An Enactive Approach to Psychiatry

This article addresses the integration problem in psychiatry: the explanatory problem of integrating such heterogeneous factors as cause or contribute to the problems at hand, ranging from traumatic experiences, dysfunctional neurotransmitters, existential worries, economic deprivation, social exclusion, and genetics. In practice, many mental health professionals work holistically in a pragmatic and eclectic way. Such pragmatic approaches often function well enough. Yet an overarching framework provides orientation, treatment rationale, a shared language for communication with all those involved, and the means to explain treatment decisions to health insurers and to society at large. It also helps to relate findings from different areas and types of research. In this article, I introduce an enactive framework that supports holistic psychiatric practice by offering an integrating account of how the diverse aspects of psychiatric disorders relate. The article starts with a short overview both of the four main dimensions of psychiatric disorders and of the currently available models. I then introduce enactivism and the enactive notion of sense-making. Subsequently, I discuss how this enactive outlook helps explicate the relation between the four dimensions and what that implies regarding the causality involved. The article concludes with an overview of treatment implications.

The enactive naturalization of normativity: from self-maintenance to situated interactions

The autopoietic enactive account of cognition explains the emergence of normativity in nature as the norm of self-maintenance of life. The autonomous nature of living agents implies that they can differentiate events and regulate their responses in terms of what is better or worse to maintain their own precarious identity. Thus, normative behavior emerges from living organisms. Under this basic understanding of normativity as self-maintenance, autopoietic enactivism defends a continuity between biological, cognitive, and social norms. The self-maintenance of an agent’s sensorimotor identity establishes the cognitive norms that regulate its behavior, and the self-maintenance of its social identity determines the social norms. However, there is no clear explanation of how individuals, who by their very constitution are primarily moved to interact with the world under the norm of self-maintenance, could interact with the world driven by non-individual norms. Furthermore, understanding all normativity as self-maintenance makes it unclear how agents establish genuine social interactions and acquire habits that have no implication for their constitution as individuals. So, to face these challenges, I propose an alternative notion of normativity grounded on a Wittgensteinian, action-oriented, and pragmatic conception of meaning that distinguishes between an agent with a normative point of view and external normative criteria. I defend that a normative phenomenon is an interaction that is established by an individual point of view as defined by autopoietic enactivism and that is part of a self-maintaining system. The latter establishes the external normative criteria to evaluate the interaction, and it may or may not coincide with the identity of the interacting agent. Separating external normative criteria from the self-constitution of the interactant agent not only solves the challenge but potentially explains the situated and relational character of agency.

The Self-Overcoming of Nihilism

In May of this year I had the opportunity to give several talks on the topic of nihilism. Initially I intended to focus on the three themes of Nietzsche, Dostoevsky, and Buddhism. When I was twenty, the fig­ures of Nietzsche and Dostoevsky burned a lasting impression deep into my soul-as I suppose they may still do to many young people even today-and the tremors I experienced at that time have con­tinued to make my heart tremble ever since. The final theme, of Buddhist “emptiness,” came to capture my interest more gradu­ally. The connections among these three topics are not merely arbi­trary or external. The nihilism that Dostoevsky plumbed so deeply has important connections with that of Nietzsche, as a number of critics have pointed out; and Nietzsche considers what he calls Eu­ropean nihilism to be the European form of Buddhism. Even though there may be in Nietzsche a radical misunderstanding of the spirit of Buddhism, the fact that he considered it in relation to ni­hilism shows how well attuned he was to the real issue. It was con­siderations such as these that inclined me toward these three themes in my discussion of nihilism.