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)

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)

The biopsychosocial model was initially proposed to overcome the normative assumption that human diseases are exclusively due to disordered biochemical and/or neurophysiological processes. The model attempts to explain how expectations, thoughts and feelings modify the patient’s motivations to deal with illness and recovery. By considering the physical health in this perspective, healthcare professionals may test the importance of socially and culturally shared principles in alleviating illness experience. The entire biopsychosocial hierarchy may thus appear as a complex network of relationships between (...) the strict logic of scientific explanations and the emotional sustainability with which beliefs may either be defended, changed or even refused. In this paper, we aim at reviewing some of the evidence-based biomedical and psychological findings that provide a unified framework for the biopsychosocial model as a multilevel integrative process. To tackle this objective, we propose to approach the model in biosemiotic terms. It is our contention that the entire biopsychosocial hierarchy could be better understood if approached biosemiotically and the multilevel interconnection of this hierarchy re-examined in the light of a collaborative meaning-making process. (shrink)