brain stimulation may experience changes to their personality or sense of self. These reports have attracted great philosophical interest. This paper surveys the philosophical literature on personal identity and DBS and draws on an emerging empirical literature on the experiences of patients who have undergone this therapy to argue that the existing philosophical discussion of DBS and personal identity frames the problem too narrowly. Much of the discussion by neuroethicists (...) centers on the nature of the threat posed by DBS, asking whether it is best understood as a threat to personal identity, autonomy, agency, or authenticity, or as putting patients at risk of self-estrangement. Our aim in this paper is to use the empirical literature on patients’ experiences post-DBS to open up a broader range of questions - both philosophical and practical, and to suggest that attention to these questions will help to provide better support to patients, both before and after treatment. (shrink)

The philosophy of grief has directed little attention to bereavement’s impact on perceptual experience. However, misperceptions, hallucinations and other anomalous experiences are strikingly common following the death of a loved one. Such experiences range from misperceiving a stranger to be the deceased, to phantom sights, sounds and smells, to nebulous quasi-sensory experiences of the loved one’s presence. This paper draws upon the enactive sensorimotor theory of perception to offer a phenomenologically sensitive and empirically informed account of these experiences. It argues (...) that they can be understood as deriving from disruption to both sensorimotor expectations and perceived opportunities for action, stemming from the upheaval of bereavement. Different facets of the enactive sensorimotor approach can help to explain different types of post-bereavement perceptual experience. Post-bereavement misperceptions can be accounted for through the way that alterations to sensorimotor expectations can result in atypical ‘amodal completion’, while bereavement hallucinations can be understood as ‘appearances’ that fail to form part of the usual patterns of sensorimotor contingency. Quasi-sensory experiences of the presence of the deceased can be understood as resulting from changes to perceived affordances. This paper aims to demonstrate the explanatory value of key aspects of the sensorimotor approach by highlighting how they can help to explain the phenomenology of post-bereavement experiences. However, it also illuminates certain areas in which the sensorimotor approach ought to be supplemented, especially if it is to account for tight connections between perception, affect, and intersubjectivity that are salient in grief. (shrink)

The philosophy of grief has directed little attention to bereavement’s impact on perceptual experience. However, misperceptions, hallucinations and other anomalous experiences are strikingly common following the death of a loved one. Such experiences range from misperceiving a stranger to be the deceased, to phantom sights, sounds and smells, to nebulous quasi-sensory experiences of the loved one’s presence. This paper draws upon the enactive sensorimotor theory of perception to offer a phenomenologically sensitive and empirically informed account of these experiences. It argues (...) that they can be understood as deriving from disruption to both sensorimotor expectations and perceived opportunities for action, stemming from the upheaval of bereavement. Different facets of the enactive sensorimotor approach can help to explain different types of post-bereavement perceptual experience. Post-bereavement misperceptions can be accounted for through the way that alterations to sensorimotor expectations can result in atypical ‘amodal completion’, while bereavement hallucinations can be understood as ‘appearances’ that fail to form part of the usual patterns of sensorimotor contingency. Quasi-sensory experiences of the presence of the deceased can be understood as resulting from changes to perceived affordances. This paper aims to demonstrate the explanatory value of key aspects of the sensorimotor approach by highlighting how they can help to explain the phenomenology of post-bereavement experiences. However, it also illuminates certain areas in which the sensorimotor approach ought to be supplemented, especially if it is to account for tight connections between perception, affect, and intersubjectivity that are salient in grief. (shrink)

Existing research on the “weapons effect” indicates that simply seeing a weapon can prime aggressive thoughts and appraisals and increase aggressive behavior. But how and why does this happen? I begin by discussing prevailing explanations of the weapons effect and propose that these accounts tend to be over-intellectualistic insofar as they downplay or overlook the important role played by affectivity. In my view, insights from the fields of situated affectivity and enactivism help us to understand how cognitive and affective processes (...) jointly contribute to the weapons effect. Insofar as the presence of weapons alters subject’s bodily-affective orientation and thereby brings about embodied mindshaping, it changes the way they engage with and understand their surroundings. To understand the weapons effect, we will need to examine the constitutive interdependency of appraisal and affectivity and the way in which they jointly motivate action. My proposed account emphasizes the role of affectivity in affordance perception and the way in which subjects gauge the meaning of an object according to its action-possibilities. (shrink)

One of humans’ distinctive cognitive abilities is that they develop an array of capacities through an enculturation process. In “Cognition as a Social Skill,” Sally points to one of the dangers associated with enculturation: ideological oppression. To conceptualize how such oppression takes root, Haslanager appeals to notions of mindshaping and social coordination, whereby people participate in oppressive social practices unthinkingly or even willingly. Arguably, an appeal to mindshaping provides a new kind of argument, grounded in philosophy of mind, which supports (...) the claims that feminist and anti-racist want to defend. However, some theorists worry that Haslanger’s account does not shed much light on how individuals could exert their agency to resist oppression. I argue that enactivist conceptions of mindshaping and habit can help us to make sense of the power of social influences and how they have the potential to both enable and undermine cognition and agency. This moves us toward increased understanding of the workings of social oppression—distinguishing between constructive and enabling forms of heteronomy, and overdetermining and pernicious modes that lead to atrophied moral cognition and a narrowing of the field of affordances. (shrink)

This paper utilizes the enactivist notion of ‘sense-making’ to discuss the nature of depression and examine some implications for treatment. As I understand it, sensemaking is fully embodied, fundamentally affective, and thoroughly embedded in a social environment. I begin by presenting an enactivist conceptualization of affective intentionality and describing how this general mode of intentional directedness to the world is disrupted in cases of major depressive disorder. Next, I utilize this enactivist framework to unpack the notion of ‘temporal desituatedness,’ and (...) maintain that the characteristic symptoms of depression result from a disruption to the future-directed structure of affective intentionality. This can be conceptualized as a loss of “online intelligence” and a shrinking of the field of affordances. Then, I argue that two of the standard modes of treatments for depression, medication and cognitive behavioral therapy, are not fully sufficient means of restoring online intelligence, and that these limitations stem partly from the approaches’ implicit commitment to a brain-bound, overly cognitivist view of the mind. I recommend expressive arts interventions such as dance-movement therapy and music therapy as important supplementary treatment methods that deserve further consideration. Insofar as they revitalize subjects’ bodies and emotions, cultivate an openness to the future, and promote self-insight and social synchrony, these treatment modes not only reflect key insights of enactivism, but also offer great potential for lasting healing. (shrink)

Most philosophical discussions of psychopathy have centered around its significance in relation to empathy, moral cognition, or moral responsibility. However, related questions about the extent to...

The recommended treatment for dual diagnosis - the co-occurrence of substance use and another mental disorder - requires seamless integration of the involved disciplines and services. However, no integrative framework exists for communicating about dual diagnosis cases across disciplinary or sectoral boundaries. We examine if Enactive Psychiatry may bridge this theoretical gap. We evaluate the enactive approach through a two-step pragmatic lens: Firstly, by taking a historical perspective to describe more accurately how the theoretical gap within the field of dual (...) diagnosis initially developed. Secondly, by applying the Enactive Psychiatry approach to data from a longitudinal study on the trajectory of cannabis use in psychosis disorders. By applying the theory rather than simply presenting it, we position ourselves better to evaluate whether it may assist the purpose of achieving a more expedient pragmatic “grip” on the field of dual diagnosis. In our discussion, we suggest that this may very well be the case. Finally, we consider the enactive approach as one of a small handful of new theories of mental disorders that draw on systems thinking and ecological psychology, and discuss whether they have the potential for a wider progressive problemshift within psychiatry. The case in favor of such potential, we argue, is less strong unless the role of complexity, similar to that seen within the dual diagnosis field, may be demonstrated for other fields of clinical practice. (shrink)

Cognition has traditionally been understood in terms of internal mental representations, and computational operations carried out on internal mental representations. Radical approaches propose to reconceive cognition in terms of agent-environment dynamics. An outstanding challenge for such a philosophical project is how to scale-up from perception and action to cases of what is typically called ‘higher-order’ cognition such as linguistic thought, the case we focus on in this paper. Perception and action are naturally described in terms of agent-environment dynamics, but can (...) a person’s thoughts about absent, abstract or counterfactual states of affairs also be accounted for in such terms? We argue such a question will seem pressing so long as one fails to appreciate how richly resourceful the human ecological niche is in terms of the affordances it provides. The explanatory work that is supposedly done by mental representations in a philosophical analysis of cognition, can instead be done by looking outside of the head to the environment structured by sociomaterial practices, and the affordances it makes available. Once one recognizes how much of the human ecological niche has become structured by activities of talking and writing, this should take away at least some of the motivation for understanding linguistic thinking in terms of content-bearing internal representations. We’ll argue that people can think about absent, abstract or counterfactual because of their skills for engaging with what we will call “enlanguaged affordances”. We make use of the phenomenological analysis of speech in Merleau-Ponty to show how the multiple affordances an individual is ready to engage with in a particular situation will typically include enlanguaged affordances. (shrink)

This paper examines an intersection between ecological psychology and the enactive approach, brought about by studying sense-making in relation to a behavior setting in Hong Kong and adopting a focus on embodied action and gesture. A cosmetics pop-up store in a downtown shopping mall provides the basis for a case study involving a two pronged analysis. I first use Barker’s behavior setting theory to describe the publically accessible structure and dynamics of the store, which reveals a bounded spatio-temporal structure with (...) several interdependent behavior-milieu parts. I then analyze video recordings of my research participant encountering, entering, and exploring this environment. Following an enactive-informed micro-ethnographic approach to embodied communication, I examine her movements, postures, gestures, and language use as she joins the behavior setting. These fine-grained descriptions of her embodied actions provide an empirical basis to analyze enactive sense-making. On the one hand, they disclose the affective and emotional experience of perceiving relevant affordances in the environment, and on the other hand, they show the specificity of sensorimotor abilities required to join the setting’s standing pattern of behavior. (shrink)

The idea that deep brain stimulation induces changes to personality, identity, agency, authenticity, autonomy and self is so deeply entrenched within neuroethics discourses that it has become an unchallenged narrative. In this article, we critically assess evidence about putative effects of DBS on PIAAAS. We conducted a literature review of more than 1535 articles to investigate the prevalence of scientific evidence regarding these potential DBS-induced changes. While we observed an increase in the number of publications in theoretical neuroethics that mention (...) putative DBS-induced changes to patients’ postoperative PIAAAS, we found a critical lack of primary empirical studies corroborating these claims. Our findings strongly suggest that the theoretical neuroethics debate on putative effects of DBS relies on very limited empirical evidence and is, instead, reliant on unsubstantiated speculative assumptions probably in lieu of robust evidence. As such, this may reflect the likelihood of a speculative neuroethics bubble that may need to be deflated. Nevertheless, despite the low number of first-hand primary studies and large number of marginal and single case reports, potential postoperative DBS changes experienced by patients remain a critical ethical concern. We recommend further empirical research in order to enhance theoretical neuroethics work in the area. In particular, we call for the development of better instruments capable of capturing potential postoperative variations of PIAAAS. (shrink)

Despite growing evidence that a significant number of patients living with Parkison’s disease experience neuropsychiatric changes following Deep Brain Stimulation treatment, the phenomenon remains poorly understood and largely unexplored in the literature. To shed new light on this phenomenon, we used qualitative methods grounded in phenomenology to conduct in-depth, semi-structured interviews with 17 patients living with Parkinson’s Disease who had undergone DBS. Our study found that patients appear to experience postoperative DBS-induced changes in the form of self-estrangement. Using the insights (...) from patients’ subjective perceptions of postoperative self-change provides a potent explanation of potential DBS-induced self-estrangement. (shrink)

Owing to an oversight, we noted that the acknowledgement section was missing from the original published version of this paper.

Abstract: The notion of a self-pattern, as developed in the pattern theory of self, which holds that the self is best explained in terms of the kind of reality that pertains to a dynamical pattern, acknowledges the importance of neural dynamics, but also expands the account of self to extra-neural (embodied and enactive) dynamics. The pattern theory of self, however, has been criticized for failing to explicate the dynamical relations among elements of the self-pattern; as such, it seems to be (...) nothing more than a mere list of elements. We’ll argue that the dynamics of a self-pattern are reflected in three significant and interrelated ways that allow for investigation. First, a self-pattern is reflectively reiterated in its narrative component. Second, studies of psychiatric or neurological disorders can help us understand the precise nature of the dynamical relations in a self-pattern, and how they can fail. Third, referencing predictive processing accounts, neuroscience can also help to explicate the dynamical relations that constitute the self-pattern. (shrink)

Questions about the nature of self and self-consciousness are closely aligned with questions about the nature of autonomy. These concepts have deep roots in traditional philosophical discussions that concern metaphysics, epistemology and ethics. They also have direct relevance to practical considerations about informed consent in medical contexts. In this paper, with reference to understanding specific side effects of deep brain stimulation treatment in cases of, for example, Parkinson’s Disease, Obsessive Compulsive Disorder, and Major Depressive Disorder, I’ll argue that it is (...) best to frame discussions of informed consent in terms of relational autonomy and a pattern theory of self. (shrink)

Affordances are possibilities for action offered by the environment. Recent research on affordances holds that there are differences in how people experience such possibilities for action. However, these differences have not been properly investigated. In this paper I start by briefly scrutinizing the existing literature on this issue, and then argue for two claims. First, that whether an affordance solicits action or not depends on its relevance to the agent’s concerns. Second, that the experiential character of how an affordance solicits (...) action depends on the character of the concern to which it is relevant. Concerns are conceived of as bodily forms of responsiveness, and solicitations are experienced through this responsiveness. The main aim of this paper is to make clear that an understanding of experiential differences in solicitations has to be based on a phenomenological appreciation of how one experiences one’s responsiveness to those solicitations. In the remainder of the paper I show how such a phenomenological appreciation reveals several characteristics of our responsiveness and I briefly explore three of them: valence, force and mineness. In the final section I discuss the self-referentiality of affordances in light of the current proposal, and argue that this self-referentiality is broader than is typically acknowledged. (shrink)

The article proposes a theoretical model to account for changes in self due to Deep Brain Stimulation. First, we argue that most existing models postulate a very narrow conception of self, and thus fail to capture the full range of potentially relevant DBS-induced changes. Second, building on previous work by Shaun Gallagher, we propose a modified ‘pattern-theory of self’, which provides a richer picture of the possible consequences of DBS treatment.

The idea that (former) patients are experts who could contribute to mental health care practices is gaining traction. Experts-by-Experience are increasingly employed by institutions to contribute to various levels of care, organization and policy-making. However, the success of this movement is hindered by conceptual and epistemological ambiguities. Our goal in this paper is to turn to the rich philosophical literature to start addressing such ambiguities. We first summarize the advantages of and challenges for Experience-based Expertise movement in mental health care. (...) Next, we explicate the theoretical assumptions of this movement by outlining its salient tenets, with a focus on the Dutch mental care system. We point out three challenges of the movement that could be addressed using the insights by recent work in philosophy of mind and philosophy of science, i.e., (i) conceptual problems, (ii) worries about the subjectivity of the contributions of Experts-by-Experience, and (iii) addressing of the conflicts between the Experts-by-Experience and other experts. We conclude by proposing an enactive affordance-based framework as a candidate for clarifying the goals of the Experience-based Expertise movement in a way that avoids the current conceptual and epistemological problems and opens up venues for its growth. (shrink)

In this paper, we set out to develop a theoretical and conceptual framework for the new field of Radical Embodied Cognitive Neuroscience. This framework should be able to integrate insights from several relevant disciplines: theory on embodied cognition, ecological psychology, phenomenology, dynamical systems theory, and neurodynamics. We suggest that the main task of Radical Embodied Cognitive Neuroscience is to investigate the phenomenon of skilled intentionality from the perspective of the self-organization of the brain-body-environment system, while doing justice to the phenomenology (...) of skilled action. In previous work, we have characterized skilled intentionality as the organism's tendency toward an optimal grip on multiple relevant affordances simultaneously. Affordances are possibilities for action provided by the environment. In the first part of this paper, we introduce the notion of skilled intentionality and the phenomenon of responsiveness to a field of relevant affordances. Second, we use Friston's work on neurodynamics, but embed a very minimal version of his Free Energy Principle in the ecological niche of the animal. Thus amended, this principle is helpful for understanding the embeddedness of neurodynamics within the dynamics of the system “brain-body-landscape of affordances.” Next, we show how we can use this adjusted principle to understand the neurodynamics of selective openness to the environment: interacting action-readiness patterns at multiple timescales contribute to the organism's selective openness to relevant affordances. In the final part of the paper, we emphasize the important role of metastable dynamics in both the brain and the brain-body-environment system for adequate affordance-responsiveness. We exemplify our integrative approach by presenting research on the impact of Deep Brain Stimulation on affordance responsiveness of OCD patients. (shrink)

This thesis proposes a perspective on language and its development by starting from two approaches. The first is the ecological-enactive approach to cognition. In opposition to the widespread idea that cognition is information-processing in the brain, the ecological-enactive approach explains human cognition in relational terms, as skilful interactions with a sociomaterial environment shaped by practices. The second is the metalinguistic approach to language, which holds that reflexive or metalinguistic language use – talking about talking – is crucial for understanding language (...) and its development. In particular, I defend two theses: 1. A child’s initial communicative behaviour can be explained in terms of attentional actions: social actions that function by directing someone else’s attention. 2. In order for the child’s communicative behaviour to be sensitive to key properties of language, such as semantic content and normativity, she needs to learn metalinguistic skills. The development of this ecological-enactive perspective on language serves two functions. First, the ecological-enactive approach started by considering basic behaviour, such as locomotion and grasping. An approach in the cognitive sciences, however, should be able to account for the full gamut of human cognition. If the perspective developed in this thesis is viable, this is a contribution to extending the ecological-enactive approach to typically human forms of cognition. Second, this perspective throws new light on philosophical problems concerning language. In the different chapters, I deal with questions concerning the nature of linguistic knowledge, explanations of communicative behaviour, and the origins of semantic content and linguistic normativity. (shrink)