Can one be ill and happy? I use a phenomenological approach to provide an answer to this question, using Merleau-Ponty’s distinction between the biological and the lived body. I begin by discussing the rift between the biological body and the ill person’s lived experience, which occurs in illness. The transparent and taken for granted biological body is problematised by illness, which exposes it as different from the lived experience of this body. I argue that because of this rift, the experience (...) of illness cannot be captured within a naturalistic view and propose to supplant this view with a phenomenological approach. The latter approach accounts for changes in the ill person’s relationship to her social and physical world. These changes, I argue, cannot be captured by a naturalistic perspective. I then propose the notion of health within illness as a useful concept for capturing the experience of well-being reported by some ill people. I present empirical evidence for this phenomenon and assess its philosophical significance. Finally, I suggest that adaptability and creativity are two common positive responses to illness, demonstrating that health within illness is possible. The three elements combined – the transformed body, health within illness and adaptability and creativity – serve as the basis for a positive answer to the question posed above. (shrink)

Autism research is increasingly moving to a view centred around sensorimotor atypicalities instead of traditional, ethically problematical, views predicated on social-cognitive deficits. We explore how an enactivist approach to autism illuminates how social differences, stereotypically associated with autism, arise from such sensorimotor atypicalities. Indeed, in a state space description, this can be taken as a skewing of sensorimotor variables that influences social interaction and so also enculturation and habituation. We argue that this construal leads to autism being treated on a (...) par with other sensorimotor atypicalities such as blindness or atypical height. This leads to our conclusion that, insofar there is an ethical call to inclusion in our public sphere regardless of contingent bodily difference, an enactivist take on autism naturally leads to extending such inclusion to autism. Moreover, our analysis suggests a concrete way forward to achieve inclusion of autistics: by being more attentive to autistic sensorimotor specifics. (shrink)

Enactive cognitive science combines questions in epistemology, ontology, and ethics by conceiving of bodies as open-ended and mutually transforming through activity. While enaction is not a theory of ethics, it can contribute to its foundations. We present a schematization of enactive ideas that underlie traditional distinctions between Being, Knowing, and Doing. Ethics in this scheme begins in the relation between knowing and becoming. Critical of dichotomous thinking, we approach the questions of alterity and ethical reality. Alterity is relevant to the (...) enactive approach, but not in the radical sense of transcendental arguments. We propose difference, instead, as a more generative concept. Following Simondon, we see norms and values manifest in webs of past and future acts together with their potentialities for becoming. We propose a transindividual concept of moral attunement that includes ethical know-how and consciousness raising. Through generative difference and attunement to configurations of becoming, enaction underpins an ethics of participation linking virtue ethics and ethics of care. (shrink)

This article uses Marc Lewis’ work as a springboard to discuss the socio-political context of the brain disease model of addiction (BDMA). The claim that promotion of the BDMA is the only way the general public can be persuaded to withhold blame and punishment from addicts is critically examined. After a discussion of public understandings of the disease concept of addiction, it is pointed out that it is possible to develop a scientific account of addiction which is neither a disease (...) nor a moral model but which the public could understand. Evidence is reviewed to suggest that public acceptance of the disease concept is largely lip-service and that the claim the BDMA removes stigma among the public and professionals is unsupported by evidence. Further, there is good evidence that biogenetic explanations of mental/behavioural disorders in general have been counterproductive in the attempt to ally stigma. A model of addiction as a disorder of choice may attract special problems in public-facing communications and risks being misunderstood. However, ways of presenting this model to the public are suggested that may avoid such risks. Lastly, the claim that the BDMA is the only way of ensuring access to treatment and of maintaining research funding for addiction is disputed and a way in which these benefits can be retained under a disorder-of-choice model proposed. The article concludes by enthusiastically endorsing Lewis’ call for a third stage in the governing image of addiction. (shrink)

This article reviews scientific advances in the prevention and treatment of substance-use disorder and related developments in public policy. In the past two decades, research has increasingly supported the view that addiction is a disease of the brain. Although the brain disease model of addiction has yielded effective preventive measures, treatment interventions, and public health policies to address substance-use disorders, the underlying concept of substance abuse as a brain disease continues to be questioned, perhaps because the aberrant, impulsive, and compulsive (...) behaviors that are characteristic of addiction have not been clearly tied to neurobiology. Here we review recent advances in the neurobiology of addiction to clarify the link between addiction and brain function and to broaden the understanding of addiction as a brain disease. (shrink)

What is the relationship between phenomenology and naturalism? Are they mutually exclusive or is a rapprochement possible between their approaches to consciousness and the natural world? Can phenomenology be naturalised and ought it to be? Or is naturalism fundamentally unable to accommodate phenomenological insights? How can phenomenological method be used within a naturalistic research programme? This cutting-edge collection of original essays contains brilliant contributions from leading phenomenologists across the world. The collection presents a wide range of fascinating and carefully argued (...) answers to these questions. (shrink)

In this paper I explore the tacit underlying sense of bodily certainty that characterizes normal everyday embodied experience. I then propose illness as one instance in which this certainty breaks down and is replaced by bodily doubt. I characterize bodily doubt as radically modifying our experience in three ways: loss of continuity, loss of transparency, and loss of faith in one's body. I then discuss the philosophical insights that arise from the experience of bodily doubt. The paper uses a Humean (...) framework with regards to bodily certainty, treating it as a taken for granted tacit aspect of normal experience. I argue that although bodily certainty is not rationally justifiable, we are nonetheless unable to reject it. Bodily certainty is thus revealed to be part of our brute animal nature. I conclude by suggesting that the study of pathology is a philosophical method useful for illuminating tacit aspects of experience. (shrink)

Previous discussions of addiction have often focused on the question of whether addiction is a disease. This discussion distinguishes that question – the disease question – from the question of whether addiction is a disability. I argue that, however one answers the disease question, and indeed on almost any credible account of addiction, addiction is a disability. I then consider the implications of this view, or why it matters that addiction is a disability. The disease model of addiction has led (...) many to see addiction as primarily a medical problem, and to make medical treatment of the addicted person the first priority in addressing addiction. Once addiction is viewed as a disability, different concerns are foregrounded. The problem of addiction resides not only in the addicted person, but also in the social environment in which the addicted person finds herself. The fundamental ethical question about addiction is not how addicted persons can be treated or otherwise changed, but how a just society can make reasonable accommodations for addicted persons. (shrink)

The notion of embodiment is central to the phenomenological approach to schizophrenia. This paper argues that fundamental concepts for the understanding of schizophrenia have a bodily dimension. We present two single cases of first-onset schizophrenic patients and analyze the reports of their experiences. Problems such as loss of self, loss of common sense, and intentionality disorders reveal a disconnectedness that can be traced back to a detachment from the lived body. Hyperreflectivity and hyperautomaticity are used as coping mechanisms, but reflect (...) the same problem of the split between body and mind. It is argued that the sole focus on cognitive impairments leads to a distorted image of schizophrenia, and that the acknowledgment of its fundamental bodily roots enables one to see the coherence between the diverse symptoms. As for the practical implications of the phenomenological approach, further research is needed to investigate if and how body- and movement-oriented therapies might strengthen the embodiment of schizophrenic patients. (shrink)

Two major philosophical movements have sought to fundamentally rethink the relationship between humans and their environment(s): environmental ethics and enactivism. Surprisingly, they virtually never refer to or seek inspiration from each other. The goal of this analysis is to bridge the gap. Our main purpose, then, is to address, from the enactivist angle, the conceptual backbone of environmental ethics, namely the concept of intrinsic value. We argue that intrinsic value does indeed exist, yet its "intrinsicality" does not boil down to (...) being independent of the interests and needs of humans. Rather, it is brought forth by what we callshared enactionof an axiological domain. The latter is built upon such core posits of enactivism as autonomy, enaction, participatory sense-making as well as the most recent concept of loving as knowing proposed by Hanne De Jaegher. (shrink)

Addiction remains a challenging disorder, both to treat and to conceptualise. While the temporal dimension of addiction has been noted before, here the aim is to ground this understanding in a coherent phenomenological-neuroscience framework. Addiction is partly understood as drawing the subject into a predominantly “now” orientated existence, with the future closed or experienced as extremely distant. Another feature of this temporal structuring is that past experiences, which are crucial in advancing intentionally forward, are experienced in addiction as a void. (...) This has implications for the generation of meaning and forming of self, amongst others. While there are areas of the brain that regulate temporal processing, there is no single location. Recent addiction research has implicated the insula and in turn this area is implicated in temporal and interoceptive awareness. Similarly these areas of disruption may affect self processes. Disruption of interoception and thus of self, may help explain why addiction is complex and involves multiple aspects of subjectivity. (shrink)

There is a conceptual crisis in the biomedical sciences that is particularly salient in psychopathology research. Underlying the crisis is a controversy that pertains to the current medical model of disease that largely draws from causal-mechanistic explanations. The bedrock of this model is the analysis of biological part-dysfunctions that aims at unequivocally defining a pathological condition and demarcating it from its neighboring entities. This endeavor has led to a quest for physiological, biochemical, and genetic signatures. Yet, so far there is (...) little evidence for reliable biomarkers for any mental disorder. The contemporary biomedical paradigm largely ignores historical, dynamic, and system-level aspects—a view that has contributed much to the conceptual disjunction of the patient as a person from his/her disease. Notwithstanding the impressive progress in the biomedical sciences, increasingly more critics question whether the constituting framework is sufficient to convey a comprehensive understanding of illnesses, especially mental illnesses. Thus, the medical model urgently requires an update. But rather than revamping it by methodological advancements, it will be necessary to critically review its philosophical roots. The most problematic issues that require reworking are: the preponderance of the biostatistical theory; the undue decoupling of physiological from evolutionary explanations of function; the clinging to the Modern Synthesis ; and the neglect of dynamic and system-level properties. The proposed overhaul requires the heeding of historical explanations that draw from the Extended Evolutionary Synthesis as well as systems biology approaches for tackling multilevel and dynamic phenomena of complex systems. (shrink)

Most people who are regular consumers of psychoactive drugs are not drug addicts, nor will they ever become addicts. In neurobiological theories, non-addictive drug consumption is acknowledged only as a “necessary” prerequisite for addiction, but not as a stable and widespread behavior in its own right. This target article proposes a new neurobiological framework theory for non-addictive psychoactive drug consumption, introducing the concept of “drug instrumentalization.” Psychoactive drugs are consumed for their effects on mental states. Humans are able to learn (...) that mental states can be changed on purpose by drugs, in order to facilitate other, non-drug-related behaviors. We discuss specific “instrumentalization goals” and outline neurobiological mechanisms of how major classes of psychoactive drugs change mental states and serve non-drug-related behaviors. We argue that drug instrumentalization behavior may provide a functional adaptation to modern environments based on a historical selection for learning mechanisms that allow the dynamic modification of consummatory behavior. It is assumed that in order to effectively instrumentalize psychoactive drugs, the establishment of and retrieval from a drug memory is required. Here, we propose a new classification of different drug memory subtypes and discuss how they interact during drug instrumentalization learning and retrieval. Understanding the everyday utility and the learning mechanisms of non-addictive psychotropic drug use may help to prevent abuse and the transition to drug addiction in the future. (shrink)

Drugged bodies are commonly depicted as passive, suffering and abject, which makes it hard for them to be known in other ways. Wanting to get closer to these alternative bodies and their resourcefulness for living, I turned to body-mapping as an inventive method for telling different kinds of drug-using stories. Drawing on a research project with people who inject heroin and crack cocaine in London, UK, I employed body-mapping as a way of studying drugged bodies in their relation to others, (...) human and non-human, in the injecting event. I invited participants to draw their bodies in describing these otherwise hard-to-articulate experiences. Following Donna Haraway, I conceptualise body-mapping as a more-than-human mode of storytelling where different kinds of bodies can be known. Here, I look at three such bodies – sensing-bodies, temporal-bodies and environment-bodies – and argue that it is through being able to respond to such bodies that more hospitable ways of living with drugs can become possible. (shrink)

Addiction remains a challenging disorder, both to treat and to conceptualise. While the temporal dimension of addiction has been noted before, here the aim is to ground this understanding in a coherent phenomenological-neuroscience framework. Addiction is partly understood as drawing the subject into a predominantly “now” orientated existence, with the future closed or experienced as extremely distant. Another feature of this temporal structuring is that past experiences, which are crucial in advancing intentionally forward, are experienced in addiction as a void. (...) This has implications for the generation of meaning and forming of self, amongst others. While there are areas of the brain that regulate temporal processing, there is no single location. Recent addiction research has implicated the insula and in turn this area is implicated in temporal and interoceptive awareness. Similarly these areas of disruption may affect self processes. Disruption of interoception and thus of self, may help explain why addiction is complex and involves multiple aspects of subjectivity. (shrink)

I review the brain disease model of addiction promoted by medical, scientific, and clinical authorities in the US and elsewhere. I then show that the disease model is flawed because brain changes in addiction are similar to those generally observed when recurrent, highly motivated goal seeking results in the development of deep habits, Pavlovian learning, and prefrontal disengagement. This analysis relies on concepts of self-organization, neuroplasticity, personality development, and delay discounting. It also highlights neural and behavioral parallels between substance addictions, (...) behavioral addictions, normative compulsive behaviors, and falling in love. I note that the short duration of addictive rewards leads to negative emotions that accelerate the learning cycle, but cortical reconfiguration in recovery should also inform our understanding of addiction. I end by showing that the ethos of the disease model makes it difficult to reconcile with a developmental-learning orientation. (shrink)

The claim that addiction is a brain disease is almost universally accepted among scientists who work on addiction. The claim’s attraction rests on two grounds: the fact that addiction seems to be characterized by dysfunction in specific neural pathways and the fact that the claim seems to the compassionate response to people who are suffering. I argue that neural dysfunction is not sufficient for disease: something is a brain disease only when neural dysfunction is sufficient for impairment. I claim that (...) the neural dysfunction that is characteristic of addiction is not sufficient for impairment, because people who suffer from that dysfunction are impaired, sufficiently to count as diseased, only given certain features of their context. Hence addiction is not a brain disease (though it is often a disease, and it may always involve brain dysfunction). I argue that accepting that addiction is not a brain disease does not entail a moralizing attitude toward people who suffer as a result of addiction; if anything, it allows for a more compassionate, and more effective, response to addiction. (shrink)

Resistance to the idea that phenomenology can be relevant to cognitive scientific explanation has faced two objections advanced, respectively, from both sides of the issue: from the scientific perspective it has been suggested that phenomenology, understood as an account of first-person experience, is ultimately reducible to cognitive neuroscientific explanation; and from a phenomenological perspective it has been argued that phenomenology cannot be naturalized. In this context it makes sense to consider that the notion of scientific reduction is linked to a (...) classic scientific conception of nature. I argue that if properly understood, the proposal to rethink the concept of nature itself, in enactivist phenomenological approaches, undermines the reductionist program and redefines what it means for phenomenology to be naturalized. (shrink)

Where does normal brain or psychological function end, and pathology begin? The line can be hard to discern, making disease sometimes a tricky word. In addiction, normal ‘wanting’ processes become distorted and excessive, according to the incentive-sensitization theory. Excessive ‘wanting’ results from drug-induced neural sensitization changes in underlying brain mesolimbic systems of incentive. ‘Brain disease’ was never used by the theory, but neural sensitization changes are arguably extreme enough and problematic enough to be called pathological. This implies that ‘brain disease’ (...) can be a legitimate description of addiction, though caveats are needed to acknowledge roles for choice and active agency by the addict. Finally, arguments over ‘brain disease’ should be put behind us. Our real challenge is to understand addiction and devise better ways to help. Arguments over descriptive words only distract from that challenge. (shrink)

Addictions are commonly accompanied by a sense of shame or self-stigmatization. Self-stigmatization results from public stigmatization in a process leading to the internalization of the social opprobrium attaching to the negative stereotypes associated with addiction. We offer an account of how this process works in terms of a range of looping effects, and this leads to our main claim that for a significant range of cases public stigma figures in the social construction of addiction. This rests on a social constructivist (...) account in which those affected by public stigmatization internalize its norms. Stigma figures as part-constituent of the dynamic process in which addiction is formed. Our thesis is partly theoretical, partly empirical, as we source our claims about the process of internalization from interviews with people in treatment for substance use problems. (shrink)

This paper explores the human significance of crack cocaine abuse by submitting its manifestation (logos) to existential-phenomenological analysis. The author conducted over fifty, first-hand interviews of recovering and active crack cocaine abusers toward disclosing the meaning of his to-be.What is revealed is the way the addiction reacts upon the with-structure of existence. Active crack cocaine addiction is being-high-and-free-of-craving. The singularity of this event eclipses the interhuman significance that substantially constitutes concern, as the meaning and Being of There-being, and radicalizes existence (...) such that the “other” is unceasingly projected as a means to free transcendence. The crack abuser forsakes the existentials being-with and There-being-with-others, ways of to-be that accommodate and gear into the existence of “others,” to being-with-crack, a way of Being that is exclusively for the sake of the dependent’s “self.”. (shrink)

This is the editors' introduction to an edited volume devoted to the relation between phenomenology and naturalism across several philosophical domains, including: epistemology, metaphysics, history of philosophy, and philosophy of science and ethics.