Wednesday, May 06, 2020

Enactive psychiatry makes the biopsychosocial model explicit

I said in a previous post that I was not convinced that Sanneke de Haan was correct that Engel’s biopsychosocial (BPS) model does not do justice to subjective experience. In her book, Enactive psychiatry, she does accept that “the way in which patients evaluatively relate to their disorder and their situation in general is implicit in the psychological aspect [of the BPS model]”.

She also notes that Engel “draws on general system theory (GST) as developed by von Bertalanffy“, although as I pointed out in in my article, what Engel actually said was that GST “provided a suitable conceptual basis” for his BPS model. As I wrote,
[A]n integrated biopsychosocial approach is not specifically dependent on systems theory, as evidenced by the psychobiology of Adolf Meyer. In Meyer’s understanding of science, there is a hierarchical relation of the disciplines with the lower or simpler categories being pertinent to, but not explanatory for, higher or more complex categories. This is comparable to systems theory, but Meyer made no attempt to create an overarching theory as in general systems theory. Von Bertalanffy ...  himself recognized that there had been many systems-theoretical developments in psychiatry that could be traced to Meyer and others, similar but separate from general systems theory itself.

Sanneke de Haan also says that the BPS model is "vague when it comes to explicating the precise nature of the interactions” between the separate aspects of biological, psychological and social. Again, I’m not sure if this is a specific fault of Engel’s model as such, although as I’ve said multiple times previously (eg. see previous post), the BPS model is now commonly wrongly interpreted in an eclectic way in modern psychiatry. I do accept, therefore, that a more explicit integrative model would be beneficial to help us to move on from the current eclecticism.

The enactive model may well be such an approach. There may even be overlap with what David Pilgrim has been doing applying critical realism to psychology and psychiatry (see previous post and recent book). An advantage of enactivism is its specific focus on the biological, viewing the brain as an organ of a living being in its environment. As Thomas Fuchs said (see last post), "An ecological neurobiology is ... obliged to draw on the integrated approaches of dynamic systems theory, psychology, cultural studies, and philosophy."

To quote from Sanneke de Haan, "we cannot understand cognition in isolation from the bodily being that is doing the cognising, nor from the environment that it is directed at". And again, "Instead of presupposing a gap between mind and world, enactivists argue that organism and world are dynamically coupled". Actually, I think both Meyer (see another previous post) and Engel had this "biological" emphasis, but restating it specifically, I think, does create a valuable new focus for critical psychiatry.

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