The recommended treatment for dual diagnosis - the co-occurrence of substance use and another mental disorder - requires seamless integration of the involved disciplines and services. However, no integrative framework exists for communicating about dual diagnosis cases across disciplinary or sectoral boundaries. We examine if Enactive Psychiatry may bridge this theoretical gap. We evaluate the enactive approach through a two-step pragmatic lens: Firstly, by taking a historical perspective to describe more accurately how the theoretical gap within the field of dual diagnosis initially developed. Secondly, by applying the Enactive Psychiatry approach to data from a longitudinal study on the trajectory of cannabis use in psychosis disorders. By applying the theory rather than simply presenting it, we position ourselves better to evaluate whether it may assist the purpose of achieving a more expedient pragmatic “grip” on the field of dual diagnosis. In our discussion, we suggest that this may very well be the case. Finally, we consider the enactive approach as one of a small handful of new theories of mental disorders that draw on systems thinking and ecological psychology, and discuss whether they have the potential for a wider progressive problemshift within psychiatry. The case in favor of such potential, we argue, is less strong unless the role of complexity, similar to that seen within the dual diagnosis field, may be demonstrated for other fields of clinical practice.

Selvom en stærk strømning, med afsæt i bl.a. psykologi, sociologi og antropologi, diskuterer og udfordrer psykiatriens vidensgrundlag og dens praksisser, lykkes det sjældent at etablere en frugtbar dialog mellem kritikerne og psykiatrien, som leder til forandring. Med andre ord fører kritikken ofte til polarisering og ikke til konstruktiv udvikling. Der er forskellige måder at forstå dette på. Enten har den psykosociale kritik ikke noget meningsfuldt eller konstruktivt at bidrage med til klinisk praksis, hvorfor den med rette bliver afvist. Eller også sker der et sammenbrud i dialogen, som i det mindste delvist kan forebygges. Vi foku- serer på den sidste mulighed. Med afsæt i eksempler taget fra to af forfatternes egne tekster diskuterer vi disse forsøg på kritik af psykiatrien. Som alternativ diskuteres, med inddra- gelse af en biopsykosocial model, hvordan fremtidens tværfaglige dialog kan udspilles mere konstruktivt. Med afsæt i fire personlige artikler om at ændre perspektiv på et vigtigt aspekt af psykiatrien, foreslås afslutningsvis hvilke dyder, der kan hjælpe en positiv udvikling mod en rigere psykiatrisk praksis på vej - et mål som deles af mange blandt såvel psykiatriens praktikere som dens kritikere.

Purpose Cannabis use in the context of psychosis has been shown to have a negative impact on prognosis and yet it is difficult to treat. Recent randomized controlled trials all have negative findings and novel approaches is sought after. This paper aims to use an embodied cognition framework to add to the understanding of cannabis use in psychosis. Design/methodology/approach The paper presents longitudinal, qualitative data on two individuals diagnosed with schizophrenia and using cannabis at least twice weekly prior to inclusion in the study. Factors influencing cannabis use were mapped in dialogue with the participants. Each participant was interviewed six times over the course of a year. The analysis was informed theoretically to describe processes maintaining or ameliorating cannabis use over time. Findings This study shows that a systems approach for understanding changes in cannabis use is meaningful; the richness of observations add to the understanding of differences in outcomes. Findings suggest that reductions in cannabis use in psychosis could be dependent on synergistic effects between contextual conditions. Attending closer to the experience of patients may help inform future interventions. However, interventions focusing on single mechanisms may be futile, if an array of individual, formative experiences are a prerequisite for change. A systemic understanding of dual diagnosis calls for tailored, individualized interventions. Originality/value The research tests a novel systemic perspective on cannabis use in psychosis by applying it to qualitative longitudinal data. Adding a systemic perspective may help develop future interventions addressing cannabis use in psychosis, which has long been considered a “hard problem” in dual diagnosis treatment.