Enactive and simondonian reflections on mental disorders

Navigating drug use, cessation, and recovery: a retrospective case notes review among sexual minority men at a community-based service in Singapore

BACKGROUND

In Singapore, where drug use is a highly stigmatized and criminalized issue, there is limited understanding of the challenges faced by individuals, particularly sexual minority men, in their journey towards recovery from substance dependence or addiction. This qualitative study aimed to investigate the driving forces behind drug use, the factors contributing to drug cessation, and the elements influencing the recovery process.

METHODS

Data were extracted from clinical records provided by  The Greenhouse Community Services Limited between January 2020 to May 2022. These records encompassed information from four distinct forms: the intake assessment, progress notes, case closing summary, and the care plan review. Thematic analysis was employed to identify and categorize recurring themes within the data.

RESULTS

Data from beneficiaries (n = 125) were analyzed and yielded a series of themes related to facilitators of drug use, motivations to cease drug use, and managing one's ongoing recovery. Within the facilitators of drug use, two sub-themes were identified: (a) addressing trauma and triggers and (b) managing emotions. Additionally, managing one's recovery was marked by four significant sub-themes: (a) uncovering personal identities, (b) losing motivation and drive, (c) overcoming obstacles, and (d) preparing for aftercare.

CONCLUSIONS

The study contributes valuable insights into the dynamics of ongoing recovery management, offering potential avenues for interventions that could enhance support for individuals in their journey to overcome substance dependence. Enhancing psychoeducation and fostering peer support have the potential to facilitate the recovery process. Clearly, a holistic approach is needed to address these complex issues that cuts across our societies.

Landau model for illustrating the learning and unlearning process of nociplastic pain

Recent advancements in understanding the consolidation of nociplastic pain point to a complex, non-conscious learned process of threat perception. Neurobiological pain education is emerging as a promising approach to unlearn nociplastic pain, supported by biopsychosocial tools such as exposure to movement, mindfulness, and group sharing formats. However, this approach is still not well-known among clinicians and the society at large, creating a communication problem that unfortunately perpetuates the suffering of patients. Herein, we propose a Landau model to describe the learning and unlearning process of nociplastic pain, aiming to clarify this complex situation and facilitate communication across different sectors of the society. Nociplastic pain corresponds to a first-order transition, with attention more likely in the alert-protection state than in the trust-explore state. Two appealing results of the model are that the perception of the critical context depends on personal history regarding the symptom and that biopsychosocial loops are formed when there is alarming learned historical information about the symptom, along with confused and contradictory expert information, as seen in nocebo messages. Learning and unlearning in the model correspond to a chang in control parametrs that can weigh more on the alert-protection state, trust-explore state, uncertain state or neutral state. This description clarifies why neurobiological education is the foundational therapy from which others must be built to embody the accessible, clear, and trustworthy information.

The ethics of sense-making

In this paper, we contribute to the arising field of "enactive ethics," that is, the application of enactive cognitive science to the field of ethics. To this end, we will make a case that an "ethics of sense-making" should exist. With "sense-making," we mean the permanent everyday embodied activity of interpreting the surroundings we are in, as well as our role in them. In other words, we mean the activity of understanding our environments in such a way that certain things, but not others, stand out as meaningful and relevant to us. We argue that sense-making can be performed in ethically better or worse ways. For example, one might make sense of a potentially provocative comment either as an insult or as an invitation for a respectful discussion. How one makes sense in this case will affect oneself, the other, and their present and future relations. We propose that it is often helpful to hold humans responsible for their ways of sense-making. This opens up the possibility to transform their sense-making and the worlds they inhabit. This also has significance for their eudaimonic well-being. Our ethics of sense-making focusses on the ubiquitous activities of sense-making, which, when changed, will lead to great ethical improvements of people's actions, choices, and character traits.