As I said in a recent previous post, I think enactivism can be a way of revitalising Engel's biopsychosocial model. Mental processes need to be understood in a dynamic, integrated and enactive way, as they are embodied in the brain and the body more generally, and embedded in the environment, which is social and cultural, affording various possibilities of action to the organism (see eg. my article). Mental illness cannot be isolated in material processes in the brain, excluded from people's relationship with their environment.
In some ways, such an anti-reductionist position is not new (eg. see another article of mine). I do think, though, that enactivism can be seen as a more thoroughgoing basis for anti-reductionism. Like Sanneke, I worry that Kristopher's position is not explicitly anti-reductionist enough. There is evidence for this in his interview with Awais Aftab. Kristopher still wants to understand mental disorders in an "entitative and more mechanistic way". He may well make too much of the biological functionality of human values, although I think there is merit in seeing mental illness as failed adaptations, as did Adolf Meyer (see eg. previous post). I summarised, in another previous post, how Sanneke demarcates 'abnormality' from 'normality'. I'm also not sure what Kristopher means by somatic and mental disorders being "probably continuous with each other". As I've highlighted before (eg. see previous post), the organic/functional distinction of mental disorders, which was abolished by DSM-IV, needs to be reinstated.
I also have questions about the implications of Sanneke's views. For example, how do they relate to American pragmatism (eg. see previous post)? For all her emphasis on the existential dimension in mental disorders, how does her perspective relate to existentialism as a philosophy (see eg. another previous post)?
As I've also been emphasising in this blog, there are links with other phenomenological perspectives, such as that of Thomas Fuchs (see eg. previous post); cultural perspectives, such as that of Laurence Kirmayer (see eg. another previous post); and other critical perspectives in psychiatry, not least Foucault (see eg. last post). I have been trying to bring them together under an umbrella term of relational psychiatry.
This is not some grandiose project, but an attempt to encourage psychiatry to move on from its misguided belief that primary mental illness will be found to be a physical disease. Relational psychiatry also has practical implications, and is not merely an out of touch academic dispute about the implications of enactivism for psychiatry. There is some urgency about the need to improve the treatment of people with mental health problems. A recent focus of this blog, for example, has been on the current reform of the Mental Health Act (see eg. previous post), as the rights of people with mental illness can be abused.
Duncan It is common for quotes to be used where understandings are blurred eg you write 'normal' or 'abnormal' Is it somehow an avoidance of being explicit? I would question whether mental illness is a 'failure' of adaption Hardly perceptible changes in the environment can make a difference to benefit the chances of some while others are casualties of a relentless level of stress. It is rare for a person to be given an optimal chance of getting well using mental health services which are in massively more rather than 'some 'urgent crisis .
Maybe if there is no failure of adaptation, Cobweb, there is no mental illness.
I think it depends of what aperson is expected to adapt to ? It could be they decide that would be harmful - their decision then labelled mental illness.
I think enactivism as a philosophical approach could be used in a much more radical fashion than de Haan and Nielsen currently use it. Not that we know yet how to do this, but the potential is there.
Post a Comment