Mental disorder as both natural and normative: Developing the normative dimension of the 3e conceptual framework for psychopathology.

Abstract

Current arguments concerning the role of normativity within the concept of mental disorder are explored, and some requirements of a successful normative construal sketched out. We then shift to a discussion of "natural" normativity in order to lay the groundwork for our own understanding of what counts as mental disorder. The view we present is grounded in an enactive, embodied, and embedded view of the mind (3e cognition). The position argued for is one where the labeling of a particular set of behaviors as disordered or dysfunctional is justified by the significant violation of norms, but where the norms in question are not socially imposed but are the functional norms of the individual being diagnosed. The strengths and weaknesses of our position are discussed, and an addendum proposed in response to a foreseeable counter-argument. This construal provides a conceptual framework for thinking critically about normative issues in diagnosis, appreciates how central normativity is to the concept of mental disorder, and finally (in being tied to the functionality of the individual), places the institutions of psychiatry and clinical psychology on good ethical ground and allows for consideration of cultural and individual variation during the diagnostic process.

Phenomena complexes as targets of explanation in psychopathology: The relational analysis of phenomena approach

“…Those disorders that roughly seem to be more “organic” in nature, such as schizophrenia or autism spectrum disorder, may not sit as well with the RAP approach, because the descriptive phases are oriented around the behavioral and symptomatic level. However, regarding the association with dysfunction at the level of the person in their environment—which, in our view, is essential to the disordered status—some degree of this circular process structure seems necessarily present (Nielsen & Ward, 2019). Because of this, even if the RAP approach does not assist with uncovering the underlying causes of these more “organic” syndromes, it may still be useful in analyzing how these disorders are associated with distress and dysfunction.…”

“…Our own conceptual work—grounded in an embodied, embedded, and enactive understanding of human functioning—also highlights emergent stability (Nielsen & Ward, 2018). We have argued that at a conceptual level it is this emergent stability that explains why sufferers continue to act contrary to their own functional norms 3 (Nielsen & Ward, 2019; see also Nesse & Stein, 2012, on disorders from control system failures).…”

“…Further to these requirements, ideal PCs may be highly circular in their organization (Fuchs, 2017)—for example, they already have a simple form of self-maintenance. It is this causal structure that represents work against the self-maintenance and adaptivity of the individual (Nielsen & Ward, 2019). This causal structure may not be present at the PC level, but instead may emerge as investigators cycle back and develop explanations of other PC structures in the problem space.…”

“…In the second half of this paper, we present our own method for developing explanations of psychopathology, which we label the Relational Analysis of Phenomena (RAP) approach. As well as stemming from the overview presented here, the justification for this approach has roots in our previous work on the nature of mental disorder when viewed through an enactive, embodied, and embedded lens, and ideas concerning the likely circular causal structures underlying the stability of disordered behavior (Fuchs, 2009, 2017; Nielsen & Ward, 2018, 2019). It is important to stress that we adopt a pluralistic perspective to the explanation of psychopathology, and as such view the RAP approach as providing an additional explanatory method, rather than being necessarily the “right way.”…”

“…They reflect the individual’s mode of functioning and flourishing, and thus change across individuals and cultures. For further discussion see Nielsen and Ward (2019).…”