Placebo From an Enactive Perspective

Abstract

Due to their complexity and variability, placebo effects remain controversial. We suggest this is also due to a set of problematic assumptions (dualism, reductionism, individualism, passivity). We critically assess current explanations and empirical evidence and propose an alternative theoretical framework—the enactive approach to life and mind—based on recent developments in embodied cognitive science. We review core enactive concepts such as autonomy, agency, and sense-making. Following these ideas, we propose a move from binary distinctions (e.g., conscious vs. non-conscious) to the more workable categories of reflective and pre-reflective activity. We introduce an ontology of individuation, following the work of Gilbert Simondon, that allow us to see placebo interventions not as originating causal chains, but as modulators and triggers in the regulation of tensions between ongoing embodied and interpersonal processes. We describe these interrelated processes involving looping effects through three intertwined dimensions of embodiment: organic, sensorimotor, and intersubjective. Finally, we defend the need to investigate therapeutic interactions in terms of participatory sense-making, going beyond the identification of individual social traits (e.g., empathy, trust) that contribute to placebo effects. We discuss resonances and differences between the enactive proposal, popular explanations such as expectations and conditioning, and other approaches based on meaning responses and phenomenological/ecological ideas.

On symptom perception, placebo effects, and the Bayesian brain

“…Uncertainty regulates and motivates ongoing bodily and interpersonal processes through the performance of the clinician, 3,9 the use of metaphors, 11,12 imagination, 6 and further interactive aspects emerging in the therapeutic encounter that contribute to shared meaning construction and the modulation of hopes and expectations. 1 Uncertainty may have an effect on the statistical quality of an input to a model, but its operative roles cannot be reduced to this effect.…”

Osteopathic Care as (En)active Inference: A Theoretical Framework for Developing an Integrative Hypothesis in Osteopathy

“…Enactivism is a perspective in embodied cognitive science, commonly known as being part of the 4E approaches which argue that mental processes are embodied, embedded, enacted, and extended (Rowlands, 2010;Thompson, 2010;Arandia and Di Paolo, 2021). Enactivism rejects an inner-outer division of mind and world and therefore considers organisms as co-arising and co-determining with their environment.…”

“…Autonomy is a necessary and sufficient condition to speak of an individual system (Varela, 1979;Di Paolo, 2005;Di Paolo and Thompson, 2014;Segundo-Ortin, 2020;Arandia and Di Paolo, 2021). In systemic terms, autonomous systems such as organisms are defined as operationally closed and precarious networks of mutually enabling processes.…”

“…In systemic terms, autonomous systems such as organisms are defined as operationally closed and precarious networks of mutually enabling processes. Moreover, they are self-constituting (self-producing and self-distinguishing), depend on active engagements with the external enabling relations, and can exist at different scales from metabolic and immune system activity to nervous, sensorimotor, and social dynamics (Arandia and Di Paolo, 2021). The most basic form of autonomy can be seen in autopoiesis-the capacity of living systems to generate and keep their identity as distinct from the environment (Segundo-Ortin, 2020).…”

“…Sense-making is, therefore, critical to living, is embodied and embedded, implies values (metabolic), is affective, and can be reflexive (existential sense-making) (De Haan, 2020a,b). The combination of precarious autonomy, sense-making, and adaptivity underpin perception, action, emotion and cognition (Arandia and Di Paolo, 2021). Being a sense-maker implies being ready to selectively act on the affordances provided by the environment, which are relevant to maintain autonomy-sense-making is paramount to understand agency (Segundo-Ortin, 2020).…”