Agency, embodiment and enactment in psychosomatic theory and practice

Abstract

In this paper, we examine some of the conceptual, pragmatic and moral dilemmas intrinsic to psychosomatic explanation in medicine, psychiatry and psychology. Psychosomatic explanation invokes a social grey zone in which ambiguities and conflicts about agency, causality and moral responsibility abound. This conflict reflects the deep-seated dualism in Western ontology and concepts of personhood that plays out in psychosomatic research, theory and practice. Illnesses that are seen as psychologically mediated tend also to be viewed as less real or legitimate. New forms of this dualism are evident in philosophical attacks on Engel’s biopsychosocial approach, which was a mainstay of earlier psychosomatic theory, and in the recent Research Domain Criteria research programme of the US National institute of Mental Health which opts for exclusively biological modes of explanation of illness. We use the example of resignation syndrome among refugee children in Sweden to show how efforts to account for such medically unexplained symptoms raise problems of the ascription of agency. We argue for an integrative multilevel approach that builds on recent work in embodied and enactive cognitive science. On this view, agency can have many fine gradations that emerge through looping effects that link neurophenomenology, narrative practices and cultural affordances in particular social contexts. This multilevel ecosocial view points the way towards a renewed biopsychosocial approach in training and clinical practice that can advance person-centred medicine and psychiatry.

Refugee mental health and human rights: A challenge for global mental health

“…This calls for an ecosocial perspective that integrates neurobiology, psychology, and individual experience with broader social and cultural contexts across time (Kirmayer & G omez-Carrillo, 2019a). With more integrative models, we can better capture the complex interactions between neurobiological, social, and political processes and forms of agency mobilized by individuals facing intractable situations (Kirmayer & G omez-Carrillo, 2019b). For refugees and migrants, as in other marginalized communities:…”

“…This calls for an ecosocial perspective that integrates neurobiology, psychology, and individual experience with broader social and cultural contexts across time (Kirmayer & Gómez-Carrillo, 2019a). With more integrative models, we can better capture the complex interactions between neurobiological, social, and political processes and forms of agency mobilized by individuals facing intractable situations (Kirmayer & Gómez-Carrillo, 2019b). For refugees and migrants, as in other marginalized communities:there is a patterning of conditions of social danger that make events of trauma all but routine … Comprehending this problem […] requires a clear recognition of a social-historical pattern of structural violence … that conduces to a reciprocal shaping of subjective experience and social structural relations.…”

“Mombrain and Sticky DNA”: The Impacts of Neurobiological and Epigenetic Framings of Motherhood on Women's Subjectivities

“…The narratives of our interlocutors expose this heightened level of awareness and self-monitoring induced by pre-emptive categories of "at-risk" that emerge as part of epigenetic research translation through cognitive-interpretative and socialinteractional looping processes (Kirmayer and Gómez-Carrillo, 2019). Processes of biolooping at the intrasubjective level couple bodily enactment and physiology (Hacking, 2000;Kirmayer and Gómez-Carrillo, 2019) that can change the course of perinatal experience, leading to symptom amplification, heightened distress, and reduced functioning thereby reinforcing the very experiences that epigenetic research warns of. Through processes of classificatory looping at the intersubjective level the pre-emptive "at risk" becomes actualized through its mere potentiality as a category.…”

Psychology and Surveillance Capitalism: The Risk of Pushing Mental Health Apps During the COVID-19 Pandemic

“…The looping effect describes a recursive process where the development of new classifications leads those classified to identify with the classification and to increasingly behave in ways that conform with the expectations of the classification (Brinkmann, 2005). As the fields of psychiatry and psychology develop and propose new constructs for classifying people, these classifications inevitably reflect the philosophical assumptions of those proposing the framework, particularly those concerning agency and personhood (Kirmayer & Gómez-Carrillo, 2019). These classifications are circulated in societal discourses and reinforced by the machinations of institutions, which serves to maintain the perceived legitimacy of the initial assumptions, limiting possibilities for paradigmatic change.…”