Problems for enactive psychiatry as a practical framework

In recent years, autopoietic enactivism has been used to address persistent conceptual problems in psychiatry, such as the problem of demarcating disorder, that other models thus far have failed to overcome. There appear to be three main enactive accounts of psychopathology with subtle, although not incompatible, differences: Maiese characterizes disorder as distinct disruptions in autonomy and agency; Nielsen characterizes disorder as behaviors that relevantly conflict with the functional norms of an individual; De Haan emphasizes patterns of disordered sense-making, that are transformed through the existential dimension. Given that these accounts are intended to provide not only an ontologically richer account of psychopathology but also reduce the stigma experienced by individuals with mental disorders by accounting for lived experience, a critical analysis of these approaches is needed. Russell provides a problematization of enactive accounts of mental disorder, showing that this particular framework does not, as it stands, necessarily reduce the harm and suffering experienced by individuals with mental disorder because of its ontological openness; enactivism leaves much to be interpreted and applied by the clinician (or patient) such that practical and ethical problems in its use arise.

Symptoms in particular: feminism and the disordered mind

Contrary to influential medical and cognitivist models governing how mental disorder is usually understood today, the socially embedded, disordered “mind,” or subject, of feminist theory leaves little room for idiopathic causal analyses, with their narrow focus on the brain and its functioning, and reluctant acknowledgment of symptoms. Mental disorder must originate well beyond the particular brain of the person with whom it is associated, feminist analyses imply. Because the voiced distress of the sufferer cannot be reduced to the downstream, “symptomatic” effects of brain dysfunction, symptoms can be seen differently, as central to the diagnostic identity, and constitutive of (at least some) disorders. And new attention is required for the testimony of women diagnosed with mental disorder, vulnerable as it is to epistemic injustices. Corrected explanations of women’s mental disorder leave remaining concerns, both epistemological and ethical, over the madwoman narrating her symptoms.

Is the first-person perspective gendered?

The notion of gender identity has been characterized as “one’s sense of oneself as male, female or transgender.” To have a sense of oneself at all, one must have a robust first-person perspective – a capacity to conceive of oneself as oneself in the first person. A robust first-person perspective requires that one have a language complex enough to express thoughts like “I wonder how I am going to die.” Since a robust first-person perspective requires that one have a language, and languages embed whole worldviews, the question arises: in learning a language, does the robust first-person perspective itself introduce gender stereotypes? Without denying that we unconsciously acquire attitudes about gender that shape our normative expectations, this chapter argues that one’s gender identity is not just attributable to the biases implicit in the language one speaks. So the robust first-person perspective itself is not responsible for which gender-specific attitudes a person acquires.

Norms and Neuroscience: The Case of Borderline Personality Disorder

Cognitive neuroscience can offer us new explanations of episodes human behavior that, unlike many explanations traditionally available, do not draw on questionable past theories arising from cultures and traditions that are in fact patriarchal. At the same time, feminists have had a number of reasons for regarding it suspiciously as, among other things, reductive and dehumanizing. In this paper, new work on borderline personality disorder provides an illustrative example of the first. It is also used in an extended argument against the second. Cognitive neuroscience is interested principally in explaining how creatures function well in their niches. It is replete with covert references to values and interests. The paper draws an important distinction between cases in which culture creates new conditions for old functions to be realized and those where it creates new functions.