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Stein DJ, Nielsen K, Hartford A, Gagné-Julien AM, Glackin S, Friston K, Maj M, Zachar P, Aftab A. Philosophy of psychiatry: theoretical advances and clinical implications. World Psychiatry 2024; 23:215-232. [PMID: 38727058 PMCID: PMC11083904 DOI: 10.1002/wps.21194] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/13/2024] Open
Abstract
Work at the intersection of philosophy and psychiatry has an extensive and influential history, and has received increased attention recently, with the emergence of professional associations and a growing literature. In this paper, we review key advances in work on philosophy and psychiatry, and their related clinical implications. First, in understanding and categorizing mental disorder, both naturalist and normativist considerations are now viewed as important - psychiatric constructs necessitate a consideration of both facts and values. At a conceptual level, this integrative view encourages moving away from strict scientism to soft naturalism, while in clinical practice this facilitates both evidence-based and values-based mental health care. Second, in considering the nature of psychiatric science, there is now increasing emphasis on a pluralist approach, including ontological, explanatory and value pluralism. Conceptually, a pluralist approach acknowledges the multi-level causal interactions that give rise to psychopathology, while clinically it emphasizes the importance of a broad range of "difference-makers", as well as a consideration of "lived experience" in both research and practice. Third, in considering a range of questions about the brain-mind, and how both somatic and psychic factors contribute to the development and maintenance of mental disorders, conceptual and empirical work on embodied cognition provides an increasingly valuable approach. Viewing the brain-mind as embodied, embedded and enactive offers a conceptual approach to the mind-body problem that facilitates the clinical integration of advances in both cognitive-affective neuroscience and phenomenological psychopathology.
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Affiliation(s)
- Dan J Stein
- South African Medical Research Council Unit on Risk and Resilience in Mental Disorders, Department of Psychiatry and Neuroscience Institute, University of Cape Town, Cape Town, South Africa
| | - Kris Nielsen
- School of Psychology, Te Herenga Waka-Victoria University of Wellington, Wellington, New Zealand
| | - Anna Hartford
- South African Medical Research Council Unit on Risk and Resilience in Mental Disorders, Department of Psychiatry and Neuroscience Institute, University of Cape Town, Cape Town, South Africa
| | - Anne-Marie Gagné-Julien
- Centre for Research in Ethics, Canada Research Chair in Epistemic Injustice and Agency, Université du Québec à Montréal, Montreal, Canada
| | - Shane Glackin
- Department of Sociology, Philosophy and Anthropology, University of Exeter, Exeter, UK
| | - Karl Friston
- Wellcome Trust Centre for Neuroimaging, Institute of Neurology, University College London, London, UK
| | - Mario Maj
- Department of Psychiatry, University of Campania "L. Vanvitelli", Naples, Italy
| | - Peter Zachar
- Department of Psychology, Auburn University Montgomery, Montgomery, AL, USA
| | - Awais Aftab
- Department of Psychiatry, School of Medicine, Case Western Reserve University, Cleveland, OH, USA
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Frohn OO, Martiny KM. The phenomenological model of depression: from methodological challenges to clinical advancements. Front Psychol 2023; 14:1215388. [PMID: 38023023 PMCID: PMC10658893 DOI: 10.3389/fpsyg.2023.1215388] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Accepted: 09/25/2023] [Indexed: 12/01/2023] Open
Abstract
In this article our overall aim is to illustrate how phenomenological psychopathology can advance the clinical work on depression. To do so, we start by unfolding the current phenomenological model of depression. We argue that this model faces a methodological challenge, which we define as 'the challenge of patho-description'. Mental disorders, such as depression, influence how people are able to access and describe their own experiences. This becomes a challenge for phenomenological psychopathology since its methodology is based on people's ability to describe their own experiences. To deal with this challenge, in the case of depression, we turn to the framework of phenomenological interview. We interview 12 participants (7 women, 5 men, age-range from 29 to 57 years) with moderate and severe depression. From the interview results, we show how phenomenological interview deals with the challenge of patho-description and how patho-description in depression conceals experiential nuances. We unfold these nuances and describe how people with depression pre-reflectively experience a variety of feelings, a type of agency, overly positive self-image, and relations in a hyper-social way. These descriptive nuances not only strengthen the phenomenological model of depression, but they also help advance the clinical work on depression. We firstly illustrate how the descriptive nuances can be added to current manuals and rating scales to advance diagnostic work. Secondly, we illustrate how phenomenological, 'bottom-up', and embodied approaches function at the pre-reflective level of experience, and that further effort at this level can help advance therapy for depression.
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Fukuda L, Tamelini M, Messas G. Obsessive-compulsive existential type: a dialectical-phenomenological approach. Front Psychol 2023; 14:1211598. [PMID: 37736151 PMCID: PMC10509482 DOI: 10.3389/fpsyg.2023.1211598] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Accepted: 08/11/2023] [Indexed: 09/23/2023] Open
Abstract
The clinical presentation of obsessive-compulsive patients is characterized by unwanted, intrusive, nonsensical, self-related, and recurrent ideas, thoughts, images, or impulses associated with active compulsive compensations. Under the operational diagnostic criteria adopted by the biological- and cognitive-oriented neopositivist medical paradigm, it is known as "obsessive-compulsive disorder." However, this paradigm has been criticized for its controversial assumptions, limited methodologies, theoretic biases, and inconsistency in producing practical outcomes. To bypass some of these issues, we propose a complementary approach that draws on and further develops existing psychopathological studies of the obsessive-compulsive anthropological condition based on dialectical phenomenological psychopathology. As such, we refer to the global clinical configuration as the "obsessive-compulsive existential type." Our theoretical inspiration comes from the classical phenomenological work on obsessions undertaken by Straus and Gebsattel, which identified the negative transformation of the obsessive-compulsive life-world or the endogenous emergence of the anti-eidos (diluting existential force). We then propose to broaden the concept of anti-eidos, especially in its dialectical correlation with eidos (unifying existential force), representing the existential dialectic between transformation and permanence. Next, we detail the dynamics of anthropological disproportions in obsessive-compulsive existential type, essentially the supremacy of the anti-eidos over the eidos. This primary imbalance modifies the obsessive-compulsive existential structure, consisting of polymorphic temporality; weakened intentionality; maladjusted calibration of distance with the world and others; an integral, isolated, besieged self with dwindling self-agency, and tense and over-protecting embodiment. We also analyze compensatory hyperreflexivity and compulsive rituals as expressions of structural counterbalancing designed to contain the primary structural disproportions and derangements. The heterogeneous obsessive-compulsive clinical manifestations are the complex result of the primary structural alteration and subsequent phenomenological compensations. They tend to be variable in temporal span and rarely assume a fixed form, hindering diagnosis. We correlate structural frameworks with multiple clinical examples. Finally, we raise some insights on how our study may contribute to scientific research and therapeutic proposals.
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Affiliation(s)
- Lívia Fukuda
- Faculdade de Ciências Médicas da Santa Casa de São Paulo, São Paulo, Brazil
| | - Melissa Tamelini
- Instituto de Psiquiatria, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Guilherme Messas
- Faculdade de Ciências Médicas da Santa Casa de São Paulo, São Paulo, Brazil
- The Collaborating Center for Values-Based Practice, St Catherine’s College, Oxford, United Kingdom
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Vaz DV, Stilwell P, Coninx S, Low M, Liebenson C. Affordance-based practice: An ecological-enactive approach to chronic musculoskeletal pain management. Braz J Phys Ther 2023; 27:100554. [PMID: 37925996 PMCID: PMC10632936 DOI: 10.1016/j.bjpt.2023.100554] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Revised: 08/16/2023] [Accepted: 10/04/2023] [Indexed: 11/07/2023] Open
Abstract
BACKGROUND The biomedical understanding of chronic musculoskeletal pain endorses a linear relationship between noxious stimuli and pain, and is often dualist or reductionist. Although the biopsychosocial approach is an important advancement, it has a limited theoretical foundation. As such, it tends to be misinterpreted in manners that lead to artificial boundaries between the biological, psychological, and social, with fragmented and polarized clinical applications. OBJECTIVE We present an ecological-enactive approach to complement the biopsychosocial model. In this approach, the disabling aspect of chronic pain is characterized as an embodied, embedded, and enactive process of experiencing a closed-off field of affordances (i.e., shutting down of action possibilities). Pain is considered as a multi-dimensional, multicausal, and dynamic process, not locatable in any of the biopsychosocial component domains. Based on a person-centered reasoning approach and a dispositional view of causation, we present tools to reason about complex clinical problems in face of uncertainty and the absence of 'root causes' for pain. Interventions to open up the field of affordances include building ability and confidence, encouraging movement variability, carefully controlling contextual factors, and changing perceptions through action according to each patient's self-identified goals. A clinical case illustrates how reasoning based on an ecological-enactive approach leads to an expanded, multi-pronged, affordance-based intervention. CONCLUSIONS The ecological-enactive perspective can provide an overarching conceptual and practical framework for clinical practice, guiding and constraining clinicians to choose, combine, and integrate tools that are consistent with each other and with a true biopsychosocial approach.
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Affiliation(s)
- Daniela Virgínia Vaz
- Faculty of Physical Therapy Department and Graduate Program in Rehabilitation Sciences, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, Brazil.
| | - Peter Stilwell
- Faculty of Medicine and Health Sciences, School of Physical and Occupational Therapy, McGill University, Montreal, Canada
| | - Sabrina Coninx
- Department of Philosophy, VU Amsterdam, Amsterdam, The Netherlands
| | - Matthew Low
- Christchurch Hospital, Fairmile Road, Dorset, United Kingdom; Visiting Fellow, Orthopaedic Research Institute, Bournemouth University, United Kingdom; Consultant Physical Therapist, University Hospitals NHS Foundation Trust, England
| | - Craig Liebenson
- Founder of First Principles of Movement, Director of L.A. Sports & Spine, Los Angeles, and Continuing Education faculty with Parker University, Dallas, United States
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Zuk P, Sanchez CE, Kostick-Quenet K, Muñoz KA, Kalwani L, Lavingia R, Torgerson L, Sierra-Mercado D, Robinson JO, Pereira S, Outram S, Koenig BA, McGuire AL, Lázaro-Muñoz G. Researcher Views on Changes in Personality, Mood, and Behavior in Next-Generation Deep Brain Stimulation. AJOB Neurosci 2023; 14:287-299. [PMID: 35435795 PMCID: PMC9639000 DOI: 10.1080/21507740.2022.2048724] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
The literature on deep brain stimulation (DBS) and adaptive DBS (aDBS) raises concerns that these technologies may affect personality, mood, and behavior. We conducted semi-structured interviews with researchers (n = 23) involved in developing next-generation DBS systems, exploring their perspectives on ethics and policy topics including whether DBS/aDBS can cause such changes. The majority of researchers reported being aware of personality, mood, or behavioral (PMB) changes in recipients of DBS/aDBS. Researchers offered varying estimates of the frequency of PMB changes. A smaller majority reported changes in personality specifically. Some expressed reservations about the scientific status of the term 'personality,' while others used it freely. Most researchers discussed negative PMB changes, but a majority said that DBS/aDBS can also result in positive changes. Several researchers viewed positive PMB changes as part of the therapeutic goal in psychiatric applications of DBS/aDBS. Finally, several discussed potential causes of PMB changes other than the device itself.
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Merner AR, Kostick-Quenet K, Campbell TA, Pham MT, Sanchez CE, Torgerson L, Robinson J, Pereira S, Outram S, Koenig BA, Starr PA, Gunduz A, Foote KD, Okun MS, Goodman W, McGuire AL, Zuk P, Lázaro-Muñoz G. Participant perceptions of changes in psychosocial domains following participation in an adaptive deep brain stimulation trial. Brain Stimul 2023; 16:990-998. [PMID: 37330169 PMCID: PMC10529988 DOI: 10.1016/j.brs.2023.06.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Revised: 05/19/2023] [Accepted: 06/14/2023] [Indexed: 06/19/2023] Open
Abstract
BACKGROUND There has been substantial controversy in the neuroethics literature regarding the extent to which deep brain stimulation (DBS) impacts dimensions of personality, mood, and behavior. OBJECTIVE/HYPOTHESIS Despite extensive debate in the theoretical literature, there remains a paucity of empirical data available to support or refute claims related to the psychosocial changes following DBS. METHODS A mixed-methods approach was used to examine the perspectives of patients who underwent DBS regarding changes to their personality, authenticity, autonomy, risk-taking, and overall quality of life. RESULTS Patients (n = 21) who were enrolled in adaptive DBS trials for Parkinson's disease, essential tremor, obsessive-compulsive disorder, Tourette's syndrome, or dystonia participated. Qualitative data revealed that participants, in general, reported positive experiences with alterations in what was described as 'personality, mood, and behavior changes.' The majority of participants reported increases in quality of life. No participants reported 'regretting the decision to undergo DBS.' CONCLUSION(S) The findings from this patient sample do not support the narrative that DBS results in substantial adverse changes to dimensions of personality, mood, and behavior. Changes reported as "negative" or "undesired" were few in number, and transient in nature.
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Affiliation(s)
- Amanda R Merner
- Center for Bioethics, Harvard Medical School, 641 Huntington Avenue, Boston, MA, 02115, United States
| | - Kristin Kostick-Quenet
- Center for Medical Ethics and Health Policy, Baylor College of Medicine, One Baylor Plaza, Suite 326D, Houston, TX, 77030, United States
| | - Tiffany A Campbell
- Center for Bioethics, Harvard Medical School, 641 Huntington Avenue, Boston, MA, 02115, United States
| | - Michelle T Pham
- Center for Bioethics and Social Justice, Michigan State University, East Fee Hall, 965 Wilson Road Rm A-126, East Lansing, MI, 48824, United States
| | - Clarissa E Sanchez
- Center for Medical Ethics and Health Policy, Baylor College of Medicine, One Baylor Plaza, Suite 326D, Houston, TX, 77030, United States
| | - Laura Torgerson
- Center for Medical Ethics and Health Policy, Baylor College of Medicine, One Baylor Plaza, Suite 326D, Houston, TX, 77030, United States
| | - Jill Robinson
- Center for Medical Ethics and Health Policy, Baylor College of Medicine, One Baylor Plaza, Suite 326D, Houston, TX, 77030, United States
| | - Stacey Pereira
- Center for Medical Ethics and Health Policy, Baylor College of Medicine, One Baylor Plaza, Suite 326D, Houston, TX, 77030, United States
| | - Simon Outram
- Program in Bioethics, University of California, San Francisco, 490 Illinois Street, San Francisco, CA, 94143, United States
| | - Barbara A Koenig
- Program in Bioethics, University of California, San Francisco, 490 Illinois Street, San Francisco, CA, 94143, United States
| | - Philip A Starr
- Department of Neurological Surgery, University of California, San Francisco, 400 Parnassus Avenue, San Francisco, CA, 94143, United States
| | - Aysegul Gunduz
- Norman Fixel Institute for Neurological Diseases, Departments of Neurology and Neurosurgery, University of Florida, 3009 SW Williston Road, Gainesville, FL, 32608, United States; Department of Biomedical Engineering, University of Florida, 1275 Center Drive, Biomedical Science Building, JG283, Gainesville, FL, 32611, United States
| | - Kelly D Foote
- Norman Fixel Institute for Neurological Diseases, Departments of Neurology and Neurosurgery, University of Florida, 3009 SW Williston Road, Gainesville, FL, 32608, United States
| | - Michael S Okun
- Norman Fixel Institute for Neurological Diseases, Departments of Neurology and Neurosurgery, University of Florida, 3009 SW Williston Road, Gainesville, FL, 32608, United States
| | - Wayne Goodman
- Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, 1977 Butler Blvd Suite E4.100, Houston, TX, 77030, United States
| | - Amy L McGuire
- Center for Medical Ethics and Health Policy, Baylor College of Medicine, One Baylor Plaza, Suite 326D, Houston, TX, 77030, United States
| | - Peter Zuk
- Center for Bioethics, Harvard Medical School, 641 Huntington Avenue, Boston, MA, 02115, United States
| | - Gabriel Lázaro-Muñoz
- Center for Bioethics, Harvard Medical School, 641 Huntington Avenue, Boston, MA, 02115, United States; Department of Psychiatry, Massachusetts General Hospital, 55 Fruit Street, Boston, MA, 02114, United States.
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Richard V, Cairney J, Woods CT. Holding open spaces to explore beyond: Toward a different conceptualization of specialization in high-performance sport. Front Psychol 2023; 14:1089264. [PMID: 36935971 PMCID: PMC10017444 DOI: 10.3389/fpsyg.2023.1089264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Accepted: 02/13/2023] [Indexed: 03/06/2023] Open
Abstract
This conceptual analysis aims to challenge the state of high-performance sport by questioning the concept of specialization. To start, we offer a brief, but critical overview of what specialization currently entails. Then, shifting the paradigm, we suggest an expansion rather than a reduction of developmental possibilities once an athlete reaches the "top". Specifically, rather than athletes conforming to national standards imposed by governing bodies about what it means to be "elite", we suggest sport systems consider a person-environment fit approach to support ongoing development. Drawing on an ecological dynamics rationale and various socio-cultural theories, we explore how concepts such as affordances and perspectives can be harnessed to create a better "fit" between athletes' action capabilities and the opportunities within their broader environment. Our conception of specialization requires moving away from a definition of success based on the accumulation of medals, toward one that accounts for the exploration and achievement of the possible. We argue that a person-environment fit welcomes diversity, so long as it sustains the person's health, wellbeing, and performance. This, it is suggested, is about collectively holding open spaces for each other to explore beyond the constraints of high-performance sport, encouraging all to carry on their lives in directions meaningfully impactful for them. We conclude this conceptual analysis with a brief case example demonstrating what our theorizing could look like in practice.
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Affiliation(s)
- Veronique Richard
- School of Human Movement and Nutrition Sciences, The University of Queensland, St Lucia, QLD, Australia
- *Correspondence: Veronique Richard,
| | - John Cairney
- School of Human Movement and Nutrition Sciences, The University of Queensland, St Lucia, QLD, Australia
| | - Carl T. Woods
- Institute for Health and Sport, Victoria University, Melbourne, VIC, Australia
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van Westen M, Rietveld E, van Hout A, Denys D. 'Deep brain stimulation is no ON/OFF-switch': an ethnography of clinical expertise in psychiatric practice. PHENOMENOLOGY AND THE COGNITIVE SCIENCES 2023; 22:129-148. [PMID: 36644375 PMCID: PMC9834163 DOI: 10.1007/s11097-021-09732-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 02/11/2021] [Indexed: 05/05/2023]
Abstract
Despite technological innovations, clinical expertise remains the cornerstone of psychiatry. A clinical expert does not only have general textbook knowledge, but is sensitive to what is demanded for the individual patient in a particular situation. A method that can do justice to the subjective and situation-specific nature of clinical expertise is ethnography. Effective deep brain stimulation (DBS) for obsessive-compulsive disorder (OCD) involves an interpretive, evaluative process of optimizing stimulation parameters, which makes it an interesting case to study clinical expertise. The aim of this study is to explore the role of clinical expertise through an ethnography of the particular case of DBS optimization in OCD. In line with the topic of the special issue this article is a part of, we will also use our findings to reflect on ethnography as a method to study complex phenomena like clinical expertise. This ethnography of DBS optimization is based on 18 months of participant observation and nine in-depth interviews with a team of expert clinicians who have been treating over 80 OCD patients since 2005. By repeatedly observing particular situations for an extended period of time, we found that there are recurrent patterns in the ways clinicians interact with patients. These patterns of clinical practice shape the possibilities clinicians have for making sense of DBS-induced changes in patients' lived experience and behavior. Collective established patterns of clinical practice are dynamic and change under the influence of individual learning experiences in particular situations, opening up new possibilities and challenges. We conclude that patterns of clinical practice and particular situations are mutually constitutive. Ethnography is ideally suited to bring this relation into view thanks to its broad temporal scope and focus on the life-world. Based on our findings, we argue that clinical expertise not only implies skillful engagement with a concrete situation but also with the patterns of clinical practice that shape what is possible in this specific situation. Given this constraining and enabling role of practices, it is important to investigate them in order to find ways to improve diagnostic and therapeutic possibilities.
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Affiliation(s)
- Maarten van Westen
- Department of Psychiatry, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, Amsterdam, Netherlands
| | - Erik Rietveld
- Department of Psychiatry, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, Amsterdam, Netherlands
| | - Annemarie van Hout
- Research Group IT Innovations in Health Care, Windesheim University of Applied Sciences, Campus 2, Zwolle, The Netherlands
| | - Damiaan Denys
- Department of Psychiatry, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, Amsterdam, Netherlands
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Rietveld E. The affordances of art for making technologies. ADAPTIVE BEHAVIOR 2022; 30:489-503. [PMID: 36404908 PMCID: PMC9667099 DOI: 10.1177/10597123221132898] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
With this inaugural lecture as Socrates Professor on the topic of Making Humane Technologies, I aim to show that artistic practices afford embedding technologies better in society. Analyzing artworks made at RAAAF, an art collective that makes visual art and experimental architecture, I will describe three aspects of making practices that may contribute to improving the embedding of technology in society: (1) the skill of working with layers of meaning; (2) the skill of creating material playgrounds that afford free exploration of the potential of new technologies and artistic experiments; and (3) the skill of openness to the possibility of having radically different socio-material practices. I will use images of several RAAAF projects to make these skills involved in making more tangible. It is artistic skills like these that can contribute to a better societal embedding of technologies.
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Affiliation(s)
- Erik Rietveld
- University of Amsterdam, Amsterdam UMC Location AMC, Psychiatry, Amsterdam, Netherlands
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10
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Dings R, Tekin Ş. A philosophical exploration of experience-based expertise in mental health care. PHILOSOPHICAL PSYCHOLOGY 2022. [DOI: 10.1080/09515089.2022.2132926] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/10/2022]
Affiliation(s)
- Roy Dings
- Institute for Philosophy II Ruhr-University Bochum, Bochum, Germany
| | - Şerife Tekin
- Department of Philosophy and Classics, University of Texas at San Antonio, San Antonio, TX, USA
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11
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García E, Arandia IR. Enactive and simondonian reflections on mental disorders. Front Psychol 2022; 13:938105. [PMID: 35992462 PMCID: PMC9382120 DOI: 10.3389/fpsyg.2022.938105] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2022] [Accepted: 07/04/2022] [Indexed: 11/13/2022] Open
Abstract
As an alternative to linear and unidimensional perspectives focused mainly on either organic or psychological processes, the enactive approach to life and mind-a branch of 4-E (embodied, embedded, enactive, extended) cognitive theories-offers an integrative framework to study mental disorders that encompasses and articulates organic, sensorimotor, and intersubjective dimensions of embodiment. These three domains are deeply entangled in a non-trivial manner. A question remains on how this systemic and multi-dimensional approach may be applied to our understanding of mental disorders and symptomatic behavior. Drawing on Gilbert Simondon's philosophy of individuation (focusing particularly on the concepts of tension, metastability, and preindividual), we provide some enactive conceptual tools to better understand the dynamic, interactive, and multi-dimensional nature of human bodies in mental disorders and psychopathological symptoms. One of such tools cursiva is sense-making, a key notion that captures the relational process of generating meaning by interacting with the sociomaterial environment. The article analyzes five aspects related to sense-making: temporality, adaptivity, the multiplicity of normativities it involves, the fundamental role of tension, and its participatory character. On this basis, we draw certain implications for our understanding of mental disorders and diverse symptoms, and suggest their interpretation in terms of difficulties to transform tensions and perform individuation processes, which result in a reduction of the field of potentialities for self-individuation and sense-making.
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Affiliation(s)
- Enara García
- IAS Research group, Department of Philosophy, University of the Basque Country, San Sebastián, Spain
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Larsen JL, Johansen KS, Mehlsen MY. What kind of science for dual diagnosis? A pragmatic examination of the enactive approach to psychiatry. Front Psychol 2022; 13:825701. [PMID: 35923725 PMCID: PMC9339962 DOI: 10.3389/fpsyg.2022.825701] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Accepted: 06/28/2022] [Indexed: 11/25/2022] Open
Abstract
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.
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Affiliation(s)
- Jonathan Led Larsen
- Sankt Hans Hospital, Roskilde, Denmark
- Department of Psychology and Behavioural Sciences, School of Business and Social Sciences, Aarhus University, Aarhus, Denmark
- *Correspondence: Jonathan Led Larsen,
| | | | - Mimi Yung Mehlsen
- Department of Psychology and Behavioural Sciences, School of Business and Social Sciences, Aarhus University, Aarhus, Denmark
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13
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Siqueiros-García JM, Manuel-Navarrete D, Eakin H, Mojica L, Charli-Joseph L, Pérez-Belmont P, Ruizpalacios B. Sense of Agency, Affectivity and Social-Ecological Degradation: An Enactive and Phenomenological Approach. Front Psychol 2022; 13:911092. [PMID: 35874411 PMCID: PMC9301310 DOI: 10.3389/fpsyg.2022.911092] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Accepted: 05/31/2022] [Indexed: 12/05/2022] Open
Abstract
In the last few years, there has been an interest in understanding the impact of environmental change and degradation on people's affective life. This issue has become particularly pressing for populations whose form of life is heavily dependent on ecosystem services and functions and whose opportunities for adaptation are limited. Based on our work with farmers from the Xochimilco urban wetland in the southwest of Mexico City, we begin to draw a theoretical approach to address and explain how environmental degradation impacts people's affective life and sense of agency. Farmers who were part of our project referred to a sense of despair and helplessness toward the loss of the ecosystem and their traditional farming-based form of life. From the perspective of phenomenology, enactivism and ecological psychology, we argue that the loss of this form of life in the area is related to the degradation of socio-ecological systems, limiting the opportunities for people to relate meaningfully to others and the environment. We posit that losing meaningful interaction with the environment generates a feeling of loss of control while leading farmers to feel frustrated, anxious and stressed. Such affective conditions have a direct impact on their sense of agency. In terms of adaptation, the negative interaction between degradation, affective states and a diminished sense of agency can create a downward spiral of vulnerability, including political vulnerability.
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Affiliation(s)
- Jesús M. Siqueiros-García
- Unidad Académica del Instituto de Investigaciones en Matemáticas Aplicadas y en Sistemas (IIMAS) en Yucatán, Institute of Applied Mathematics and Systems Research, Universidad Nacional Autónoma de México, Mexico City, Mexico
- *Correspondence: Jesús M. Siqueiros-García
| | | | - Hallie Eakin
- School of Sustainability, Arizona State University, Tempe, AZ, United States
| | - Laura Mojica
- División de Ciencias Sociales y Humanidades, Universidad Autónoma Metropolitana Unidad Cuajimalpa, Mexico City, Mexico
- Embodied Cognitive Science Unit, Okinawa Institute of Science and Technology, Okinawa, Japan
| | - Lakshmi Charli-Joseph
- Laboratorio Nacional de Ciencias de la Sostenibilidad, Instituto de Ecología, Universidad Nacional Autónoma de México, Mexico City, Mexico
| | - Patricia Pérez-Belmont
- Posgrado en Ciencias de la Sostenibilidad, Universidad Nacional Autónoma de México, Mexico City, Mexico
| | - Beatriz Ruizpalacios
- Posgrado en Ciencias de la Sostenibilidad, Universidad Nacional Autónoma de México, Mexico City, Mexico
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14
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Kim NG, Effken JA. Disturbance of Ecological Self and Impairment of Affordance Perception. Front Psychol 2022; 13:925359. [PMID: 35734450 PMCID: PMC9207710 DOI: 10.3389/fpsyg.2022.925359] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Accepted: 05/17/2022] [Indexed: 11/23/2022] Open
Abstract
Affordance, a radical concept James Gibson introduced in the 1970s, remains controversial today. Defined as environmental properties taken with reference to an animal's anatomy and action capabilities, affordances are opportunities for action the environment offers. By perceiving affordances, organisms hold meaningful relationships with their surroundings. Affordance is not just a theoretical concept but, as the embodiment of meanings and values, has serious psychological implications. We contend that the lack of these meanings and values underlies the irrational behavior seen in patients with self disorders such as schizophrenia. We reason that it is by perceiving affordances that individuals keep in touch with their surroundings and stay mentally healthy. Using contrapositive reasoning, the reverse could also be true. That is, when individuals experience difficulty maintaining meaningful relations with their surroundings and suffer from mental health problems, we might anticipate that their affordance detection systems are impaired. In two studies conducted in our laboratory, patients with schizophrenia and Alzheimer's disease were shown to have impaired capacity to perceive affordances, a result qualifying as contra-positive evidence corroborating the affordance concept. In addition, our results provide support for accepting contra-positive evidence as a complementary tool to positive evidence for empirically validating concepts such as affordance and meaning.
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Affiliation(s)
- Nam-Gyoon Kim
- Department of Psychology, Keimyung University, Daegu, South Korea
| | - Judith A. Effken
- College of Nursing, University of Arizona, Tucson, AZ, United States
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15
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Barrios-Anderson A, McLaughlin NCR, Patrick MT, Marsland R, Noren G, Asaad WF, Greenberg BD, Rasmussen S. The Patient Lived-Experience of Ventral Capsulotomy for Obsessive-Compulsive Disorder: An Interpretive Phenomenological Analysis of Neuroablative Psychiatric Neurosurgery. Front Integr Neurosci 2022; 16:802617. [PMID: 35273481 PMCID: PMC8902594 DOI: 10.3389/fnint.2022.802617] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Accepted: 01/13/2022] [Indexed: 11/13/2022] Open
Abstract
Ventral Capsulotomy (VC) is a surgical intervention for treatment-resistant Obsessive-Compulsive Disorder (OCD). Despite clinical studies, little is known about patient perception and lived experience after neurosurgery for severe OCD. To examine the lived experiences of patients who have undergone VC for severe, treatment-resistant OCD through qualitative analysis. We conducted semi-structured interviews with six participants treated with VC for OCD. Interviews were analyzed using Interpretive Phenomenological Analysis. The following themes emerged: (1) After years of conventional treatments, patients felt neurosurgery was their “last hope” and described themselves as “desperate,” (2) While some described the surgery as a “supernatural experience,” patients also demonstrated understanding of the scientific procedure, its risks and potential benefits, (3) The surgical experience itself was positive or neutral, which was linked to trust in the clinical team, (4) Post-surgery, participants described months of heightened fear as they awaited lesion formation and functional improvement. (5) Patients consistently contextualized outcome in the context of their own life goals. Patients undergoing VC have positive views of this neurosurgical intervention, but psychiatric neurosurgical teams should anticipate patient discomfort with the time needed to achieve behavioral improvement following surgery and emphasize the importance of post-operative psychiatric care.
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Affiliation(s)
- Adriel Barrios-Anderson
- Warren Alpert Medical School of Brown University, Providence, RI, United States
- Department of Neurosurgery, Warren Alpert Medical School of Brown University, Providence, RI, United States
- Psychiatric Neurosurgery Program, Butler Hospital, Providence, RI, United States
- *Correspondence: Adriel Barrios-Anderson,
| | - Nicole C. R. McLaughlin
- Psychiatric Neurosurgery Program, Butler Hospital, Providence, RI, United States
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI, United States
| | - Morgan T. Patrick
- Psychiatric Neurosurgery Program, Butler Hospital, Providence, RI, United States
| | - Richard Marsland
- Psychiatric Neurosurgery Program, Butler Hospital, Providence, RI, United States
| | - Georg Noren
- Department of Neurosurgery, Warren Alpert Medical School of Brown University, Providence, RI, United States
- Psychiatric Neurosurgery Program, Butler Hospital, Providence, RI, United States
| | - Wael F. Asaad
- Department of Neurosurgery, Warren Alpert Medical School of Brown University, Providence, RI, United States
- Department of Neuroscience, Brown University, Providence, RI, United States
- Carney Institute for Brain Science, Brown University, Providence, RI, United States
| | - Benjamin D. Greenberg
- Psychiatric Neurosurgery Program, Butler Hospital, Providence, RI, United States
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI, United States
- Center for Neurorestoration and Neurotechnology (CfNN), Providence VA Medical Center, Providence, RI, United States
| | - Steven Rasmussen
- Psychiatric Neurosurgery Program, Butler Hospital, Providence, RI, United States
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI, United States
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16
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Vegas C, Laurent É. Mood Influences the Perception of the Sitting Affordance. Atten Percept Psychophys 2022; 84:270-288. [PMID: 34907512 DOI: 10.3758/s13414-021-02419-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/20/2021] [Indexed: 11/08/2022]
Abstract
This study tested the influence of mood on the perception of the sitting affordance in two experiments. The objective of Experiment 1 was to evaluate participants' perception of the sitting affordance, without mood induction. Forty-three participants assessed their maximum sitting height (SHmax) from different seat heights (perceptual SHmax) before performing the action (motor SHmax). They accurately perceived the sitting affordance, in body-scaled intrinsic units. Indeed, participants all perceived they could sit as long as the seat height did not exceed 82% (perceptual πc) of their total leg length (L), while the actual value of this intrinsic relationship was 83% (motor πc). In Experiment 2, forty participants were subjected to a mood induction procedure before performing the task employed in Experiment 1. Neutral participants accurately perceived the sitting affordance, as their perceptual πc was equivalent to their motor πc. However, both joyful and sad participants had their perceptual πc significantly lower than their motor πc. These differences between mood groups were not explained by a variation in maximal effective action capabilities. Indeed, participants had equivalent motor πc, whatever their mood. Two interpretations are offered to explain how joyful and sad moods could influence the accuracy of affordance perception. The first is based on their potential effect on organism's energy level. The second is related to the disruption of participants' attunement to optical variables relevant for action guidance and/or to perceptual-motor calibration.
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Affiliation(s)
- Colin Vegas
- Université Bourgogne Franche-Comté (UBFC), Besançon, France
| | - Éric Laurent
- Université Bourgogne Franche-Comté (UBFC), Besançon, France.
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17
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Bluhm R, Castillo E, Achtyes ED, McCright AM, Cabrera LY. They Affect the Person, but for Better or Worse? Perceptions of Electroceutical Interventions for Depression Among Psychiatrists, Patients, and the Public. QUALITATIVE HEALTH RESEARCH 2021; 31:2542-2553. [PMID: 34672815 PMCID: PMC8579329 DOI: 10.1177/10497323211037642] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
Responding to reports of cases of personality change following deep brain stimulation, neuroethicists have debated the nature and ethical implications of these changes. Recently, this literature has been challenged as being overblown and therefore potentially an impediment to patients accessing needed treatment. We interviewed 16 psychiatrists, 16 patients with depression, and 16 members of the public without depression, all from the Midwestern United States, about their views on how three electroceutical interventions (deep brain stimulation, electroconvulsive therapy, and transcranial magnetic stimulation) used to treat depression might affect the self. Participants were also asked to compare the electroceuticals' effects on the self with the effects of commonly used depression treatments (psychotherapy and pharmaceuticals). Using qualitative content analysis, we found that participants' views on electroceuticals' potential effects on the self mainly focused on treatment effectiveness and side effects. Our results have implications for both theoretical discussions in neuroethics and clinical practice in psychiatry.
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Affiliation(s)
- Robyn Bluhm
- Michigan State University, East Lansing, Michigan, USA
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18
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Wilt JA, Merner AR, Zeigler J, Montpetite M, Kubu CS. Does Personality Change Follow Deep Brain Stimulation in Parkinson's Disease Patients? Front Psychol 2021; 12:643277. [PMID: 34393883 PMCID: PMC8361492 DOI: 10.3389/fpsyg.2021.643277] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Accepted: 03/15/2021] [Indexed: 12/19/2022] Open
Abstract
Deep Brain Stimulation (DBS) has emerged as a safe, effective, and appealing treatment for Parkinson's Disease (PD), particularly for improving motor symptoms (e. g., tremor, bradykinesia, and rigidity). However, concerns have been raised about whether DBS causes psychological changes, including changes to personality: characteristic and relatively stable patterns of affect, behavior, cognition, and desire. In this article, after first presenting some background information about PD and DBS, we examined evidence obtained from various empirical research methods (quantitative, qualitative, and mixed methods for evaluating patient valued characteristics) pertaining to whether DBS causes personality change. General limitations across research methods include a lack of randomized clinical trials and small sample sizes. We organized our review of findings according to different layers of personality variables: dispositional traits (including personality pathology), characteristic adaptations, and narrative identity. Though most work has been done on dispositional traits, there is not much evidence that dispositional traits change following DBS. Little work has been done on characteristic adaptations, but there is somewhat consistent evidence for positive perceived progress toward goals across a number of domains: routine activities, work, social/relational, and leisure. Nascent work on narrative identity holds promise for revealing issues around self-image that may be common following DBS. We listed a number of strategies for advancing research, highlighting opportunities related to personality conceptualization, personality assessment, and interdisciplinary scholarship. Finally, we offer practical applications of our findings for the informed consent process and for ongoing treatment.
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Affiliation(s)
- Joshua A Wilt
- Department of Psychological Sciences, Case Western Reserve University, Cleveland, OH, United States
| | - Amanda R Merner
- Department of Psychological Sciences, Case Western Reserve University, Cleveland, OH, United States.,Department of Neurology, Cleveland Clinic, Cleveland, OH, United States
| | - Jaclyn Zeigler
- Department of Neurology, Cleveland Clinic, Cleveland, OH, United States
| | | | - Cynthia S Kubu
- Department of Neurology, Cleveland Clinic, Cleveland, OH, United States.,Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, OH, United States
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19
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20
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Satchell LP, Kaaronen RO, Latzman RD. An ecological approach to personality: Psychological traits as drivers and consequences of active perception. SOCIAL AND PERSONALITY PSYCHOLOGY COMPASS 2021. [DOI: 10.1111/spc3.12595] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Affiliation(s)
| | - Roope Oskari Kaaronen
- Faculty of Social Sciences Helsinki Institute of Sustainability Science University of Helsinki Helsinki Finland
| | - Robert D. Latzman
- Department of Psychology Georgia State University Atlanta Georgia USA
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21
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Schmidt S, Wagner G, Walter M, Stenner MP. A Psychophysical Window onto the Subjective Experience of Compulsion. Brain Sci 2021; 11:brainsci11020182. [PMID: 33540916 PMCID: PMC7913241 DOI: 10.3390/brainsci11020182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Revised: 01/19/2021] [Accepted: 01/25/2021] [Indexed: 11/16/2022] Open
Abstract
In this perspective, we follow the idea that an integration of cognitive models with sensorimotor theories of compulsion is required to understand the subjective experience of compulsive action. We argue that cognitive biases in obsessive-compulsive disorder may obscure an altered momentary, pre-reflective experience of sensorimotor control, whose detection thus requires an implicit experimental operationalization. We propose that a classic psychophysical test exists that provides this implicit operationalization, i.e., the intentional binding paradigm. We show how intentional binding can pit two ideas against each other that are fundamental to current sensorimotor theories of compulsion, i.e., the idea of excessive conscious monitoring of action, and the idea that patients with obsessive-compulsive disorder compensate for diminished conscious access to "internal states", including states of the body, by relying on more readily observable proxies. Following these ideas, we develop concrete, testable hypotheses on how intentional binding changes under the assumption of different sensorimotor theories of compulsion. Furthermore, we demonstrate how intentional binding provides a touchstone for predictive coding accounts of obsessive-compulsive disorder. A thorough empirical test of the hypotheses developed in this perspective could help explain the puzzling, disabling phenomenon of compulsion, with implications for the normal subjective experience of human action.
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Affiliation(s)
- Stefan Schmidt
- Department of Psychiatry and Psychotherapy, Jena University Hospital, 07743 Jena, Germany; (S.S.); (G.W.); (M.W.)
| | - Gerd Wagner
- Department of Psychiatry and Psychotherapy, Jena University Hospital, 07743 Jena, Germany; (S.S.); (G.W.); (M.W.)
| | - Martin Walter
- Department of Psychiatry and Psychotherapy, Jena University Hospital, 07743 Jena, Germany; (S.S.); (G.W.); (M.W.)
- Department of Behavioral Neurology, Leibniz Institute for Neurobiology, 39118 Magdeburg, Germany
| | - Max-Philipp Stenner
- Department of Behavioral Neurology, Leibniz Institute for Neurobiology, 39118 Magdeburg, Germany
- Department of Neurology, Otto-von-Guericke University, 39120 Magdeburg, Germany
- Correspondence: ; Tel.: +49-391-626392301; Fax: +49-391-6715233
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22
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Stevens I, Gilbert F. Ethical examination of deep brain stimulation's 'last resort' status. JOURNAL OF MEDICAL ETHICS 2021; 47:medethics-2020-106609. [PMID: 33441307 DOI: 10.1136/medethics-2020-106609] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Revised: 10/26/2020] [Accepted: 11/01/2020] [Indexed: 06/12/2023]
Abstract
Deep brain stimulation (DBS) interventions are novel devices being investigated for the management of severe treatment-resistant psychiatric illnesses. These interventions require the invasive implantation of high-frequency neurostimulatory probes intracranially aiming to provide symptom relief in treatment-resistant disorders including obsessive-compulsive disorder and anorexia nervosa. In the scientific literature, these neurostimulatory interventions are commonly described as reversible and to be used as a last resort option for psychiatric patients. However, the 'last resort' status of these interventions is rarely expanded upon. Contrastingly, usages of DBS devices for neurological symptoms (eg, Parkinson's disease, epilepsy or dystonia) have paved the way for established safety and efficacy standards when used earlier in a disease's timeline. As DBS treatments for these neurological diseases progress to have earlier indications, there is a parallel ethical concern that early implementation may one day become prescribed for psychiatric illnesses. The purpose of this article is to build off contemporary understandings of reversible neurostimulatory interventions to examine and provide clarifications on the 'last resort' status of DBS to better address its ethically charged use in psychiatric neurosurgery. To do this, evaluative differences between DBS treatments will be discussed to demonstrate how patient autonomy would be a paramount guiding principle when one day implementing these devices at various points along a psychiatric disease's timeline. In presenting the clarification of 'last resort' status, the ethical tensions of early DBS interventions will be better understood to assist in providing psychiatric patients with more quality of life years in line with their values.
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Affiliation(s)
- Ian Stevens
- Philosophy & Gender Studies, University of Tasmania School of Humanities, Hobart, Tasmania, Australia
| | - Frederic Gilbert
- Philosophy & Gender Studies, University of Tasmania School of Humanities, Hobart, Tasmania, Australia
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23
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Glackin SN, Roberts T, Krueger J. Out of our heads: Addiction and psychiatric externalism. Behav Brain Res 2020; 398:112936. [PMID: 33065141 DOI: 10.1016/j.bbr.2020.112936] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Revised: 08/31/2020] [Accepted: 09/21/2020] [Indexed: 10/23/2022]
Abstract
In addiction, apparently causally significant phenomena occur at a huge number of levels; addiction is affected by biomedical, neurological, pharmacological, clinical, social, and politico-legal factors, among many others. In such a complex, multifaceted field of inquiry, it seems very unlikely that all the many layers of explanation will prove amenable to any simple or straightforward, reductive analysis; if we are to unify the many different sciences of addiction while respecting their causal autonomy, then, what we are likely to need is an integrative framework. In this paper, we propose the theory of "Externalist" or "4E" - for extended, embodied, embedded, and enactive - cognition, which focuses on the empirical and conceptual centrality of the wider extra-neural environment to cognitive and mental processes, as a candidate for such a framework. We begin in Section 2 by outlining how such a perspective might apply to psychiatry more generally, before turning to some of the ways it can illuminate addiction in particular: Section 3 points to a way of dissolving the classic dichotomy between the "choice model" and "disease model" in the addiction literature; Section 4 shows how 4E concepts can clarify the interplay between the addict's brain and her environment; and Section 5 considers how these insights help to explain the success of some recovery strategies, and may help to inform the development of new ones.
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Affiliation(s)
- Shane N Glackin
- Department of Sociology, Philosophy, and Anthropology, University of Exeter, UK.
| | - Tom Roberts
- Department of Sociology, Philosophy, and Anthropology, University of Exeter, UK
| | - Joel Krueger
- Department of Sociology, Philosophy, and Anthropology, University of Exeter, UK
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24
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Harrison S. Through the Magical Pink Walkway: A Behavior Setting's Invitation to Embodied Sense-Makers. Front Psychol 2020; 11:1576. [PMID: 33013495 PMCID: PMC7511542 DOI: 10.3389/fpsyg.2020.01576] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Accepted: 06/12/2020] [Indexed: 11/25/2022] Open
Abstract
This paper examines an intersection between ecological psychology and the enactive approach brought about by studying sense-making in relation to a behavior setting in Hong Kong and adopting a focus on embodied action and gesture. A cosmetics pop-up store embedded in a downtown shopping mall provides the basis for a case study involving a two-pronged analysis. I first use Barker’s behavior setting theory to describe the publicly accessible structure and dynamics of the store, which reveals a bounded spatiotemporal entity with several interdependent behavior–milieu parts. I then analyze video recordings of my research participant encountering, entering, and exploring this environment. Following an enactive-informed micro-ethnographic approach to embodied communication, I examine her movements, postures, gestures, and language use as she joins the behavior setting. These fine-grained descriptions of her embodied actions provide an empirical basis to analyze enactive sense-making. On the one hand, they disclose the affective and emotional experience of perceiving relevant affordances in the environment, and on the other hand, they show the specificity of sensorimotor abilities required to join the setting’s standing pattern of behavior.
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Affiliation(s)
- Simon Harrison
- Department of English, City University of Hong Kong, Kowloon, Hong Kong
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25
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Berkovich-Ohana A, Dor-Ziderman Y, Trautwein FM, Schweitzer Y, Nave O, Fulder S, Ataria Y. The Hitchhiker's Guide to Neurophenomenology - The Case of Studying Self Boundaries With Meditators. Front Psychol 2020; 11:1680. [PMID: 32793056 PMCID: PMC7385412 DOI: 10.3389/fpsyg.2020.01680] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Accepted: 06/19/2020] [Indexed: 11/13/2022] Open
Abstract
This paper is a practical guide to neurophenomenology. Varela's neurophenomenological research program (NRP) aspires to bridge the gap between, and integrate, first-person (1P) and third-person (3P) approaches to understanding the mind. It does so by suggesting a methodological framework allowing these two irreducible phenomenal domains to relate and reciprocally support the investigation of one another. While highly appealing theoretically, neurophenomenology invites researchers to a challenging methodological endeavor. Based on our experience with empirical neurophenomenological implementation, we offer practical clarifications and insights learnt along the way. In the first part of the paper, we outline the theoretical principles of the NRP and briefly present the field of 1P research. We speak to the importance of phenomenological training and outline the utility of cooperating with meditators as skilled participants. We suggest that 1P accounts of subjective experience can be placed on a complexity continuum ranging between thick and thin phenomenology, highlighting the tension and trade-off inherent to the neurophenomenological attempt to naturalize phenomenology. We then outline a typology of bridges, which create mutual constraints between 1P and 3P approaches, and argue for the utility of alternating between the bridges depending on the available experimental resources, domain of interest and level of sought articulation. In the second part of the paper, we demonstrate how the theory can be put into practice by describing a decade of neurophenomenological studies investigating the sense of self with increasing focus on its embodied, and minimal, aspects. These aspects are accessed via the dissolution of the sense-of-boundaries, shedding new light on the multi-dimensionality and flexibility of embodied selfhood. We emphasize the evolving neurophenomenological dialogue, showing how consecutive studies, placed differently on the thin-to-thick 1P continuum, advance the research project by using the bridging principles appropriate for each stage.
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Affiliation(s)
- Aviva Berkovich-Ohana
- Department of Learning, Instruction and Teacher Education, Faculty of Education, University of Haifa, Haifa, Israel
- Department of Counseling and Human Development, Faculty of Education, University of Haifa, Haifa, Israel
- Edmond J. Safra Brain Research Center, University of Haifa, Haifa, Israel
- The Integrated Brain and Behavior Research Center (IBBRC), University of Haifa, Haifa, Israel
| | - Yair Dor-Ziderman
- Department of Learning, Instruction and Teacher Education, Faculty of Education, University of Haifa, Haifa, Israel
- Department of Counseling and Human Development, Faculty of Education, University of Haifa, Haifa, Israel
- Edmond J. Safra Brain Research Center, University of Haifa, Haifa, Israel
| | - Fynn-Mathis Trautwein
- Edmond J. Safra Brain Research Center, University of Haifa, Haifa, Israel
- Department of Psychosomatic Medicine and Psychotherapy, Medical Center – University of Freiburg, Freiburg im Breisgau, Germany
| | - Yoav Schweitzer
- Department of Learning, Instruction and Teacher Education, Faculty of Education, University of Haifa, Haifa, Israel
- Department of Counseling and Human Development, Faculty of Education, University of Haifa, Haifa, Israel
- Edmond J. Safra Brain Research Center, University of Haifa, Haifa, Israel
| | - Ohad Nave
- Department of Cognitive Sciences, The Hebrew University of Jerusalem, Jerusalem, Israel
| | | | - Yochai Ataria
- Department of Psychology, Tel-Hai Academic College, Tel Hai, Israel
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26
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Humpston CS, Broome MR. Thinking, believing, and hallucinating self in schizophrenia. Lancet Psychiatry 2020; 7:638-646. [PMID: 32105619 DOI: 10.1016/s2215-0366(20)30007-9] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2019] [Revised: 01/09/2020] [Accepted: 01/09/2020] [Indexed: 01/01/2023]
Abstract
In this Personal View, we discuss the history and concept of self-disturbance in relation to the pathophysiology and subjective experience of schizophrenia in terms of three approaches: the perceptual anomalies approach of the early Heidelberg School of Psychiatry, the ipseity model, and the predictive coding framework. Despite the importance of these approaches, there has been a notable absence of efforts to compare them and consider how they might be integrated. This Personal View compares the three approaches and offers suggestions as to how they might work together, which represents a novel position. We view self-disturbances as transformations of self that form the inseparable background against which psychotic symptoms emerge. Integrating computational psychiatric approaches with those used by phenomenologists in the first two listed approaches, we argue that delusions and hallucinations are inferences produced under extraordinary conditions and are both statistically and experientially as real for patients as other mental events. Such inferences still approximate Bayes-optimality, given the personal, neurobiological, and environmental circumstances, and might be the only ones available to minimise prediction error. The added contribution we hope to make focuses on how the dialogue between neuroscience and phenomenology might improve clinical practice. We hope this Personal View will act as a timely primer and bridging point for the different approaches of computational psychiatry and phenomenological psychopathology for interested clinicians.
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Affiliation(s)
- Clara S Humpston
- Institute for Mental Health, School of Psychology, University of Birmingham, Birmingham, UK.
| | - Matthew R Broome
- Institute for Mental Health, School of Psychology, University of Birmingham, Birmingham, UK
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27
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Toro J, Kiverstein J, Rietveld E. The Ecological-Enactive Model of Disability: Why Disability Does Not Entail Pathological Embodiment. Front Psychol 2020; 11:1162. [PMID: 32595560 PMCID: PMC7300276 DOI: 10.3389/fpsyg.2020.01162] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Accepted: 05/05/2020] [Indexed: 11/13/2022] Open
Abstract
In the last 50 years, discussions of how to understand disability have been dominated by the medical and social models. Paradoxically, both models overlook the disabled person's experience of the lived body, thus reducing the body of the disabled person to a physiological body. In this article we introduce what we call the Ecological-Enactive (EE) model of disability. The EE-model combines ideas from enactive cognitive science and ecological psychology with the aim of doing justice simultaneously to the lived experience of being disabled, and the physiological dimensions of disability. More specifically, we put the EE model to work to disentangle the concepts of disability and pathology. We locate the difference between pathological and normal forms of embodiment in the person's capacity to adapt to changes in the environment. To ensure that our discussion remains in contact with lived experience, we draw upon phenomenological interviews we have carried out with people with Cerebral Palsy.
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Affiliation(s)
- Juan Toro
- Center for Subjectivity Research, Faculty of Humanities, University of Copenhagen, Copenhagen, Denmark.,The Enactlab, Copenhagen, Denmark
| | - Julian Kiverstein
- Amsterdam Brain and Cognition, Amsterdam, Netherlands.,Amsterdam University Medical Center, Amsterdam, Netherlands
| | - Erik Rietveld
- Amsterdam University Medical Center, Amsterdam, Netherlands.,Department of Philosophy, University of Twente, Enschede, Netherlands.,Institute for Logic, Language and Computation, Faculty of Science, University of Amsterdam, Amsterdam, Netherlands
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Kiverstein J, Miller M, Rietveld E. How mood tunes prediction: a neurophenomenological account of mood and its disturbance in major depression. Neurosci Conscious 2020; 2020:niaa003. [PMID: 32818063 PMCID: PMC7425816 DOI: 10.1093/nc/niaa003] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2019] [Revised: 02/21/2020] [Accepted: 03/07/2020] [Indexed: 12/12/2022] Open
Abstract
In this article, we propose a neurophenomenological account of what moods are, and how they work. We draw upon phenomenology to show how mood attunes a person to a space of significant possibilities. Mood structures a person's lived experience by fixing the kinds of significance the world can have for them in a given situation. We employ Karl Friston's free-energy principle to show how this phenomenological concept of mood can be smoothly integrated with cognitive neuroscience. We will argue that mood is a consequence of acting in the world with the aim of minimizing expected free energy-a measure of uncertainty about the future consequences of actions. Moods summarize how the organism is faring overall in its predictive engagements, tuning the organism's expectations about how it is likely to fare in the future. Agents that act to minimize expected free energy will have a feeling of how well or badly they are doing at maintaining grip on the multiple possibilities that matter to them. They will have what we will call a 'feeling of grip' that structures the possibilities they are ready to engage with over long time-scales, just as moods do.
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Affiliation(s)
- Julian Kiverstein
- Department of Psychiatry, Amsterdam University Medical Centre, Meibergdreef 9, 1105AZ Amsterdam South East, The Netherlands
| | - Mark Miller
- Department of Informatics, University of Sussex, Sussex House, Falmer, Brighton, BN1 9RH, UK
| | - Erik Rietveld
- Department of Psychiatry, Amsterdam University Medical Centre, Meibergdreef 9, 1105AZ Amsterdam South East, The Netherlands
- Department of Philosophy/ILLC, University of Amsterdam, Oude Turfmarkt 141-3, 1012GC Amsterdam, The Netherlands
- Department of Philosophy, University of Twente, 7500AE Enschede, The Netherlands
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Thirioux B, Harika-Germaneau G, Langbour N, Jaafari N. The Relation Between Empathy and Insight in Psychiatric Disorders: Phenomenological, Etiological, and Neuro-Functional Mechanisms. Front Psychiatry 2020; 10:966. [PMID: 32116810 PMCID: PMC7020772 DOI: 10.3389/fpsyt.2019.00966] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2019] [Accepted: 12/06/2019] [Indexed: 01/12/2023] Open
Abstract
Lack of insight, i.e., unawareness of one's mental illness, is frequently encountered in psychiatric conditions. Insight is the capacity to recognize (psychical insight) and accept one's mental illness (emotional insight). Insight growth necessitates developing an objective perspective on one's subjective pathological experiences. Therefore, insight has been posited to require undamaged self-reflexion and cognitive perspective-taking capacities. These enable patients to look objectively at themselves from the imagined perspective of someone else. Preserved theory-of-mind performances have been reported to positively impact insight in psychosis. However, some patients with schizophrenia or obsessive-compulsive disorders, although recognizing their mental disease, are still not convinced of this and do not accept it. Hence, perspective-taking explains psychical insight (recognition) but not emotional insight (acceptance). Here, we propose a new conceptual model. We hypothesize that insight growth relies upon the association of intact self-reflexion and empathic capacities. Empathy (feeling into someone else) integrates heterocentered visuo-spatial perspective (feeling into), embodiment, affective (feeling into) and cognitive processes, leading to internally experience the other's thought. We posit that this subjective experience enables to better understand the other's thought about oneself and to affectively adhere to this. We propose that the process of objectification, resulting from empathic heterocentered, embodiment, and cognitive processes, generates an objective viewpoint on oneself. It enables to recognize one's mental illness and positively impacts psychical insight. The process of subjectification, resulting from empathic affective processes, enables to accept one's illness and positively impacts emotional insight. That is, affectively experiencing the thought of another person about oneself reinforces the adhesion of the emotional system to the objective recognition of the disease. Applying our model to different psychiatric disorders, we predict that the negative effect of impaired self-reflexion and empathic capacities on insight is a transnosographic state and that endophenotypical differences modulate this common state, determining a psychiatric disease as specific.
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Affiliation(s)
- Bérangère Thirioux
- Unité de Recherche Clinique Intersectorielle en Psychiatrie à vocation régionale Pierre Deniker, Centre Hospitalier Henri Laborit, Poitiers, France
| | - Ghina Harika-Germaneau
- Unité de Recherche Clinique Intersectorielle en Psychiatrie à vocation régionale Pierre Deniker, Centre Hospitalier Henri Laborit, Poitiers, France
| | - Nicolas Langbour
- Unité de Recherche Clinique Intersectorielle en Psychiatrie à vocation régionale Pierre Deniker, Centre Hospitalier Henri Laborit, Poitiers, France
| | - Nematollah Jaafari
- Unité de Recherche Clinique Intersectorielle en Psychiatrie à vocation régionale Pierre Deniker, Centre Hospitalier Henri Laborit, Poitiers, France
- Université de Poitiers, CHU de Poitiers, INSERM U 1084, Experimental and Clinical Neuroscience Laboratory, Groupement de Recherche CNRS 3557, Poitiers, France
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Gilbert F, Brown, Dasgupta, Martens, Klein, Goering. An Instrument to Capture the Phenomenology of Implantable Brain Device Use. NEUROETHICS-NETH 2019. [DOI: 10.1007/s12152-019-09422-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
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van Westen M, Rietveld E, Denys D. Effective Deep Brain Stimulation for Obsessive-Compulsive Disorder Requires Clinical Expertise. Front Psychol 2019; 10:2294. [PMID: 31695638 PMCID: PMC6817500 DOI: 10.3389/fpsyg.2019.02294] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2019] [Accepted: 09/24/2019] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Deep brain stimulation (DBS) is an innovative treatment for severe obsessive-compulsive disorder (OCD). Electrodes implanted in specific brain areas allow clinicians to directly modulate neural activity. DBS affects symptomatology in a completely different way than established forms of treatment for OCD, such as psychotherapy or medication. OBJECTIVE To understand the process of improvement with DBS in patients with severe OCD. METHODS By means of open-ended interviews and participant observation we explore how expert clinicians involved in the post-operative process of DBS optimization evaluate DBS effects. RESULTS Evaluating DBS effect is an interactive and context-sensitive process that gradually unfolds over time and requires integration of different sources of knowledge. Clinicians direct DBS optimization toward a critical point where they sense that patients are being moved with regard to behavior, emotion, and active engagement, opening up possibilities for additional cognitive behavioral therapy (CBT). DISCUSSION Based on the theoretical framework of radical embodied cognitive science (RECS), we assume that clinical expertise manifests itself in the pattern of interaction between patient and clinician. To the expert clinician, this pattern reflects the patient's openness to possibilities for action ("affordances") offered by their environment. OCD patients' improvement with DBS can be understood as a change in openness to their environment. The threshold for patients to engage in activities is decreased and a broader range of daily life and therapeutic activities becomes attractive. Movement is improvement.
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Affiliation(s)
- Maarten van Westen
- Department of Psychiatry, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
| | - Erik Rietveld
- Department of Psychiatry, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
- Amsterdam Brain and Cognition, University of Amsterdam, Amsterdam, Netherlands
- Institute for Logic, Language and Computation, University of Amsterdam, Amsterdam, Netherlands
- Department of Philosophy, University of Twente, Enschede, Netherlands
| | - Damiaan Denys
- Department of Psychiatry, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
- Amsterdam Brain and Cognition, University of Amsterdam, Amsterdam, Netherlands
- Netherlands Institute for Neurosciences, Institute of the Royal Dutch Academy of Arts and Sciences, Amsterdam, Netherlands
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Zuk P, Lázaro-Muñoz G. DBS and Autonomy: Clarifying the Role of Theoretical Neuroethics. NEUROETHICS-NETH 2019; 14:83-93. [DOI: 10.1007/s12152-019-09417-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Snoek A, de Haan S, Schermer M, Horstkötter D. On the Significance of the Identity Debate in DBS and the Need of an Inclusive Research Agenda. A Reply to Gilbert, Viana and Ineichen. NEUROETHICS-NETH 2019. [DOI: 10.1007/s12152-019-09411-w] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Daly A, Gallagher S. Towards a Phenomenology of Self-Patterns in Psychopathological Diagnosis and Therapy. Psychopathology 2019; 52:33-49. [PMID: 31018215 PMCID: PMC6878753 DOI: 10.1159/000499315] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2018] [Revised: 02/28/2019] [Accepted: 02/28/2019] [Indexed: 11/19/2022]
Abstract
Categorization-based diagnosis, which endeavors to be consistent with the third-person, objective measures of science, is not always adequate with respect to problems concerning diagnostic accuracy, demarcation problems when there are comorbidities, well-documented problems of symptom amplification, and complications of stigmatization and looping effects. While psychiatric categories have proved useful and convenient for clinicians in identifying a recognizable constellation of symptoms typical for a particular disorder for the purposes of communication and eligibility for treatment regimes, the reification of these categories has without doubt had negative consequences for the patient and also for the general understanding of psychiatric disorders. We argue that a complementary, integrated framework that focuses on descriptive symptom-based classifications (drawing on phenomenological interview methods and narrative) combined with a more comprehensive conception of the human subject (found in the pattern theory of self), can not only offer a solution to some of the vexed issues of psychiatric diagnosis but also support more efficacious therapeutic interventions.
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Affiliation(s)
- Anya Daly
- School of Philosophical and Historical Studies, The University of Melbourne, Melbourne, Victoria, Australia,
| | - Shaun Gallagher
- Lillian and Morrie Moss Chair of Excellence in Philosophy, Department of Philosophy, University of Memphis, Memphis, Tennessee, USA
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What we (Should) Talk about when we Talk about Deep Brain Stimulation and Personal Identity. NEUROETHICS-NETH 2019. [DOI: 10.1007/s12152-019-09396-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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Withagen R. Towards an ecological approach to emotions and the individual differences therein. NEW IDEAS IN PSYCHOLOGY 2018. [DOI: 10.1016/j.newideapsych.2018.04.004] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Kiverstein JD, Rietveld E. Reconceiving representation-hungry cognition: an ecological-enactive proposal. ADAPTIVE BEHAVIOR 2018; 26:147-163. [PMID: 30135620 PMCID: PMC6088514 DOI: 10.1177/1059712318772778] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Enactive approaches to cognitive science aim to explain human cognitive processes across the board without making any appeal to internal, content-carrying representational states. A challenge to such a research programme in cognitive science that immediately arises is how to explain cognition in so-called 'representation-hungry' domains. Examples of representation-hungry domains include imagination, memory, planning and language use in which the agent is engaged in thinking about something that may be absent, possible or abstract. The challenge is to explain how someone could think about things that are not concretely present in their environment other than by means of an internal mental representation. We call this the 'Representation-Hungry Challenge' (RHC). The challenge we take up in this article is to show how hunger for representations could possibly be satisfied by means other than the construction and manipulation of internal representational states. We meet this challenge by developing a theoretical framework that integrates key ideas drawn from enactive cognitive science and ecological psychology. One of our main aims is thus to show how ecological and enactive theories as non-representational and non-computational approaches to cognitive science might work together. From enactive cognitive science, we borrow the thesis of the strict continuity of lower and higher cognition. We develop this thesis to argue against any sharp conceptual distinction between higher and lower cognition based on representation-hunger. From ecological psychology, we draw upon our earlier work on the rich landscape of affordances. We propose thinking of so-called representation-hungry cognition in terms of temporally extended activities in which the agent skilfully coordinates to a richly structured landscape of affordances. In our framework, putative cases of representation-hungry cognition are explained by abilities to coordinate nested activities to an environment structured by interrelated socio-material practices. The RHC has often figured in arguments for the limitations of non-representational approaches to cognitive science. We showcase the theoretical resources available to an integrated ecological-enactive approach for addressing this type of sceptical challenge.
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Gallagher S, Daly A. Dynamical Relations in the Self-Pattern. Front Psychol 2018; 9:664. [PMID: 29867642 PMCID: PMC5958307 DOI: 10.3389/fpsyg.2018.00664] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2018] [Accepted: 04/17/2018] [Indexed: 02/02/2023] Open
Abstract
The notion of a self-pattern, as developed in the pattern theory of self (Gallagher, 2013), which holds that the self is best explained in terms of the kind of reality that pertains to a dynamical pattern, acknowledges the importance of neural dynamics, but also expands the account of self to extra-neural (embodied and enactive) dynamics. The pattern theory of self, however, has been criticized for failing to explicate the dynamical relations among elements of the self-pattern (e.g., Kyselo, 2014; Beni, 2016; de Haan et al., 2017); as such, it seems to be nothing more than a mere list of elements. We'll argue that the dynamics of a self-pattern are reflected in three significant and interrelated ways that allow for investigation. First, a self-pattern is reflectively reiterated in its narrative component. Second, studies of psychiatric or neurological disorders can help us understand the precise nature of the dynamical relations in a self-pattern, and how they can fail. Third, referencing predictive processing accounts, neuroscience can also help to explicate the dynamical relations that constitute the self-pattern.
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Affiliation(s)
- Shaun Gallagher
- Department of Philosophy, University of Memphis, Memphis, TN, United States
- Philosophy, Faculty of Law, Humanities and the Arts, University of Wollongong, Wollongong, NSW, Australia
| | - Anya Daly
- School of Philosophy, University College Dublin, Dublin, Ireland
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Francken JC, Slors M. Neuroscience and everyday life: Facing the translation problem. Brain Cogn 2018; 120:67-74. [DOI: 10.1016/j.bandc.2017.09.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2016] [Revised: 09/02/2017] [Accepted: 09/05/2017] [Indexed: 10/18/2022]
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Kim NG, Kim H. Schizophrenia: An Impairment in the Capacity to Perceive Affordances. Front Psychol 2017; 8:1052. [PMID: 28701973 PMCID: PMC5487489 DOI: 10.3389/fpsyg.2017.01052] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2016] [Accepted: 06/08/2017] [Indexed: 01/05/2023] Open
Abstract
Phenomenological psychopathologists conceptualize schizophrenia as a self-disorder involving profound distortions of selfhood. For James Gibson, “to perceive the world is to coperceive oneself.” If the sense of self is disturbed in individuals with schizophrenia, this could also lead to disturbances in these individuals’ ability to perceive affordances, environmental properties taken with reference to the perceiver’s action capabilities (e.g., a rigid surface affording ‘walk-on-able,’ chairs ‘sit-on-able,’ and so on). To test this hypothesis, three experiments investigated schizophrenia patients’ affordance perception. Participants were presented with a photo of a common object on the computer and then asked to judge its secondary affordance (a non-designed function) in a two-choice reaction time task in Experiment 1 and in a yes/no task in Experiment 2. Schizophrenia participants performed less accurately and more slowly than controls. To rule out visual impairment as a contributing factor, in Experiment 3, participants identified physical properties (color, shape, material composition) of the objects. Schizophrenia participants were as accurate as controls and responded faster than in the previous experiments. Results suggest that the capacity to perceive affordances is likely impaired in people with schizophrenia, although the capacity to detect the object’s physical properties is kept intact. Inability to perceive affordances, those functionally significant properties of the surrounding environment, may help explain why schizophrenia patients may appear as somewhat detached from the world.
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Affiliation(s)
- Nam-Gyoon Kim
- Department of Psychology, Keimyung UniversityDaegu, South Korea
| | - Hakboon Kim
- Department of Psychology, Keimyung UniversityDaegu, South Korea
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de Haan S, Rietveld E, Stokhof M, Denys D. Becoming more oneself? Changes in personality following DBS treatment for psychiatric disorders: Experiences of OCD patients and general considerations. PLoS One 2017; 12:e0175748. [PMID: 28426824 PMCID: PMC5398533 DOI: 10.1371/journal.pone.0175748] [Citation(s) in RCA: 65] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2016] [Accepted: 03/30/2017] [Indexed: 11/19/2022] Open
Abstract
Does DBS change a patient's personality? This is one of the central questions in the debate on the ethics of treatment with Deep Brain Stimulation (DBS). At the moment, however, this important debate is hampered by the fact that there is relatively little data available concerning what patients actually experience following DBS treatment. There are a few qualitative studies with patients with Parkinson's disease and Primary Dystonia and some case reports, but there has been no qualitative study yet with patients suffering from psychiatric disorders. In this paper, we present the experiences of 18 patients with Obsessive-Compulsive Disorder (OCD) who are undergoing treatment with DBS. We will also discuss the inherent difficulties of how to define and assess changes in personality, in particular for patients with psychiatric disorders. We end with a discussion of the data and how these shed new light on the conceptual debate about how to define personality.
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Affiliation(s)
- Sanneke de Haan
- The Berlin School of Mind and Brain, Humboldt-Universität zu Berlin, Berlin, Germany
- Faculty of Philosophy, Theology and Religious Studies, Radboud University Nijmegen, Nijmegen, The Netherlands
| | - Erik Rietveld
- Department of Psychiatry, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
- Amsterdam Brain and Cognition, University of Amsterdam, Amsterdam, the Netherlands
- Institute for Logic, Language and Computation, Department of Philosophy, University of Amsterdam, Amsterdam, the Netherlands
| | - Martin Stokhof
- Institute for Logic, Language and Computation, Department of Philosophy, University of Amsterdam, Amsterdam, the Netherlands
| | - Damiaan Denys
- Department of Psychiatry, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
- The Netherlands Institute for Neuroscience, Royal Netherlands Academy of Arts and Sciences, Amsterdam, the Netherlands
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van Dijk L, Rietveld E. Foregrounding Sociomaterial Practice in Our Understanding of Affordances: The Skilled Intentionality Framework. Front Psychol 2017; 7:1969. [PMID: 28119638 PMCID: PMC5220071 DOI: 10.3389/fpsyg.2016.01969] [Citation(s) in RCA: 57] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2016] [Accepted: 12/05/2016] [Indexed: 11/13/2022] Open
Abstract
Social coordination and affordance perception always take part in concrete situations in real life. Nonetheless, the different fields of ecological psychology studying these phenomena do not seem to make this situated nature an object of study. To integrate both fields and extend the reach of the ecological approach, we introduce the Skilled Intentionality Framework that situates both social coordination and affordance perception within the human form of life and its rich landscape of affordances. We argue that in the human form of life the social and the material are intertwined and best understood as sociomateriality. Taking the form of life as our starting point foregrounds sociomateriality in each perspective we take on engaging with affordances. Using ethnographical examples we show how sociomateriality shows up from three different perspectives we take on affordances in a real-life situation. One perspective shows us a landscape of affordances that the sociomaterial environment offers. Zooming in on this landscape to the perspective of a local observer, we can focus on an individual coordinating with affordances offered by things and other people situated in this landscape. Finally, viewed from within this unfolding activity, we arrive at the person's lived perspective: a field of relevant affordances solicits activity. The Skilled Intentionality Framework offers a way of integrating social coordination and affordance theory by drawing attention to these complementary perspectives. We end by showing a real-life example from the practice of architecture that suggests how this situated view that foregrounds sociomateriality can extend the scope of ecological psychology to forms of so-called "higher" cognition.
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Affiliation(s)
- Ludger van Dijk
- Amsterdam Medical Center, Department of Psychiatry and Amsterdam Brain and Cognition, University of AmsterdamAmsterdam, Netherlands
| | - Erik Rietveld
- Amsterdam Medical Center, Department of Psychiatry and Amsterdam Brain and Cognition, University of AmsterdamAmsterdam, Netherlands
- Department of Philosophy/Institute for Logic, Language and Computation, University of AmsterdamAmsterdam, Netherlands
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Rodriguez MM, Overshiner C, Leander JD, Li X, Morrow D, Conway RG, Nelson DL, Briner K, Witkin JM. Behavioral Effects of a Novel Benzofuranyl-Piperazine Serotonin-2C Receptor Agonist Suggest a Potential Therapeutic Application in the Treatment of Obsessive-Compulsive Disorder. Front Psychiatry 2017; 8:89. [PMID: 28588509 PMCID: PMC5438973 DOI: 10.3389/fpsyt.2017.00089] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2017] [Accepted: 05/03/2017] [Indexed: 01/23/2023] Open
Abstract
Selective serotonin reuptake inhibitors (SSRIs) are the only effective pharmacological treatments for obsessive-compulsive disorder (OCD). Nonetheless, their generally limited efficacy, side-effects, and delayed onset of action require improved medications for this highly prevalent disorder. Preclinical and clinical findings have suggested serotonin2C (5-HT2C) receptors as a potential drug target. Data in rats and mice are presented here on the effects of a novel 5-HT2C receptor agonist ((3S)-3-Methyl-1-[4-(trifluoromethyl)-7-benzofuranyl]-piperazine) (CPD 1) with high potency and full efficacy at 5-HT2C receptors and less potency and partial agonism at 5-HT2A and 5-HT2B receptors. Effects of CPD 1 on consummatory (schedule-induced polydipsia in rats) and non-consummatory behaviors (marble-burying and nestlet-shredding in mice) that are repetitive and non-habituating were studied. We also evaluated the effects of CPD 1 in rats with isoproterenol- and deprivation-induced drinking in rats to compare with the polydipsia studies. The SSRIs, fluoxetine, and chlomipramine decreased the high rates of drinking in rats engendered by a schedule of intermittent food delivery (schedule-induced polydipsia). The effects of fluoxetine, but not of d-amphetamine, were prevented by the selective 5-HT2C receptor antagonist SB242084. The 5-HT2C receptor agonists Ro 60-0175 and CPD 1 also decreased drinking, but unlike the SSRIs and Ro 60-0175, CPD 1 dose-dependently decreased excessive drinking without affecting lever press responses that produced food. The effects of CPD 1 were prevented by SB242084. CPD 1 also suppressed drinking induced by isoproterenol and by water deprivation without affecting normative drinking behavior. CPD 1, like fluoxetine, also suppressed marble-burying and nestlet-shredding in mice at doses that did not affect rotarod performance or locomotor activity. The behavioral specificity of effects of CPD 1 against repetitive and excessive behaviors suggests a potential therapeutic application in OCD.
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Affiliation(s)
- Michelle M Rodriguez
- Neuroscience Discovery Research and Discovery Chemistry, Lilly Research Laboratories, Eli Lilly and Company, Indianapolis, IN, USA
| | - Carl Overshiner
- Neuroscience Discovery Research and Discovery Chemistry, Lilly Research Laboratories, Eli Lilly and Company, Indianapolis, IN, USA
| | - J David Leander
- Neuroscience Discovery Research and Discovery Chemistry, Lilly Research Laboratories, Eli Lilly and Company, Indianapolis, IN, USA
| | - Xia Li
- Neuroscience Discovery Research and Discovery Chemistry, Lilly Research Laboratories, Eli Lilly and Company, Indianapolis, IN, USA
| | - Denise Morrow
- Neuroscience Discovery Research and Discovery Chemistry, Lilly Research Laboratories, Eli Lilly and Company, Indianapolis, IN, USA
| | - Richard G Conway
- Neuroscience Discovery Research and Discovery Chemistry, Lilly Research Laboratories, Eli Lilly and Company, Indianapolis, IN, USA
| | - David L Nelson
- Neuroscience Discovery Research and Discovery Chemistry, Lilly Research Laboratories, Eli Lilly and Company, Indianapolis, IN, USA
| | - Karin Briner
- Neuroscience Discovery Research and Discovery Chemistry, Lilly Research Laboratories, Eli Lilly and Company, Indianapolis, IN, USA
| | - Jeffrey M Witkin
- Neuroscience Discovery Research and Discovery Chemistry, Lilly Research Laboratories, Eli Lilly and Company, Indianapolis, IN, USA
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Giordano F, Cavallo M, Spacca B, Pallanti S, Tomaiuolo F, Pieraccini F, Fagiolini A, Grandoni M, Melani F, Zicca A, Sestini S, Genitori L. Deep Brain Stimulation of the Anterior Limb of the Internal Capsule May Be Efficacious for Explosive Aggressive Behaviour. Stereotact Funct Neurosurg 2016; 94:371-378. [DOI: 10.1159/000449171] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2016] [Accepted: 08/16/2016] [Indexed: 11/19/2022]
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Ramstead MJD, Veissière SPL, Kirmayer LJ. Cultural Affordances: Scaffolding Local Worlds Through Shared Intentionality and Regimes of Attention. Front Psychol 2016; 7:1090. [PMID: 27507953 PMCID: PMC4960915 DOI: 10.3389/fpsyg.2016.01090] [Citation(s) in RCA: 100] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2016] [Accepted: 07/05/2016] [Indexed: 11/13/2022] Open
Abstract
In this paper we outline a framework for the study of the mechanisms involved in the engagement of human agents with cultural affordances. Our aim is to better understand how culture and context interact with human biology to shape human behavior, cognition, and experience. We attempt to integrate several related approaches in the study of the embodied, cognitive, and affective substrates of sociality and culture and the sociocultural scaffolding of experience. The integrative framework we propose bridges cognitive and social sciences to provide (i) an expanded concept of ‘affordance’ that extends to sociocultural forms of life, and (ii) a multilevel account of the socioculturally scaffolded forms of affordance learning and the transmission of affordances in patterned sociocultural practices and regimes of shared attention. This framework provides an account of how cultural content and normative practices are built on a foundation of contentless basic mental processes that acquire content through immersive participation of the agent in social practices that regulate joint attention and shared intentionality.
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Affiliation(s)
- Maxwell J D Ramstead
- Department of Philosophy, McGill University, Montreal, QCCanada; Division of Social and Transcultural Psychiatry, Department of Psychiatry, McGill University, Montreal, QCCanada
| | - Samuel P L Veissière
- Division of Social and Transcultural Psychiatry, Department of Psychiatry, McGill University, Montreal, QCCanada; Department of Anthropology, McGill University, Montreal, QCCanada; Raz Lab in Cognitive Neuroscience, McGill University, Montreal, QCCanada; Department of Communication and Media Studies, Faculty of Humanities, University of JohannesburgJohannesburg, South Africa
| | - Laurence J Kirmayer
- Division of Social and Transcultural Psychiatry, Department of Psychiatry, McGill University, Montreal, QC Canada
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Wood J, Ahmari SE. A Framework for Understanding the Emerging Role of Corticolimbic-Ventral Striatal Networks in OCD-Associated Repetitive Behaviors. Front Syst Neurosci 2015; 9:171. [PMID: 26733823 PMCID: PMC4681810 DOI: 10.3389/fnsys.2015.00171] [Citation(s) in RCA: 57] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2015] [Accepted: 11/23/2015] [Indexed: 11/13/2022] Open
Abstract
Significant interest in the mechanistic underpinnings of obsessive-compulsive disorder (OCD) has fueled research on the neural origins of compulsive behaviors. Converging clinical and preclinical evidence suggests that abnormal repetitive behaviors are driven by dysfunction in cortico-striatal-thalamic-cortical (CSTC) circuits. These findings suggest that compulsive behaviors arise, in part, from aberrant communication between lateral orbitofrontal cortex (OFC) and dorsal striatum. An important body of work focused on the role of this network in OCD has been instrumental to progress in the field. Disease models focused primarily on these regions, however, fail to capture an important aspect of the disorder: affective dysregulation. High levels of anxiety are extremely prevalent in OCD, as is comorbidity with major depressive disorder. Furthermore, deficits in processing rewards and abnormalities in processing emotional stimuli are suggestive of aberrant encoding of affective information. Accordingly, OCD can be partially characterized as a disease in which behavioral selection is corrupted by exaggerated or dysregulated emotional states. This suggests that the networks producing OCD symptoms likely expand beyond traditional lateral OFC and dorsal striatum circuit models, and highlights the need to cast a wider net in our investigation of the circuits involved in generating and sustaining OCD symptoms. Here, we address the emerging role of medial OFC, amygdala, and ventral tegmental area projections to the ventral striatum (VS) in OCD pathophysiology. The VS receives strong innervation from these affect and reward processing regions, and is therefore poised to integrate information crucial to the generation of compulsive behaviors. Though it complements functions of dorsal striatum and lateral OFC, this corticolimbic-VS network is less commonly explored as a potential source of the pathology underlying OCD. In this review, we discuss this network's potential role as a locus of OCD pathology and effective treatment.
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Affiliation(s)
- Jesse Wood
- Translational Neuroscience Program, Department of Psychiatry, University of PittsburghPittsburgh, PA, USA
- Center for Neuroscience, University of PittsburghPittsburgh, PA, USA
| | - Susanne E. Ahmari
- Translational Neuroscience Program, Department of Psychiatry, University of PittsburghPittsburgh, PA, USA
- Center for Neuroscience, University of PittsburghPittsburgh, PA, USA
- Center for the Neural Basis of Cognition, University of PittsburghPittsburgh, PA, USA
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