Brains, it has recently been argued, are essentially prediction machines. They are bundles of cells that support perception and action by constantly attempting to match incoming sensory inputs with top-down expectations or predictions. This is achieved using a hierarchical generative model that aims to minimize prediction error within a bidirectional cascade of cortical processing. Such accounts offer a unifying model of perception and action, illuminate the functional role of attention, and may neatly capture the special contribution of cortical processing to (...) adaptive success. This target article critically examines this approach, concluding that it offers the best clue yet to the shape of a unified science of mind and action. Sections 1 and 2 lay out the key elements and implications of the approach. Section 3 explores a variety of pitfalls and challenges, spanning the evidential, the methodological, and the more properly conceptual. The paper ends (sections 4 and 5) by asking how such approaches might impact our more general vision of mind, experience, and agency. (shrink)

An exciting theory in neuroscience is that the brain is an organ for prediction error minimization. This theory is rapidly gaining influence and is set to dominate the science of mind and brain in the years to come. PEM has extreme explanatory ambition, and profound philosophical implications. Here, I assume the theory, briefly explain it, and then I argue that PEM implies that the brain is essentially self-evidencing. This means it is imperative to identify an evidentiary boundary between the brain (...) and its environment. This boundary defines the mind-world relation, opens the door to skepticism, and makes the mind transpire as more inferentially secluded and neurocentrically skull-bound than many would nowadays think. Therefore, PEM somewhat deflates contemporary hypotheses that cognition is extended, embodied and enactive; however, it can nevertheless accommodate the kinds of cases that fuel these hypotheses. (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.

A novel theoretical framework for an embodied, non-representational approach to language that extends and deepens enactive theory, bridging the gap between sensorimotor skills and language. -/- Linguistic Bodies offers a fully embodied and fully social treatment of human language without positing mental representations. The authors present the first coherent, overarching theory that connects dynamical explanations of action and perception with language. Arguing from the assumption of a deep continuity between life and mind, they show that this continuity extends to language. (...) Expanding and deepening enactive theory, they offer a constitutive account of language and the co-emergent phenomena of personhood, reflexivity, social normativity, and ideality. Language, they argue, is not something we add to a range of existing cognitive capacities but a new way of being embodied. Each of us is a linguistic body in a community of other linguistic bodies. The book describes three distinct yet entangled kinds of human embodiment, organic, sensorimotor, and intersubjective; it traces the emergence of linguistic sensitivities and introduces the novel concept of linguistic bodies; and it explores the implications of living as linguistic bodies in perpetual becoming, applying the concept of linguistic bodies to questions of language acquisition, parenting, autism, grammar, symbol, narrative, and gesture, and to such ethical concerns as microaggression, institutional speech, and pedagogy. (shrink)

There is a new way of thinking about the mind that does not locate mental processes exclusively "in the head." Some think that this expanded conception of the mind will be the basis of a new science of the mind. In this book, leading philosopher Mark Rowlands investigates the conceptual foundations of this new science of the mind. The new way of thinking about the mind emphasizes the ways in which mental processes are embodied, embedded, enacted, and extended. The new (...) way of thinking about the mind, Rowlands writes, is actually an old way of thinking that has taken on new form. Rowlands describes a conception of mind that had its clearest expression in phenomenology -- in the work of Husserl, Heidegger, Sartre, and Merleau-Ponty. He builds on these views, clarifies and renders consistent the ideas of embodied, embedded, enacted, and extended mind, and develops a unified philosophical treatment of the novel conception of the mind that underlies the new science of the mind. (shrink)

A fascinating exploration of the very essence of life itself sheds new light on the order and evolution in complex life systems and defines and explains autonomous agents and work within the contexts of thermodynamics and information theory, setting the stage for a dramatic technological revolution. 50,000 first printing.

Predictive processing (PP) is now a prominent theoretical framework in the philosophy of mind and cognitive science. This review focuses on PP research with a relatively philosophical focus, taking stock of the framework and discussing new directions. The review contains an introduction that describes the full PP toolbox; an exploration of areas where PP has advanced understanding of perceptual and cognitive phenomena; a discussion of PP's impact on foundational issues in cognitive science; and a consideration of the philosophy of science (...) of PP. The overall picture is that PP is a fruitful framework, with exciting new directions awaiting exploration. (shrink)

As yet, there is no enactive account of social cognition. This paper extends the enactive concept of sense-making into the social domain. It takes as its departure point the process of interaction between individuals in a social encounter. It is a well-established finding that individuals can and generally do coordinate their movements and utterances in such situations. We argue that the interaction process can take on a form of autonomy. This allows us to reframe the problem of social cognition as (...) that of how meaning is generated and transformed in the interplay between the unfolding interaction process and the individuals engaged in it. The notion of sense-making in this realm becomes participatory sense-making. The onus of social understanding thus moves away from strictly the individual only. (shrink)

Shaun Gallagher presents a ground-breaking interdisciplinary account of action. He shows that in order to understand human agency and the aspects of mind that are associated with it, we need to grasp the crucial role of context or circumstance in action, and the normative constraints of social and cultural practices.

In this paper, we argue for a theoretical separation of the free-energy principle from Helmholtzian accounts of the predictive brain. The free-energy principle is a theoretical framework capturing the imperative for biological self-organization in information-theoretic terms. The free-energy principle has typically been connected with a Bayesian theory of predictive coding, and the latter is often taken to support a Helmholtzian theory of perception as unconscious inference. If our interpretation is right, however, a Helmholtzian view of perception is incompatible with Bayesian (...) predictive coding under the free-energy principle. We argue that the free energy principle and the ecological and enactive approach to mind and life make for a much happier marriage of ideas. We make our argument based on three points. First we argue that the free energy principle applies to the whole animal–environment system, and not only to the brain. Second, we show that active inference, as understood by the free-energy principle, is incompatible with unconscious inference understood as analagous to scientific hypothesis-testing, the main tenet of a Helmholtzian view of perception. Third, we argue that the notion of inference at work in Bayesian predictive coding under the free-energy principle is too weak to support a Helmholtzian theory of perception. Taken together these points imply that the free energy principle is best understood in ecological and enactive terms set out in this paper. (shrink)

The aim of this paper is twofold: (1) to assess whether the construct of neural representations plays an explanatory role under the variational free-energy principle and its corollary process theory, active inference; and (2) if so, to assess which philosophical stance - in relation to the ontological and epistemological status of representations - is most appropriate. We focus on non-realist (deflationary and fictionalist-instrumentalist) approaches. We consider a deflationary account of mental representation, according to which the explanatorily relevant contents of neural (...) representations are mathematical, rather than cognitive, and a fictionalist or instrumentalist account, according to which representations are scientifically useful fictions that serve explanatory (and other) aims. After reviewing the free-energy principle and active inference, we argue that the model of adaptive phenotypes under the free-energy principle can be used to furnish a formal semantics, enabling us to assign semantic content to specific phenotypic states (the internal states of a Markovian system that exists far from equilibrium). We propose a modified fictionalist account: an organism-centered fictionalism or instrumentalism. We argue that, under the free-energy principle, pursuing even a deflationary account of the content of neural representations licenses the appeal to the kind of semantic content involved in the aboutness or intentionality of cognitive systems; our position is thus coherent with, but rests on distinct assumptions from, the realist position. We argue that the free-energy principle thereby explains the aboutness or intentionality in living systems and hence their capacity to parse their sensory stream using an ontology or set of semantic factors. (shrink)

The concept of agency is of crucial importance in cognitive science and artificial intelligence, and it is often used as an intuitive and rather uncontroversial term, in contrast to more abstract and theoretically heavy-weighted terms like “intentionality”, “rationality” or “mind”. However, most of the available definitions of agency are either too loose or unspecific to allow for a progressive scientific program. They implicitly and unproblematically assume the features that characterize agents, thus obscuring the full potential and challenge of modeling agency. (...) We identify three conditions that a system must meet in order to be considered as a genuine agent: a) a system must define its own individuality, b) it must be the active source of activity in its environment (interactionalasymmetry) and c) it must regulate this activity in relation to certain norms (normativity). We find that even minimal forms of proto-celular systems can already provide a paradigmatic example of genuine agency. By abstracting away some specific details of minimal models of living agency we define the kind of organization that is capable to meet the required conditions for agency (which is not restricted to living organisms). On this basis, we define agency as an autonomous organization that adaptively regulates its coupling with its environment and contributes to sustaining itself as a consequence. We find that spatiality and temporality are the two fundamental domains in which agency spans at different scales. We conclude by giving an outlook to the road that lies ahead in the pursuit to understand, model and synthesis agents. (shrink)

A proposal for the biological grounding of intrinsic teleology and sense-making through the theory of autopoiesis is critically evaluated. Autopoiesis provides a systemic language for speaking about intrinsic teleology but its original formulation needs to be elaborated further in order to explain sense-making. This is done by introducing adaptivity, a many-layered property that allows organisms to regulate themselves with respect to their conditions of viability. Adaptivity leads to more articulated concepts of behaviour, agency, sense-construction, health, and temporality than those given (...) so far by autopoiesis and enaction. These and other implications for understanding the organismic generation of values are explored. (shrink)

Predictive processing approaches to the mind are increasingly popular in the cognitive sciences. This surge of interest is accompanied by a proliferation of philosophical arguments, which seek to either extend or oppose various aspects of the emerging framework. In particular, the question of how to position predictive processing with respect to enactive and embodied cognition has become a topic of intense debate. While these arguments are certainly of valuable scientific and philosophical merit, they risk underestimating the variety of approaches gathered (...) under the predictive label. Here, we first present a basic review of neuroscientific, cognitive, and philosophical approaches to PP, to illustrate how these range from solidly cognitivist applications—with a firm commitment to modular, internalistic mental representation—to more moderate views emphasizing the importance of ‘body-representations’, and finally to those which fit comfortably with radically enactive, embodied, and dynamic theories of mind. Any nascent predictive processing theory must take into account this continuum of views, and associated theoretical commitments. As a final point, we illustrate how the Free Energy Principle attempts to dissolve tension between internalist and externalist accounts of cognition, by providing a formal synthetic account of how internal ‘representations’ arise from autopoietic self-organization. The FEP thus furnishes empirically productive process theories by which to guide discovery through the formal modelling of the embodied mind. (shrink)

This book is forthcoming in Routledge. Here is the barest sketch of our aims: -/- We have two aims in this book. First, we aim to persuade you that conscious experience is sometimes realised by cycles of embodied and world-involving engagement. Second, we aim to persuade you that it is possible to develop and defend the thesis of extended consciousness through the increasingly powerful predictive processing theory developed in cognitive neuroscience.

The processes underwriting the acquisition of culture remain unclear. How are shared habits, norms, and expectations learned and maintained with precision and reliability across large-scale sociocultural ensembles? Is there a unifying account of the mechanisms involved in the acquisition of culture? Notions such as “shared expectations,” the “selective patterning of attention and behaviour,” “cultural evolution,” “cultural inheritance,” and “implicit learning” are the main candidates to underpin a unifying account of cognition and the acquisition of culture; however, their interactions require greater (...) specification and clarification. In this article, we integrate these candidates using the variational (free-energy) approach to human cognition and culture in theoretical neuroscience. We describe the construction by humans of social niches that afford epistemic resources called cultural affordances. We argue that human agents learn the shared habits, norms, and expectations of their culture through immersive participation in patterned cultural practices that selectively pattern attention and behaviour. We call this process “thinking through other minds” (TTOM) – in effect, the process of inferring other agents’ expectations about the world and how to behave in social context. We argue that for humans, information from and about other people's expectations constitutes the primary domain of statistical regularities that humans leverage to predict and organize behaviour. The integrative model we offer has implications that can advance theories of cognition, enculturation, adaptation, and psychopathology. Crucially, this formal (variational) treatment seeks to resolve key debates in current cognitive science, such as the distinction between internalist and externalist accounts of theory of mind abilities and the more fundamental distinction between dynamical and representational accounts of enactivism. (shrink)

In the last 60,000 years humans have expanded across the globe and now occupy a wider range than any other terrestrial species. Our ability to successfully adapt to such a diverse range of habitats is often explained in terms of our cognitive ability. Humans have relatively bigger brains and more computing power than other animals and this allows us to figure out how to live in a wide range of environments. Here we argue that humans may be smarter than other (...) creatures, but none of us is nearly smart enough to acquire all of the information necessary to survive in any single habitat. In even the simplest foraging societies, people depend on a vast array of tools, detailed bodies of local knowledge, and complex social arrangements, and often do not understand why these tools, beliefs, and behaviors are adaptive. We owe our success to our uniquely-developed ability to learn from others. This capacity enables humans to gradually accumulate information across generations, and develop well-adapted tools, beliefs, and practices that are too complex for any single individual to invent during their lifetime. (shrink)

Explaining agency is a significant challenge for those who are interested in the sciences of the mind, and non-representationalists are no exception to this. Even though both ecological psychologists and enactivists agree that agency is to be explained by focusing on the relation between the organism and the environment, they have approached it by focusing on different aspects of the organism-environment relation. In this paper, I offer a suggestion for a radical embodied account of agency that combines ecological psychology with (...) recent trends in enactive cognitive science. According to this proposal, while enactivism focuses primarily on describing how our acquired sensorimotor schemes and habits mutually equilibrate, affecting our tendency to act upon some affordances instead of others, ecological psychology focuses on studying how perceptual information contributes to the actualization of the sensorimotor schemes and habits without mediating representations, inferences, and computations. The paper concludes by briefly exploring how this ecological-enactive theory of agency can account for how socio-cultural norms shape human agency. (shrink)

Psychiatry is enormously complex. One of its main difficulties is how to connect the wide diversity of factors that may cause or contribute to the problems at hand, factors ranging from traumatic experiences, dysfunctional neurotransmitters, existential worries, economic deprivation, and social exclusion, to genetic bad luck. Interventions are also diverse, with options including chemical or electrical treatment, therapies aimed at behavior change and those promoting insight. Much is still unknown: what are the causal pathways, which interventions work best for which (...) patients and why?In practice, many mental health care professionals work holistically in a pragmatic and eclectic way. Without using any explicit... (shrink)

In recent years, the societal and personal impacts of pain, and the fact that we still lack an effective method of treatment, has motivated researchers from diverse disciplines to try to think in new ways about pain and its management. In this paper, we aim to develop an enactive approach to pain and the transition to chronicity. Two aspects are central to this project. First, the paper conceptualizes differences between acute and chronic pain, as well as the dynamic process of (...) pain chronification, in terms of changes in the field of affordances. This is, in terms of the possibilities for action perceived by subjects in pain. As such, we aim to do justice to the lived experience of patients as well as the dynamic role of behavioral learning, neural reorganization, and socio-cultural practices in the generation and maintenance of pain. Second, we aim to show in which manners such an enactive approach may contribute to a comprehensive understanding of pain that avoids conceptual and methodological issues of reductionist and fragmented approaches. It proves particularly beneficial as a heuristic in pain therapy addressing the heterogenous yet dynamically intertwined aspects that may contribute to pain and its chronification. (shrink)

The recent distinction between sense of agency and sense of body-ownership has attracted considerable empirical and theoretical interest. The respective contributions of central motor signals and peripheral afferent signals to these two varieties of body experience remain unknown. In the present review, we consider the methodological problems encountered in the empirical study of agency and body-ownership, and we then present a series of experiments that study the interplay between motor and sensory information. In particular, we focus on how multisensory signals (...) interact with body representations to generate the sense of body-ownership, and how the sense of agency modulates the sense of body-ownership. Finally, we consider the respective roles of efferent and afferent signals for the experience of one’s own body and actions, in relation to self-recognition and the recognition of other people’s actions. We suggest that the coherent experience of the body depends on the integration of efferent information with afferent information in action contexts. Overall, whereas afferent signals provide the distinctive content of one’s own body experience, efferent signals seem to structure the experience of one’s own body in an integrative and coherent way. (shrink)

According to the free energy principle all living systems aim to minimise free energy in their sensory exchanges with the environment. Processes of free energy minimisation are thus ubiquitous in the biological world. Indeed it has been argued that even plants engage in free energy minimisation. Not all living things however feel alive. How then did the feeling of being alive get started? In line with the arguments of the phenomenologists, I will claim that every feeling must be felt by (...) someone. It must have mineness built into it if it is to feel a particular way. The question I take up in this paper asks how mineness might have arisen out of processes of free energy minimisation, given that many systems that keep themselves alive lack mineness. The hypothesis I develop in this paper is that the life of an organism can be seen as an inferential process. Every living system embodies a probability distribution conditioned on a model of the sensory, physiological, and morphological states that are highly probably given the life it leads and the niche it inhabits. I argue for an ecological and enactive interpretation of free energy. I show how once the life of an organism reaches a certain level of complexity mineness emerges as an intrinsic part of the process of life itself. (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)

One of the criteria to a strong principle in natural sciences is simplicity. This paper claims that the Free Energy Principle (FEP), by virtue of unifying particles with mind, is the simplest. Motivated by Hilbert’s 24th problem of simplicity, the argument is made that the FEP takes a seemingly mathematical complex domain and reduces it to something simple. More specifically, it is attempted to show that every ‘thing’, from particles to mind, can be partitioned into systemic states by virtue of (...) self-organising symmetry break, i.e. self-entropy in terms of the balance between risk and ambiguity to achieve epistemic gain. By virtue of its explanatory reach, the FEP becomes the simplest principle under quantum, statistical and classical mechanics conditions. (shrink)

Recent theoretical work in developmental psychology suggests that humans are predisposed to align their mental states with those of other individuals. One way this manifests is in cooperative communication ; that is, intentional communication aimed at aligning individuals’ mental states with respect to events in their shared environment. This idea has received strong empirical support. The purpose of this paper is to extend this account by proposing an integrative model of the biobehavioral dynamics of cooperative communication. Our formulation is based (...) on active inference. Active inference suggests that action-perception cycles operate to minimize uncertainty and optimize an individual’s internal model of the world. We propose that humans are characterized by an evolved adaptive prior belief that their mental states are aligned with, or similar to, those of conspecifics (i.e., that ‘we are the same sort of creature, inhabiting the same sort of niche’). The use of cooperative communication emerges as the principal means to gather evidence for this belief, allowing for the development of a shared narrative that is used to disambiguate interactants’ (hidden and inferred) mental states. Thus, by using cooperative communication, individuals effectively attune to a hermeneutic niche composed, in part, of others’ mental states; and, reciprocally, attune the niche to their own ends via epistemic niche construction. This means that niche construction enables features of the niche to encode precise, reliable cues about the deontic or shared value of certain action policies (e.g., the utility of using communicative constructions to disambiguate mental states, given expectations about shared prior beliefs). In turn, the alignment of mental states (prior beliefs) enables the emergence of a novel, contextualizing scale of cultural dynamics that encompasses the actions and mental states of the ensemble of interactants and their shared environment. The dynamics of this contextualizing layer of cultural organization feedback, across scales, to constrain the variability of the prior expectations of the individuals who constitute it. Our theory additionally builds upon the active inference literature by introducing a new set of neurobiologically plausible computational hypotheses for cooperative communication. We conclude with directions for future research. (shrink)

This paper deals with the question of agency and intentionality in the context of the free-energy principle. The free-energy principle is a system-theoretic framework for understanding living self-organizing systems and how they relate to their environments. I will first sketch the main philosophical positions in the literature: a rationalist Helmholtzian interpretation (Hohwy 2013; Clark 2013), a cybernetic interpretation (Seth 2015b) and the enactive affordance-based interpretation (Bruineberg and Rietveld 2014; Bruineberg et al. 2016) and will then show how agency and intentionality (...) are construed differently on these different philosophical interpretations. I will then argue that a purely Helmholtzian is limited, in that it can account only account for agency in the context of perceptual inference. The cybernetic account cannot give a full account of action, since purposiveness is accounted for only to the extent that it pertains to the control of homeostatic essential variables. I will then argue that the enactive affordance-based account attempts to provide broader account of purposive action without presupposing goals and intentions coming from outside of the theory. In the second part of the paper, I will discuss how each of these three interpretations conceives of the sense agency and intentionality in different ways. (shrink)

In this paper, we address reports of “selfless” experiences from the perspective of active inference and predictive processing. Our argument builds upon grounding self-modelling in active inference as action planning and precision control within deep generative models – thus establishing a link between computational mechanisms and phenomenal selfhood. We propose that “selfless” experiences can be interpreted as cases in which normally congruent processes of computational and phenomenal self-modelling diverge in an otherwise conscious system. We discuss two potential mechanisms – within (...) the Bayesian mechanics of active inference – that could lead to such a divergence by attenuating the experience of selfhood: “self-flattening” via reduction in the depth of active inference and “self-attenuation” via reduction of the expected precision of self-evidence. (shrink)

In this paper, I argue for an embodied, embedded approach to predictive processing and thus align the framework with situated cognition. The recent popularity of theories conceiving of the brain as a predictive organ has given rise to two broad camps in the literature that I callfree energy enactivismandcognitivist predictive processing. The two approaches vary in scope and methodology. The scope ofcognitivist predictive processingis narrow and restricts cognition to brain processes and structures; it does not consider the body-beyond-brain and the (...) environment as constituents of cognitive processes.Free energy enactivism, on the other hand, includes all self-organizing systems that minimize free energy (including non-living systems) and thus does not offer any unique explanations for more complex cognitive phenomena that are unique to human cognition. Furthermore, because of its strong commitment to the mind-life continuity thesis, it does not provide an explanation of what distinguishes more sophisticated cognitive systems from simple systems. The account that I develop in this paper rejects both of these radical extremes. Instead, I propose a compromise that highlights the necessary components of predictive processing by making use of a mechanistic methodology of explanation. The starting point of the argument in this paper is that despite the interchangeable use of the terms, prediction error minimization and the free energy principle are not identical. But this distinction does not need to disrupt thestatus quoof the literature if we consider an alternative approach: Embodied, Embedded Predictive Processing (EEPP). EEPP accommodates the free energy principle, as argued for by free energy enactivism, but it also allows for mental representations in its explanation of cognition. Furthermore, EEPP explains how prediction error minimization is realized but, unlike cognitivist PP, it allocates a constitutive role to the body in cognition. Despite highlighting concerns regarding cognitivist PP, I do not wish to discredit the role of the neural domain or representations as free energy enactivism does. Neural structures and processes undeniably contribute to the minimization of prediction error but the role of the body is equally important. On my account, prediction error minimization and free energy minimization are deeply dependent on the body of an agent, such that the body-beyond-brain plays aconstitutiverole in cognitive processing. I suggest that the body plays three constitutive roles in prediction error minimization: The bodyregulatescognitive activity, ensuring that cognition and action are intricately linked. The body acts asdistributorin the sense that it carries some of the cognitive load by fulfilling the function of minimizing prediction error. Finally, the body serves toconstrainthe information that is processed by an agent. In fulfilling these three roles, the agent and environment enter into a bidirectional relation through influencing and modeling the structure of the other. This connects EEPP to the free energy principle because the whole embodied agent minimizes free energy in virtue of being a model of its econiche. This grants the body a constitutive role as part of the collection of mechanisms that minimize prediction error and free energy. The body can only fulfill its role when embedded in an environment, of which it is a model. In this sense, EEPP offers the most promising alternative to cognitivist predictive processing and free energy enactivism. (shrink)

Until recently, the medical community assumed that placebos required either concealment in randomized controlled trials or deception in clinical practice to elicit placebo effects. Henry Beecher emphasized this orthodoxy, when he stated that placebo pills only work "as long as it is not detected as a placebo by the subject or the observer" and therefore, patients "believe it [is a drug] and consequently the expected results occurs". The time was ripe for such ideas: Norman Vincent Peale's The Power of Positive (...) Thinking was already in its fourth year on the bestseller list when Beecher published his landmark paper. As time went on, the use of placebo pills became trapped in an... (shrink)

Tschacher and Haken have recently applied a systems-based approach to modeling psychotherapy process in terms of potentially beneficial tendencies toward deterministic as well as chaotic forms of change in the client’s behavioral, cognitive and affective experience during the course of therapy. A chaotic change process refers to a greater exploration of the states that a client can be in, and it may have a potential positive role to play in their development. A distinction is made between on the one hand, (...) specific instances of instability which are due to techniques employed by the therapist, and on the other, a more general instability which is due to the therapeutic relationship, and a key, necessary result of a successful therapeutic alliance. Drawing on Friston’s systems-based model of free energy minimization and predictive coding, it is proposed here that the increase in the instability of a client’s functioning due to therapy can be conceptualized as a reduction in the precisions with which the client’s prior beliefs about themselves and their world, are held. It is shown how a good therapeutic alliance results in the emergence of a new hierarchical level in the client’s generative model of themselves and their relationship with the world. The emergence of this new level of functioning permits the reduction of the precisions of the client’s priors, which allows the client to ‘open up’: to experience thoughts, emotions and experiences they did not have before. It is proposed that this process is a necessary precursor to change due to psychotherapy. A good consilience can be found between this approach to understanding the role of the therapeutic alliance, and the role of epistemic trust in psychotherapy as described by Fonagy and Allison. It is suggested that beneficial forms of instability in clients are an underappreciated influence on psychotherapy process, and thoughts about the implications, as well as situations in which instability may not be beneficial for therapy, are considered. (shrink)

Learning is fundamentally about action, enabling the successful navigation of a changing and uncertain environment. The experience of pain is central to this process, indicating the need for a change in action so as to mitigate potential threat to bodily integrity. This review considers the application of Bayesian models of learning in pain that inherently accommodate uncertainty and action, which, we shall propose are essential in understanding learning in both acute and persistent cases of pain.

Recognizing and aligning individuals’ unique adaptive beliefs or “priors” through cooperative communication is critical to establishing a therapeutic relationship and alliance. Using active inference, we present an empirical integrative account of the biobehavioral mechanisms that underwrite therapeutic relationships. A significant mode of establishing cooperative alliances—and potential synchrony relationships—is through ostensive cues generated by repetitive coupling during dynamic touch. Established models speak to the unique role of affectionate touch in developing communication, interpersonal interactions, and a wide variety of therapeutic benefits for (...) patients of all ages; both neurophysiologically and behaviorally. The purpose of this article is to argue for the importance of therapeutic touch in establishing a therapeutic alliance and, ultimately, synchrony between practitioner and patient. We briefly overview the importance and role of therapeutic alliance in prosocial and clinical interactions. We then discuss how cooperative communication and mental state alignment—in intentional communication—are accomplished using active inference. We argue that alignment through active inference facilitates synchrony and communication. The ensuing account is extended to include the role of tactile afferents in realizing the beneficial effect of therapeutic synchrony. We conclude by proposing a method for synchronizing the effects of touch using the concept of active inference. (shrink)

This paper aims to provide a theoretical framework for explaining the subjective character of pain experience in terms of what we will call ‘embodied predictive processing’. The predictive processing (PP) theory is a family of views that take perception, action, emotion and cognition to all work together in the service of prediction error minimisation. In this paper we propose an embodied perspective on the PP theory we call the ‘embodied predictive processing (EPP) theory. The EPP theory proposes to explain pain (...) in terms of processes distributed across the whole body. The prediction error minimising system that generates pain experience comprises the immune system, the endocrine system, and the autonomic system in continuous causal interaction with pathways spread across the whole neural axis. We will argue that these systems function in a coordinated and coherent manner as a single complex adaptive system to maintain homeostasis. This system, which we refer to as the neural-endocrine-immune (NEI) system, maintains homeostasis through the process of prediction error minimisation. We go on to propose a view of the NEI ensemble as a multiscale nesting of Markov blankets that integrates the smallest scale of the cell to the largest scale of the embodied person in pain. We set out to show how the EPP theory can make sense of how pain experience could be neurobiologically constituted. We take it to be a constraint on the adequacy of a scientific explanation of subjectivity of pain experience that it makes it intelligible how pain can simultaneously be a local sensing of the body, and, at the same time, a more global, all-encompassing attitude towards the environment. Our aim in what follows is to show how the EPP theory can meet this constraint. (shrink)

Placebos are commonly defined as ineffective treatments. They are treatments that lack a known mechanism linking their properties to the properties of the condition on which treatment aims to intervene. Given this, the fact that placebos can have substantial therapeutic effects looks puzzling. The puzzle, we argue, arises from the relationship placebos present between culturally meaningful entities, our intentional relationship to the environment and bodily effects. How can a mere attitude toward a treatment result in appropriate bodily changes? We argue (...) that an ‘enactive’ conception of cognition accommodates and renders intelligible the phenomenon of placebo effects. Enactivism depicts an organism’s adaptive bodily processes, its intentional directedness, and the meaningful properties of its environment as co-emergent aspects of a single dynamic system. In doing so it provides an account of the interrelations between mind, body and world that demystifies placebo effects. (shrink)

This paper disputes the theoretical assumptions of mainstream approaches in philosophy of pain, representationalism and imperativism, and advances an enactive approach as an alternative. It begins by identifying three shared assumptions in the mainstream approaches: the internalist assumption, the brain-body assumption, and the semantic assumption. It then articulates an alternative, enactive approach that considers pain as an embodied response to the situation. This approach entails the hypothesis of the sociocultural embeddedness of pain, which states against the brain-body assumption that the (...) intentional character of pain depends on the agent’s sociocultural background. The paper then proceeds to consider two objections. The first questions the empirical basis of this hypothesis. It is argued based on neuroscientific evidence, however, that there is no empirical reason to suppose that the first-order experience of pain is immune to sociocultural influences. The second objection argues that the mainstream approaches can account for sociocultural influences on pain by drawing on the conceptual distinction between narrow and wide content. In response, the semantic conception of pain underpinning the proposal is challenged. Pain experience can occur in pre-reflective, affectively reflective, or cognitively reflective forms, but the semantic conception at most only applies to the last form. The paper concludes that the enactive approach offers a promising alternative framework in philosophy of pain. (shrink)

Most mainstream attempts to understand the “placebo effect” invoke expectancy theory, arguing that expecting certain outcomes from a treatment or intervention can manifest those outcomes. Expectancy theory is incompatible with the phenomena of placebo responses, more appropriately named “meaning responses.” The expectancy account utilizes reflexive consciousness to connect a world of conceptual representations to mechanical physiology. An alternative account based upon Merleau-Ponty's motor intentionality argues that the body understands and is capable of responding to meanings without the need for any (...) conceptual or linguistic content. A motor intentional framework of meaning poses dramatic implications for the interpretation of clinical trials and in the clinical practice of medicine. Most strongly, it argues that the empathic physician can facilitate the physiologic effects of treatments through skillful participation and manipulation of the meaning response. (shrink)