From analytic to synthetic-organizational pluralisms: A pluralistic enactive psychiatry

Abstract

IntroductionReliance on sole reductionism, whether explanatory, methodological or ontological, is difficult to support in clinical psychiatry. Rather, psychiatry is challenged by a plurality of approaches. There exist multiple legitimate ways of understanding human functionality and disorder, i.e., different systems of representation, different tools, different methodologies and objectives. Pluralistic frameworks have been presented through which the multiplicity of approaches in psychiatry can be understood. In parallel of these frameworks, an enactive approach for psychiatry has been proposed. In this paper, we consider the relationships between the different kinds of pluralistic frameworks and this enactive approach for psychiatry.MethodsWe compare the enactive approach in psychiatry with wider analytical forms of pluralism.ResultsOn one side, the enactive framework anchored both in cognitive sciences, theory of dynamic systems, systems biology, and phenomenology, has recently been proposed as an answer to the challenge of an integrative psychiatry. On the other side, two forms of explanatory pluralisms can be described: a non-integrative pluralism and an integrative pluralism. The first is tolerant, it examines the coexistence of different potentially incompatible or untranslatable systems in the scientific or clinical landscape. The second is integrative and proposes to bring together the different levels of understanding and systems of representations. We propose that enactivism is inherently a form of integrative pluralism, but it is at the same time a component of the general framework of explanatory pluralism, composed of a set of so-called analytical approaches.ConclusionsA significant number of mental health professionals are already accepting the variety of clinical and scientific approaches. In this way, a rigorous understanding of the theoretical positioning of psychiatric actors seems necessary to promote quality clinical practice. The study of entanglements between an analytical pluralism and a synthetic-organizational enactivist pluralism could prove fruitful.

Philosophy of psychiatry: theoretical advances and clinical implications

“…It is therefore an integrative view, demanding both current and historical analysis of the entire brain-bodyenvironment system if we are to understand patterns in human behavior and cognition. This approach is consistent with a coordinated pluralism 218 , and arguably even with an integrative pluralism 219 , and has led to the suggestion that accounts of mental disorder grounded in embodied/4E cognition may represent a path to solving the "integration problem" in psychiatry; i.e., the fact that we have identified causal factors across the brain, body and environment, but struggle to conceptualize how these causes come together to shape patterns of disorder 220 .…”

On motivating irruptions: the need for a multilevel approach at the interface between life and mind

“…We suggest that future motivation-involving accounts of motivated activity, especially from an enactive perspective, should avoid explaining the role of motivations in entirely nonmotivational terms. Instead, we recommend endorsing a multilevel, pluralistic approach to causation and explanation, such as those being recently discussed in theoretical assessments of psychiatry and psychedelic medicine (Aday et al, 2023;Carhart-Harris, 2018;Gauld et al, 2022;Girn et al, 2023;van Elk & Yaden, 2022;Yaden & Griffiths, 2020). Concerning the explanatory and causal role of the phenomenological dimension in psychedelic medicine, for instance, it has been recently declared that "the case for subjective effects playing a major role in enduring beneficial effects is compelling… underlying neurobiological-based mechanisms are undoubtedly necessary but likely not sufficient to confer full beneficial effects" (Yaden and Griffiths 2020, p. 570).…”

Desde el pluralismo integrativo hacia un modelo enactivo en psiquiatría

“…En la ausencia de este relato, todo afán integracionista tiende a la unificación reduccionista de dichos aspectos. En su defecto, tiende a un frágil pluralismo no integrativo (Kendler, 2012;Gauld et al, 2022) o, cómo el BPS, a un holismo radical donde todo es significativo (Ghaemi, 2009).…”

“…Dicha comunicación efectiva entre los diversos modelos psiquiátricos se asienta en la pretensión de un pluralismo integrativo, el cual podría ser posible gracias a la integración anti-reduccionista de las diversas dimensiones de lo mental bajo el marco enactivo. Otros tipos de pluralismos no-integrativos (Gauld et al, 2022) aspiran a una frágil tolerancia pragmática que arriesga algún tipo de reduccionismo implícito a la base, o en su defecto pluralismos dualistas, relativistas o aislacionistas. Por otro lado, la visión enactivista de lo mental en psiquiatría pretende una integración original, que permita un pluralismo sin los riesgos mencionados, y que evite una unificación reduccionista en el ejercicio científico de los trastornos mentales.…”

“…El enactivismo promueve una integración ontológica desde su visión relacional. En esta línea, rechaza aspiraciones pluralistas o integrativas que resulten limitadas a aspectos pragmáticos o metodológicos (Gauld et al, 2022). Sin embargo, no pretende renegar de aquellos aspectos.…”