In this article we offer a two-part commentary on Bolton and Gillett’s reconceptualization of Engel’s biopsychosocial model. In the first section we present a conceptual and historical assessment of the biopsychosocial model that differs from the analysis by Bolton and Gillett. Specifically, we point out that Engel in his vision of the biopsychosocial model was less concerned with the ontological possibility and nature of psychosocial causes, and more concerned with psychosocial influences in the form of illness interpretation and presentation, sick (...) role, seeking or rejection of care, the doctor-patient therapeutic relationship, and role of personality factors and family relationships in recovery from illness, etc. On the basis of this assessment, we then question Bolton and Gillett’s restricted focus on accounting for biopsychosocial causal interactions. The second section compares Bolton and Gillett’s account with a recent enactivist account of mental disorder that tackles similar conceptual problems of causal interactions. Bolton and Gillett’s utilize elements of the 4E cognition, but they combine these proto-ideas with an information-processing paradigm. Given their explicit endorsement of 4E approaches to mind and cognition, we illustrate some key ways in which a more fleshed out enactive account, particularly one that doesn’t rely on notions of information-processing, differs from the account proposed by Bolton and Gillett. (shrink)

I discuss Watsuji’s characterization of aidagara or “betweenness”. First, I develop a phenomenological reading of aidagara. I argue that the notion can help illuminate aspects of our embodied subjectivity and its interrelation with the world and others. Along the way, I also indicate how the notion can be fruitfully supplemented by different sources of empirical research. Second, I put aidagara to work in the context of psychopathology. I show how disruptions of aidagara in schizophrenia not only affirm the foundational role (...) it plays in organizing our experience of self and world in everyday life. Additionally, I suggest the notion can, in this context of application, potentially enhance our understanding of and empathy for those living with schizophrenic disorders. (shrink)

This paper argues that phenomenological insights regarding selfhood are relevant to the informed consent process in the treatment of depression using electro-convulsive therapy. One of the most significant side-effects associated with ECT is retrograde amnesia. Unfortunately, the current informed consent model does not adequately appreciate the full extent in which memory loss disturbs lived-experience. Through the philosophy of Merleau-Ponty, it is possible to appreciate the way in which memory loss affects a person’s self-experience, with emphasis given to one’s pre-reflective and (...) embodied, relationship with things in the world. This paper aims to demonstrate that proper informed consent should acknowledge the extent to which repeated ECT treatments affect a patient’s sense self. (shrink)

Central to the identity of modern medical specialities, including psychiatry, is the notion of hypostatic abstraction: doctors treat conditions or disorders, which are conceived of as “things” that people “have.” Mad activism rejects this notion and hence challenges psychiatry’s identity as a medical specialty. This article elaborates the challenge of Mad activism and develops the hypostatic abstraction as applied to medicine. For psychiatry to maintain its identity as a medical speciality while accommodating the challenge of Mad activism, it must develop (...) an additional conception of the clinical encounter. Toward elaborating this conception, this article raises two basic framing questions: For what kind of understanding of the situation should the clinical encounter aim? What is the therapeutic aim of the encounter as a whole? It proposes that the concepts of “secondary insight” and of “identity-making” can allow the clinical encounter to proceed in a way that accommodates the challenge of Mad activism. (shrink)

What Kyselo calls the “body-social problem” concerns whether to individuate the human self in terms of its bodily aspects or social aspects. In her view, either approach risks privileging one dimension while reducing the other to a mere contextual element. However, she proposes that principles from enactivism can help us to find a middle ground and solve the body-social problem. Here Kyselo looks to the notions of “needful freedom” and "individuation through and from a world" and extends them from the (...) realm of biological individuation to an individuation in terms of social interactions. However, I will argue that because Kyselo’s solution to the body-social problem downplays the role of the living body, it actually is in tension with the enactivist framework. First, while enactivism places the living body at the center of selfhood and subjectivity, Kyselo’s account treats the living body as mere means and mediator. Second, her claim that the self is socially enacted and individuated is in tension with the enactivist conception of autonomous agency, which centers on the autonomous organization of the living body. However, suppose we grant Kyselo’s claim that we are necessarily social beings, but claim that the mind of a minded human animal constitutively extends to the limits of its living organismic body, but no further. My proposed “life shaping” thesis says that the self is not just essentially embodied, but also partially causally determined or shaped by social interactions, and thoroughly influenced by social norms and values. The life shaping thesis can explain how the self is individuated biologically, in terms of the autonomous organization of the living body, but nonetheless deeply embedded in the social world. (shrink)

In recent years, a growing number of thinkers have begun to challenge the long-held view that the mind is neurally realized. One strand of critique comes from work on extended cognition, a second comes from research on embodied cognition, and a third comes from enactivism. I argue that theorists who embrace the claim that the mind is fully embodied and enactive cannot consistently also embrace the extended mind thesis. This is because once one takes seriously the central tenets of enactivism, (...) it becomes implausible to suppose that life, affectivity, and sense-making can extend. According to enactivism, the entities that enact a world of meaning are autonomous, embodied agents with a concerned point of view. Such agents are spatially situated, differentiated from the environment, and intentionally directed towards things that lie at a distance. While the extended mind thesis blurs the distinction between organism and environment, the central tenets of enactivism emphasize differentiations between the two. In addition, enactivism emphasizes that minded organisms are enduring subjects of action and experience, and thus it is implausible to suppose that they transform into a new form of life whenever they become intimately coupled to some new element in their environment. The proponent of enactivism and embodied cognition should acknowledge that life and affectivity are relational and environmentally embedded, but resist the further claim that these phenomena are extended. (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)

This paper looks to phenomenology and enactive cognition in order to shed light on the self and sense of self of patients with locked-in syndrome. It critically discusses the concept of the minimal self, both in its phenomenological and ontological dimension. Ontologically speaking, the self is considered to be equal to a person’s sensorimotor embodiment. This bodily self also grounds the minimal sense of self as being a distinct experiential subject. The view from the minimal bodily self presupposes that sociality (...) comes after the self, or that in other words, the essence of self remains independent of our social interactions and relations. In this paper, I rely on the idea of enactive autonomy and Heidegger’s and Merleau-Ponty’s views of human existence as primordially social, to argue for the contrary. The self is fundamentally relational and this is also reflected at the level of the subjective experience of being a self. I indicate how a strong relational view of selfhood can serve as a preliminary heuristic to make sense of the situation of the patient with LIS and conclude with some practical implications concerning patient autonomy, our ethical responsibility toward the patient, and the possibilities for improving the life of patients with LIS. (shrink)

A family of recent externalist approaches in philosophy of mind argues that our psychological capacities are synchronically and diachronically “scaffolded” by external resources. I consider how these “scaffolded” approaches might inform debates in phenomenological psychopathology. I first introduce the idea of “affective scaffolding” and make some taxonomic distinctions. Next, I use schizophrenia as a case study to argue—along with others in phenomenological psychopathology—that schizophrenia is fundamentally a self-disturbance. However, I offer a subtle reconfiguration of these approaches. I argue that schizophrenia (...) is not simply a disruption of ipseity or minimal self-consciousness but rather a disruption of the scaffolded self, established and regulated via its ongoing engagement with the world and others. I conclude by considering how this scaffolded framework indicates the need to consider new forms of intervention and treatment. (shrink)

Within the last fifty years as philosophy, psychology, and cognitive science have moved towards increasingly more embodied theoretical frameworks, there has been growing interest in Dance Movement Therapy. DMT has been shown to be effective in mitigating negative symptoms in several psychopathologies including PTSD, autism, and schizophrenia. Further, DMT generally helps participants gain a stronger sense of agency and connection with their body. However, it has been argued that it is not always clear what constitutes these changes in DMT participants. (...) I argue that we can better understand the empirical and phenomenological results of DMT across psychopathologies if we adapt an enactive embodied approach to cognition. I use the framework of embodied enactive cognition and narrative theories of the self to develop an account of DMT as a form of narrative change. I claim that through the acquisition of new bodily skill and bodily awareness, DMT can cause changes to the participant’s narrative self-understanding. (shrink)

Underlying the recent focus on embodied and interactive aspects of social understanding are several intuitions about what roles the body, interaction processes, and interpersonal experience play. In this paper, we introduce a systematic, hands-on method for investigating the experience of interacting and its role in intersubjectivity. Special about this method is that it starts from the idea that researchers of social understanding are themselves one of the best tools for their own investigations. The method provides ways for researchers to calibrate (...) and to trust themselves as sophisticated instruments to help generate novel insights into human interactive experience. We present the basics of the method, and two empirical studies. The first is a video-study on autism, which shows greater refinement in the way people with autism embody their social interactions than previously thought. The second is a study of thinking in live interactions, which provides insight into the common feeling that too much thinking can hamper interaction, and into how this kind of interactional awkwardness might be unblocked. (shrink)

Despite a recent surge in publications on Tourette Syndrome, we still lack substantial insight into first-personal aspects of “what it is like” to live with this condition. This is despite the fact that developments in phenomenological psychiatry have demonstrated the scientific and clinical importance of understanding subjective experience in a range of other neuropsychiatric conditions. We argue that it is time for Tourette Syndrome research to tap into the sophisticated frameworks developed in the philosophical tradition of phenomenology for describing experience (...) in a way that integrates discrete symptoms into an overarching experiential framework concerning the self, the body, and its modes of experience. Following a historical introduction that contextualises the pertinence of phenomenology to psychopathology, we distinguish this approach from the existing, psychologically oriented studies on TS that are also qualitative. We then outline gaps and opportunities for future research, including the sorts of questions that might be utilised in phenomenological interviews and why they are of potential benefit to research programs in philosophy, psychology, and neuroscience. In conclusion we address some of the broader implications for phenomenology of the body and philosophy of action. (shrink)

This paper contributes to the debate in the philosophy of psychiatry regarding the relation between thought insertion in schizophrenia and the sense of selfhood. Some scholars have suggested that thought insertion presents a case where the sense of selfhood is lacking. Other scholars have disputed this by proposing that a form of minimal selfhood is a necessary feature of consciousness that is still present in thought insertion, albeit in a disturbed manner. Herein, I argue that the notion of minimal selfhood (...) that is used by these scholars is ambiguous between two meanings. The first is an ontological notion concerning the first-person individuation of consciousness. The second is a phenomenological notion concerning how a conscious experience is experienced as being given to the first-person subject. I argue that the former ontological notion is indeed a necessary feature of conscious experience, but the latter phenomenological notion is only a contingent feature. Therefore, even if it is possible that thought insertion presents a case where the feeling of first-person givenness is lacking or disturbed, the first-person individuation of consciousness remains present and undisturbed. As well as further clarifying the connection between consciousness and selfhood, this philosophical analysis reveals the extent to which schizophrenia can and cannot be said to comprise a disorder of selfhood. (shrink)

This dissertation in Theory of Practical Knowledge contends that depression is a disorder of the self. Using the existential-phenomenology of Maurice Merleau-Ponty, I argue that if we want to disclose the basic structure of depressed experience, then we must likewise disclose how selfexperience is inseparable from depressed experience. However, even though depression is a contemporary psychiatric category of illness, it is nevertheless a historically and heterogenous concept. To make sense of depression in the context of contemporary psychiatric practice, I show (...) that depression has historically been characterized by two broad models of causation; that is, a phenomenon that is causally explained by either a biological dysfunction or a psychological conflict. But this stark characterization is not limited just to history; by conducting qualitative interviews with psychiatric professionals, I illustrate how this causal dichotomy remains prevalent in contemporary psychiatric practice. On one hand, the clinicians report dissatisfaction with the depression diagnostic criteria (i.e. it is impersonal or vague), while on the other hand, the clinicians also recognize that a depression diagnosis is useful insofar as a diagnosis facilitates access to various resources associated with psychiatric care. Consequently, clinicians have developed a coping strategy that is witnessed in their empathetic desire to distance patients from their depression diagnosis, which led to statements such as, “you are not the problem, the problem is depression.” One consequence of this approach is that depression is artificially cleaved from the person who experiences depression, which subsequently means that depression is viewed to be something independent of oneself. Because I argue that depression and the self are mutually implicated, it is crucial to disseminate some of the most influential contemporary models of selfhood. I show that the brainbound, situated, psychological, and narrative model of self, all have respective strengths and weaknesses. But I also go beyond these models and characterize selfhood as a developmental phenomenon that is expressed as an embodied-style. This style reflects the way in which we establish perceptual contact with the otherness, without which there could be no self-experience. (shrink)

Self-disorders in depression and schizophrenia have been the focus of much recent work in phenomenological psychopathology. But little has been said about the role the material environment plays in shaping the affective character of these disorders. In this paper, we argue that enjoying reliable (i.e., trustworthy) access to the things and spaces around us — the constituents of our material environment — is crucial for our ability to stabilize and regulate our affective life on a day-today basis. These things and (...) spaces often play an ineliminable role in shaping what we feel and how we feel it; when we interact with them, they contribute ongoing feedback that " scaffolds " the character and temporal development of our affective experiences. However, in some psychopathological conditions, the ability to access to these things and spaces becomes disturbed. Individuals not only lose certain forms of access to the practical significance of the built environment but also to its ​ regulative​ significance, too — and the stability and organization of their affective life is compromised. In developing this view, we discuss core concepts like " affordance spaces " , " scaffolding " , and " incorporation ". We apply these concepts to two case studies, severe depression and schizophrenia, and we show why these cases support our main claim. We conclude by briefly considering implications of this view for developing intervention and treatment strategies. (shrink)

Clinically significant delusion is a symptom of a number of mental illnesses. We rely on what a person says and how she behaves in order to identify if she has this symptom and it is clear from the literature that delusions are heterogeneous and extremely difficult to define. People with active delusions were interviewed to explore what it is like to develop and experience delusion. The transcribed interview data was analysed to identify themes and narrative trajectories that help to explain (...) the phenomenon. Results showed that delusions can sometimes provide pragmatic benefits and that the genesis of some delusions can be characterised in terms of the enactivist notion of affective framing. Affective framing is a term that captures the background emotions that enable know-how in terms of goal directed action and cognition. If a person’s affective frame alters the world is no longer understood and know-how is lost. The way in which a person relates to her environment can be highly anomalous thus requiring her to find an extraordinary explanation. I argue that delusions arise as a result of a breakdown in affective framing and offer a conceptualisation of delusion supported by empirical findings. (shrink)

I argue that conscious visual experience is essentially a non-representational demonstration of a skill. The explication and defense of this position depends on both phenomenological and empirical considerations. The central phenomenological claim is this: as a matter of human psychology, it is impossible to produce a conscious visual experience of a mind-independent object that is sufficiently like typical cases, without including concomitant proprioceptive sensations of the sort of extra-neural behavior that allows us to there and then competently detect such objects. (...) I then argue that this view, which is a version of enactivism, best explains the temporality of conscious experience—what is often called the specious present. (shrink)

We argue that the notion of "mental institutions"-discussed in recent debates about extended cognition-can help better understand the origin and character of social impairments in autism, and also help illuminate the extent to which some mechanisms of autistic dysfunction extend across both internal and external factors (i.e., they do not just reside within an individual's head). After providing some conceptual background, we discuss the connection between mental institutions and embodied habits of mind. We then discuss the significance of our view (...) for understanding autistic habits of mind and consider why these embodied habits are sometimes a poor fit with neurotypical mental institutions. We conclude by considering how these insights highlight the two-way, extended nature of social impairments in autism, and how this extended picture might assist in constructing more inclusive mental institutions and intervention strategies. (shrink)