Here is a thoroughly updated edition of a classic in palliative medicine. Two new chapters have been added to the 1991 edition, along with a new preface summarizing where progress has been made and where it has not in the area of pain management. This book addresses the timely issue of doctor-patient relationships arguing that the patient, not the disease, should be the central focus of medicine. Included are a number of compelling patient narratives. Praise for the first edition "Well (...) written. . .should be read by everyone in medical practice or considering a career in medicine."---JAMA. "Memorable passages, important ideas, and critical analysis. This is a book that clinicians and educators should read."---New England Journal of Medicine. (shrink)

This is a book about how we see: the environment around us (its surfaces, their layout, and their colors and textures); where we are in the environment; whether or not we are moving and, if we are, where we are going; what things are good for; how to do things (to thread a needle or drive an automobile); or why things look as they do.The basic assumption is that vision depends on the eye which is connected to the brain. The (...) author suggests that natural vision depends on the eyes in the head on a body supported by the ground, the brain being only the central organ of a complete visual system. When no constraints are put on the visual system, people look around, walk up to something interesting and move around it so as to see it from all sides, and go from one vista to another. That is natural vision—and what this book is about. (shrink)

For many years emotion theory has been characterized by a dichotomy between the head and the body. In the golden years of cognitivism, during the nineteen-sixties and seventies, emotion theory focused on the cognitive antecedents of emotion, the so-called “appraisal processes.” Bodily events were seen largely as byproducts of cognition, and as too unspecific to contribute to the variety of emotion experience. Cognition was conceptualized as an abstract, intellectual, “heady” process separate from bodily events. Although current emotion theory has moved (...) beyond this disembodied stance by conceiving of emotions as involving both cognitive processes (perception, attention, and evaluation) and bodily events (arousal, behavior, and facial expressions), the legacy of cognitivism persists in the tendency to treat cognitive and bodily events as separate constituents of emotion. Thus the cognitive aspects of emotion are supposedly distinct and separate from the bodily ones. This separation indicates that cognitivism’s disembodied conception of cognition continues to shape the way emotion theorists conceptualize emotion. (shrink)

The Embodied Mind provides a unique, sophisticated treatment of the spontaneous and reflective dimension of human experience.

The primary difference between direct and inferential theories of perception concerns the location of perceptual content, the meaning of our perceptions. In inferential theories of perception, these meanings arise inside animals, based upon their interactions with the physical environment. Light, for example, bumps into receptors causing a sensation. The animal (or its brain) performs inferences on the sensation, yielding a meaningful perception. In direct theories of perception, on the other hand, meaning is in the environment, and perception does not depend (...) upon meaning- conferring inferences. Instead the animal simply gathers information from a meaning- laden environment. But if the environment contains meanings, then it cannot be merely physical. This places a heavy theoretical burden on direct theories of perception, a burden so severe that it may outweigh all the advantages to conceiving perception as. (shrink)

Radical embodied cognitive science is split into two camps: the ecological approach and the enactive approach. We propose that these two approaches can be brought together into a productive synthesis. The key is to recognize that the two approaches are pursuing different but complementary types of explanation. Both approaches seek to explain behavior in terms of the animal–environment relation, but they start at opposite ends. Ecological psychologists pursue an ontological strategy. They begin by describing the habitat of the species, and (...) use this to explain how action possibilities are constrained for individual actors. Enactivists, meanwhile, pursue an epistemic strategy: start by characterizing the exploratory, self-regulating behavior of the individual organism, and use this to understand how that organism brings forth its animal-specific umwelt. Both types of explanation are necessary: the ontological strategy explains how structure in the environment constrains how the world can appear to an individual, while the epistemic strategy explains how the world can appear differently to different members of the same species, relative to their skills, abilities, and histories. Making the distinction between species habitat and animal-specific umwelt allows us to understand the environment in realist terms while acknowledging that individual living organisms are phenomenal beings. (shrink)

In addiction, apparently causally significant phenomena occur at a huge number of levels; addiction is affected by biomedical, neurological, pharmacological, clinical, social, and politico-legal factors, among many others. In such a complex, multifaceted field of inquiry, it seems very unlikely that all the many layers of explanation will prove amenable to any simple or straightforward, reductive analysis; if we are to unify the many different sciences of addiction while respecting their causal autonomy, then, what we are likely to need is (...) an integrative framework. In this paper, we propose the theory of “Externalist” or “4E” – for extended, embodied, embedded, and enactive – cognition, which focuses on the empirical and conceptual centrality of the wider extra-neural environment to cognitive and mental processes, as a candidate for such a framework. We begin in Section 2 by outlining how such a perspective might apply to psychiatry more generally, before turning to some of the ways it can illuminate addiction in particular: Section 3 points to a way of dissolving the classic dichotomy between the “choice model” and “disease model” in the addiction literature; Section 4 shows how 4E concepts can clarify the interplay between the addict’s brain and her environment; and Section 5 considers how these insights help to explain the success of some recovery strategies, and may help to inform the development of new ones. (shrink)

According to pure imperativism, pain experiences are experiences of a specific phenomenal type that are entirely constituted by imperative content. As their primary argument, proponents of imperativism rely on the biological role that pain experiences fulfill, namely, the motivation of actions whose execution ensures the normal functioning of the body. In the paper, I investigate which specific types of action are of relevance for an imperative interpretation and how close their link to pain experiences actually is. I argue that, although (...) imperative theories constitute an apparently promising version of strong intentionalism, they cannot provide an imperative content that meets their own criteria of both sufficiency and necessity. I further argue that this issue cannot be solved by impure imperative theories either. (shrink)

Philosophers of embodied and situated cognition have provided convincing explanations of what objects do in affective processes (e.g., in emotion regulation). They have often used the concept of 'affective affordance' to account for the affective role of objects but it is not clear how this concept relates to other concepts of affordance, in particular those used in empirical works in cognitive science. We start to fill this gap by providing a new definition of affective affordances and we suggest a possible (...) way to test this novel theoretical construct through a kinematic analysis of hand movements. (shrink)

Remembering and forgetting are the two poles of the memory system. Consequently, any approach to memory should be able to explain both remembering and forgetting in order to gain a comprehensive and insightful understanding of the memory system. Can an enactive approach to memory processes do so? In this article I propose a possible way to provide a positive answer to this question. In line with some current enactive approaches to memory, I suggest that forgetting –similarly to remembering– might be (...) constituted within an embodied and active process. Within this process, some simulation and re-enactment paths would acquire more relevance than others. This acquired relevance would make the activation of other paths of recall less likely, thus preventing the memory system from engaging in some episodic simulations. These changes in the likelihood of activation of some paths of recall –the forgotten ones– can be accounted for in an enactive fashion by studying both “internal” and “external” re-enactment and simulation paths. With regard to the latter, I propose to examine the process of forgetting by considering the engagement and affective relation of an embodied agent with her field of affordances. I suggest that, in the case of emotion-laden memories, the agent’s decoupling from some affordances of the environment might contribute to the process of forgetting, in that it would reduce the agent’s opportunities for situated episodic simulations. (shrink)

We propose a new conceptualization of pain by incorporating advancements made by phenomenologists and cognitive scientists. The biomedical understanding of pain is problematic as it inaccurately endorses a linear relationship between noxious stimuli and pain, and is often dualist or reductionist. From a Cartesian dualist perspective, pain occurs in an immaterial mind. From a reductionist perspective, pain is often considered to be “in the brain.” The biopsychosocial conceptualization of pain has been adopted to combat these problematic views. However, when considering (...) pain research advancements, paired with the work of phenomenologists’ and cognitive scientists’ advanced understanding of perception, the biopsychosocial model is inadequate in many ways. The boundaries between the biological, psychological, and social are artificial, and the model is often applied in a fragmented manner. The model has a limited theoretical foundation, resulting in the perpetuation of dualistic and reductionist beliefs. A new framework may serve to better understand and treat pain. In this paper, we conceptualize pain as a 5E process, arguing that it is: Embodied, Embedded, Enacted, Emotive, and Extended. This perspective is applied using back pain as an exemplar and we explore potential clinical applications. With enactivism at the core of this approach, pain does not reside in a mysterious immaterial mind, nor is it an entity to be found in the blood, brain, or other bodily tissues. Instead, pain is a relational and emergent process of sense-making through a lived body that is inseparable from the world that we shape and that shapes us. (shrink)

Scaffolded Minds offers a novel account of cognitive scaffolding and its significance for understanding mental disorders. The book is part of the growing philosophical engagement with empirically informed philosophy of mind, which studies the interfaces between philosophy and cognitive science. It draws on two recent shifts within empirically informed philosophy of mind: the first, toward an intensified study of the embodied mind; and the second, toward a study of the disordered mind that acknowledges the convergence of the explanatory concerns of (...) psychiatry and interdisciplinary inquiries into the mind. The book sets out to accomplish a dual task: theoretical mapping of cognitive scaffolding; and the application/calibration of fine-grained philosophical distinctions to empirical research. It introduces the notion of actively scaffolded cognition (ASC) and offers a taxonomy that distinguishes between intrasomatic and extrasomatic scaffolding. It then shows that ASC offers a productive framework for considering certain characteristic features of mental disorders, focusing on altered bodily experience and social cognition deficits. (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)

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)

Enactivist Interventions is an interdisciplinary work that explores how theories of embodied cognition illuminate many aspects of the mind, including perception, affect, and action. Gallagher argues that the brain is not secluded from the world or isolated in its own processes, but rather is dynamically connected with body and environment.

Challenging and rewarding in equal measure, _Phenomenology of Perception_ is Merleau-Ponty's most famous work. Impressive in both scope and imagination, it uses the example of perception to return the body to the forefront of philosophy for the first time since Plato. Drawing on case studies such as brain-damaged patients from the First World War, Merleau-Ponty brilliantly shows how the body plays a crucial role not only in perception but in speech, sexuality and our relation to others.

Challenging and rewarding in equal measure, _Phenomenology of Perception_ is Merleau-Ponty's most famous work. Impressive in both scope and imagination, it uses the example of perception to return the _body_ to the forefront of philosophy for the first time since Plato. Drawing on case studies such as brain-damaged patients from the First World War, Merleau-Ponty brilliantly shows how the body plays a crucial role not only in perception but in speech, sexuality and our relation to others. Perhaps above all, Merleau-Ponty's (...) insights about the embodied mind are a bold and refreshing challenge to the new era of virtual reality and artificial intelligence, as scientists and psychologists discover the centrality of the body to mind and intelligence. (shrink)

First published in 1945, Maurice Merleau-Ponty’s monumental _Phénoménologie de la perception _signalled the arrival of a major new philosophical and intellectual voice in post-war Europe. Breaking with the prevailing picture of existentialism and phenomenology at the time, it has become one of the landmark works of twentieth-century thought. This new translation, the first for over fifty years, makes this classic work of philosophy available to a new generation of readers. _Phenomenology of Perception _stands in the great phenomenological tradition of Husserl, (...) Heidegger, and Sartre. Yet Merleau-Ponty’s contribution is decisive, as he brings this tradition and other philosophical predecessors, particularly Descartes and Kant, to confront a neglected dimension of our experience: the lived body and the phenomenal world. Charting a bold course between the reductionism of science on the one hand and "intellectualism" on the other, Merleau-Ponty argues that we should regard the body not as a mere biological or physical unit, but as the body which structures one’s situation and experience within the world. Merleau-Ponty enriches his classic work with engaging studies of famous cases in the history of psychology and neurology as well as phenomena that continue to draw our attention, such as phantom limb syndrome, synaesthesia, and hallucination. This new translation includes many helpful features such as the reintroduction of Merleau-Ponty’s discursive Table of Contents as subtitles into the body of the text, a comprehensive Translator’s Introduction to its main themes, essential notes explaining key terms of translation, an extensive Index, and an important updating of Merleau-Ponty’s references to now available English translations. Also included is a new foreword by Taylor Carman and an introduction to Merleau-Ponty_ _by Claude Lefort. Translated by Donald A. Landes. (shrink)

How the Body Shapes the Mind is an interdisciplinary work that addresses philosophical questions by appealing to evidence found in experimental psychology, neuroscience, studies of pathologies, and developmental psychology. There is a growing consensus across these disciplines that the contribution of embodiment to cognition is inescapable. Because this insight has been developed across a variety of disciplines, however, there is still a need to develop a common vocabulary that is capable of integrating discussions of brain mechanisms in neuroscience, behavioural expressions (...) in psychology, design concerns in artificial intelligence and robotics, and debates about embodied experience in the phenomenology and philosophy of mind. Shaun Gallagher's book aims to contribute to the formulation of that common vocabulary and to develop a conceptual framework that will avoid both the overly reductionistic approaches that explain everything in terms of bottom-up neuronal mechanisms, and inflationistic approaches that explain everything in terms of Cartesian, top-down cognitive states. Gallagher pursues two basic sets of questions. The first set consists of questions about the phenomenal aspects of the structure of experience, and specifically the relatively regular and constant features that we find in the content of our experience. If throughout conscious experience there is a constant reference to one's own body, even if this is a recessive or marginal awareness, then that reference constitutes a structural feature of the phenomenal field of consciousness, part of a framework that is likely to determine or influence all other aspects of experience. The second set of questions concerns aspects of the structure of experience that are more hidden, those that may be more difficult to get at because they happen before we know it. They do not normally enter into the content of experience in an explicit way, and are often inaccessible to reflective consciousness. To what extent, and in what ways, are consciousness and cognitive processes, which include experiences related to perception, memory, imagination, belief, judgement, and so forth, shaped or structured by the fact that they are embodied in this way? (shrink)

We are even less aware of our internal organs and the physiological processes that keep us alive. In this fascinating work, Drew Leder examines all the ways in which the body is absent—forgotten, alien, uncontrollable, obscured.

In this paper we focus on what is referred to as the ‘mineness’ of experience, that is, the intimate familiarity we have with our own thoughts, perceptions, and emotions. Most accounts characterize mineness in terms of an experiential dimension, the first-person givenness of experience, that is subsumed under the notion of minimal self-consciousness or a ‘minimal self’. We argue that this account faces problems and develop an alternative account of mineness in terms of the coherence of experiences with what we (...) label an ‘embodied biography’. Building on a near consensus among consciousness researchers over the function of consciousness as integrating infor- mation, we argue that the phenomenology of mineness consists in the absence of any further thought on top of the experience itself. Finally we argue that this non-phenomenological account of mineness fits well with existing data on pathologies of mineness such as delusions of thought insertion. (shrink)

How physicians approach patients and the problems they present is much influenced by the conceptual models around which their knowledge is organized. In this paper the implications of the biopsychosocial model for the study and care of a patient with an acute myocardial infarction are presented and contrasted with approaches used by adherents of the more traditional biomedical model. CiteULike Connotea Del.icio.us What's this?

It has been argued that affordances are not meaningful and are thus not useful to be applied in contexts where specifically meaningfulness of experience is at stake (e.g. clinical contexts or discussions of autonomous agency). This paper aims to reconceptualize affordances such as to make them relevant and applicable in such contexts. It starts by investigating the ‘ambiguity’ of (possibilities for) action. In both philosophy of action and affordance research, this ambiguity is typically resolved by adhering to the agents intentions (...) and concerns. I discuss some recent accounts of affordances that highlight these concerns but argue that they tend to adopt an ‘atomistic’ approach where there is no acknowledgement of how these concerns are embedded in the agents wider concerns, values, projects and commitments. An holistic approach that does acknowledge this can be found in psychological research on agents having a sense of what they’re doing. I will discuss this research in the second part of the paper and argue that agents can analogously have a sense of what is afforded. This is deemed the entry point for understanding the meaningfulness of affordances. In the final part of the paper I apply this analysis to recent attempts which seek to make sense of authentic and autonomous agency in terms of affordances. (shrink)

I argue that a variety of physical disabilities, and neurological and psychiatric disorders can be understood in terms of changes to the subject’s affordance space. Understanding disorders in this way also has some implications for therapy. On the basis of a phenomenological- and pragmatist-inspired enactivism I propose an affordance-based approach to therapy with a focus on changing physical, social, and cultural environments, and I consider the role of virtual and mixed realities in this context.

In What the Body Commands, Colin Klein proposes and defends a novel theory of pain. Klein argues that pains are imperative; they are sensations with a content, and that content is a command to protect the injured part of the body. He terms this view "imperativism about pain," and argues that imperativism can account for two puzzling features of pain: its strong motivating power and its uninformative nature. Klein argues that the biological purpose of pain is homeostatic; like hunger and (...) thirst, pain helps solve a challenge to bodily integrity. It does so by motivating you to act in ways that help the body recover. If you obey pain's command, you get better. He develops his account to handle a variety of pain phenomena and applies it to solve a number of historically puzzling cases. Klein's intent is to defend the imperativist view in a pure form -- without requiring pain to represent facts about the world.Klein presents a model of imperative content showing that intrinsically motivating sensations are best understood as imperatives, and argues that pain belongs to this class. He considers the distinction between pain and suffering; explains how pain motivates; addresses variations among pains; and offers an imperativist account of maladaptive pains, pains that don't appear to hurt, masochism, and why pain feels bad. (shrink)

This comprehensive new book introduces the core history of phenomenology and assesses its relevance to contemporary psychology, philosophy of mind, and cognitive science. From critiques of artificial intelligence research programs to ongoing work on embodiment and enactivism, the authors trace how phenomenology has produced a valuable framework for analyzing cognition and perception, whose impact on contemporary psychological and scientific research, and philosophical debates continues to grow. The first part of _An Introduction to Phenomenology_ is an extended overview of the history (...) and development of phenomenology, looking at its key thinkers, focusing particularly on Husserl, Heidegger and Merleau-Ponty, as well as its cultural and intellectual precursors. In the second half Chemero and Käufer turn their attention to the contemporary interpretations and uses of phenomenology in cognitive science, showing that phenomenology is a living source of inspiration in contemporary interdisciplinary studies of the mind. Käufer and Chemero have written a clear, jargon-free account of phenomenology, providing abundant examples and anecdotes to illustrate and to entertain. This book is an ideal introduction to phenomenology and cognitive science for the uninitiated, as well as for philosophy and psychology students keen to deepen their knowledge. (shrink)

Following a brief reconstruction of Hutto & Satne’s paper we focus our critical comments on two issues. First we take up H&S’s claim that a non-representational form of ur-intentionality exists that performs essential work in setting the scene for content-involving forms of intentionality. We will take issue with the characterisation that H&S give of this non-representational form of intentionality. Part of our commentary will therefore be aimed at motivating an alternative account of how there can be intentionality without mental content, (...) which we have called skilled intentionality. Skilled intentionality is the individual’s selective openness and responsiveness to a rich landscape of affordances.A second issue we take up concerns the distinction between ur-intentionality and content-involving intentionality. We will argue that our notion of skilled intentionality as it is found in humans cuts across these two categories. Instead of distinguishing between different forms of intentionality we recommend focusing on how skilled intentionality takes different forms in different forms of life. (shrink)

This article develops a phenomenological exploration of chronic pain from a first-person perspective that can serve to enrich the medical third-person perspective. The experience of chronic pain is found to be a feeling in which we become alienated from the workings of our own bodies. The bodily-based mood of alienation is extended, however, in penetrating the whole world of the chronic pain sufferer, making her entire life unhomelike. Furthermore, the pain mood not only opens up the world as having an (...) alien quality, it also makes the world more lonesome and poor by forcing the sufferer to attend to the workings of her own body. To suffer pain is to find oneself in a situation of passivity in relation to the hurtful experiences one is undergoing. In making the body and the world more unhomelike places to be in, pain also tends to rob a person of her language. Severe pain is hard to describe because it pushes the person towards the borderlines of imaginable experience and because it makes it hard to see any meaning and purpose in the situation one has been forced into. The analysis of chronic pain in the article is guided by the attempts made by Maurice Merleau-Ponty, Jean-Paul Sartre, and Martin Heidegger to understand the nature of human embodiment and existence, and also by descriptions of chronic pain found in the Swedish author Lars Gustafsson’s novel The Death of a Beekeeper. (shrink)

In 1937, John Dewey delivered a lecture to the College of Physicians in Saint Louis. His clear message was that in the practice of medicine it does not suffice for physicians to treat just the body, or to look to just the body for the mechanism of disease. Emphasizing the relational nature of organism-environment, he argued that the physician must treat the whole patient and must therefore consider the environment of the patient. It makes no sense, he suggested, to provide (...) medicine to address a problem with the patient's lungs and then to send him back into the coal mine. As he put it: "We must observe and understand internal processes and their interactions from the standpoint of their interactions with what is... (shrink)

Major depression is a prevalent mental disorder that leads to persistent negative mood and tremendous suffering in affected individuals. However, the biological realization of this disorder and associated symptom clusters remain poorly understood. Recently, phenomenological accounts of major depressive disorder and contributions to the emerging predictive processing account have provided valuable insights into the phenomenological and neuro-functional components that lead to manifestations of major depressive episodes. The purpose of this paper is to weave together these different strands of research to (...) develop a predictive processing account of major depressive disorder. In doing so, I will relate personal-level descriptions of associated phenomenal experiences to a sub-personal-level predictive processing account of the functional realization of major depression. I will argue that pervasive symptoms of the disorder, which include a diminished sense of agency, fatigue, social withdrawal, and rumination, are integrated by existential feelings of loss and impossibility. These phenomenal experiences, I will argue, are associated with dysfunctional processes of prediction error minimization, which are characterized by an overall decrease of the causal contributions of active inference and by distorted precision estimates. The emerging account promises to contribute to a better understanding of the complex processes that give rise to depressive experiences. (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)

I examine what happens in the brain when patients experience chronic pain and when subjects are addicted to alcohol. We can find important parallels between these two cases, and these parallels can perhaps point us toward new ways of treating (or at least understanding) both issues. Interestingly, we can understand both cases as our pleasure system gone awry. In brief, I argue that chronic pain and alcohol addiction both stem from a dysregulation in our brain’s reward structure. This dysregulation in (...) what should be our pleasure circuitry pushes individuals to behave in ways counterproductive to their needs and to feel unpleasant things. In other words, there is likely both something quite right and perhaps quite wrong about how some philosophers are thinking about pain as an evaluative state. I shall be arguing that pain is both hedonic and evaluative, though perhaps not in the ways they are imagining. (shrink)

A distinguishing characteristic of the biomedical model is its compartmentalized view of man. This way of seeing human beings has its origin in Greek thought; it was stated by Descartes and to this day it still considers humans as beings composed of distinct entities combined into a certain form. Because of this observation, one began to believe that the focus of a health treatment could be exclusively on the affected area of the body, without the need to pay attention to (...) patient’s subjectivity. By seeing pain as a merely sensory response, this model was not capable of encompassing chronic pain, since the latter is a complex process that can occur independently of tissue damage. As of the second half of the twentieth century, when it became impossible to deny the relationship between psyche and soma, the current understanding of chronic pain emerges: that of chronic pain as an individual experience, the result of a sum of physical, psychological, and social factors that, for this reason, cannot be approached separately from the individual who expresses pain. This understanding has allowed a significant improvement in perspective, emphasizing the characteristic of pain as an individual experience. However, the understanding of chronic pain as a sum of factors corresponds to the current way of seeing the process of falling ill, for its conception holds a Cartesian duality and the positivist premise of a single reality. For phenomenology, on the other hand, the individual in his/her unity is more than a simple sum of parts. Phenomenology sees a human being as an intending entity, in which body, mind, and the world are intertwined and constitute each other mutually, thus establishing the human being’s integral functioning. Therefore, a real understanding of the chronic pain process would only be possible from a phenomenological point of view at the experience lived by the individual who expresses and communicates pain. (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)

The need for a model -- Currently available models in psychiatry -- Introduction to enactivism -- Body and mind - and world -- The existential dimension and its role in psychiatry -- Enriched enactivism : existential sense-making, values, and socio-cultural worlds -- Enactive psychiatry : psychiatric disorders are disorders of sense-making -- An enactive approach to causes, diagnosis and treatment of psychiatric disorders.

In the last 50 years, discussions of how to understand disability have been dominated by the medical and social models. Paradoxically, both models overlook the disabled person’s experience of the lived body, thus reducing the body of the disabled person to a physiological body. In this article we introduce what we call the Ecological-Enactive (EE) model of disability. The EE-model combines ideas from enactive cognitive science and ecological psychology with the aim of doing justice simultaneously to the lived experience of (...) being disabled, and the physiological dimensions of disability. More specifically, we put the EE model to work to disentangle the concepts of disability and pathology. We locate the difference between pathological and normal forms of embodiment in the person’s capacity to adapt to changes in the environment. To ensure that our discussion remains in contact with lived experience, we draw upon phenomenological interviews we have carried out with people with Cerebral Palsy. (shrink)