This article addresses the integration problem in psychiatry: the explanatory problem of integrating such heterogeneous factors as cause or contribute to the problems at hand, ranging from traumatic experiences, dysfunctional neurotransmitters, existential worries, economic deprivation, social exclusion, and genetics. In practice, many mental health professionals work holistically in a pragmatic and eclectic way. Such pragmatic approaches often function well enough. Yet an overarching framework provides orientation, treatment rationale, a shared language for communication with all those involved, and the means to explain treatment decisions to health insurers and to society at large. It also helps to relate findings from different areas and types of research. In this article, I introduce an enactive framework that supports holistic psychiatric practice by offering an integrating account of how the diverse aspects of psychiatric disorders relate. The article starts with a short overview both of the four main dimensions of psychiatric disorders and of the currently available models. I then introduce enactivism and the enactive notion of sense-making. Subsequently, I discuss how this enactive outlook helps explicate the relation between the four dimensions and what that implies regarding the causality involved. The article concludes with an overview of treatment implications.
Moral imagination, disability and embodiment
In this paper we question the basis on which judgements are made about the ‘quality’ of the lives of people whose embodied experience is anomalous, specifically in cases of impairments. In moral and political philosophy it is often assumed that, suitably informed, we can overcome epistemic gaps through the exercise of moral imagination: ‘putting ourselves in the place of others’, we can share their points of view. Drawing on phenomenology and theories of embodied cognition, and on empirical studies, we suggest that there are barriers to imagining oneself differently situated, or imagining being another person, arising in part from the way imagination is constrained by embodied experience. We argue that the role of imagination in moral engagement with others is to expand the scope of our sympathies rather than to enable us to put ourselves in the other’s place. We argue for explicit acknowledgement that our assessments of others’ QOL are likely to be shaped by the specifics of our own embodiment, and by the assumptions we make as a consequence about what is necessary for a good quality of life.
Mindshaping, Enactivism, and Ideological Oppression
One of humans’ distinctive cognitive abilities is that they develop an array of capacities through an enculturation process. In “Cognition as a Social Skill”, Sally points to one of the dangers associated with enculturation: ideological oppression. To conceptualize how such oppression takes root, Haslanager appeals to notions of mindshaping and social coordination, whereby people participate in oppressive social practices unthinkingly or even willingly. Arguably, an appeal to mindshaping provides a new kind of argument, grounded in philosophy of mind, which supports the claims that feminist and anti-racist want to defend. However, some theorists worry that Haslanger’s account does not shed much light on how individuals could exert their agency to resist oppression. I argue that enactivist conceptions of mindshaping and habit can help us to make sense of the power of social influences and how they have the potential to both enable and undermine cognition and agency. This moves us toward increased understanding of the workings of social oppression – distinguishing between constructive and enabling forms of heteronomy, and overdetermining and pernicious modes that lead to atrophied moral cognition and a narrowing of the field of affordances.
Materialized Oppression in Medical Tools and Technologies
It is well-known that racism is encoded into the social practices and institutions of medicine. Less well-known is that racism is encoded into the material artifacts of medicine. We argue that many medical devices are not merely biased, but materialize oppression. An oppressive device exhibits a harmful bias that reflects and perpetuates unjust power relations. Using pulse oximeters and spirometers as case studies, we show how medical devices can materialize oppression along various axes of social difference, including race, gender, class, and ability. Our account uses political philosophy and cognitive science to give a theoretical basis for understanding materialized oppression, explaining how artifacts encode and carry oppressive ideas from the past to the present and future. Oppressive medical devices present a moral aggregation problem. To remedy this problem, we suggest redundantly layered solutions that are coordinated to disrupt reciprocal causal connections between the attitudes, practices, and artifacts of oppressive systems.
Instituting impairment: Extended cognition and the construction of Female Sexual Dysfunction
I further the argument for a socially extended mind by examining gender and the role it plays in cognition. My first claim is that gender is a social institution that often if not always subtends our cognitive processes, especially those that are maximally embodied. The social institution of gender often serves to inhibit female embodied cognitive processing, as a quick glance at the myriad of oppressive forces at play in gender dynamics illustrates. To combat the potential objection that gender is not a vehicle for extending cognitive processes, but rather plays a shaping role in embodied practice, I propose looking at the history of Female Sexual Dysfunction and its construction by the social institutions of the pharmaceutical companies and media. By doing so, I claim a case can be made that these institutions have actually invaded the minds of many women to the point that cognition pertaining to sex, sexual functioning, and health are wholly dependent upon and constituted by the interplay of these social systems.
Throwing Like a Girl: A Phenomenology of Feminine Body Comportment, Motility and Spatiality
From the introduction: This paper seeks to begin to fill a gap that thus exists both in existential phenomenology and feminist theory. It traces in a provisional way some of the basic modalities of feminine body comportment, manner of moving, and relation in space. It brings intelligibility and significance to certain observable and rather ordinary ways in which women in our society typically comport themselves and move differently from the ways that men do. In accordance with the existentialist concern with the situatedness of human experience, I make no claim to the universality of this typicality of the bodily comportment of women and the phenonemological description based on it. The account developed here claims only to describe the modalities of feminine bodily existence for women situated in contemporary advanced industrial, urban, and commercial society. Elements of the account developed here may or may not apply to the situation of woman in other societies and other epoch, but it is not the concern of this paper to determine to which, if any, other social circumstances this account applies.
Pregnant Agencies: Movement and Participation in Maternal-Fetal Interactions
Pregnancy presents some interesting challenges for the philosophy of embodied cognition. Mother and fetus are generally considered to be passive during pregnancy, both individually and in their relation. In this paper, we use the enactive operational concepts of autonomy, agency, individuation, and participation to examine the relation between mother and fetus in utero. Based on biological, physiological, and phenomenological research, we explore the emergence of agentive capacities in embryo and fetus, as well as how maternal agency changes as pregnancy advances. We show that qualitatively different kinds of agency have their beginnings already in utero, and to what extent fetal and maternal movement modulate affectivity and individuation in pregnancy. We thus propose that mother and fetus are both agents who participate in pregnancy. Pregnancy then emerges as a relational developmental organization that anchors and holds its developing participants. We end the paper with reflections on ethical implications of this proposal, and suggestions for future research.
Extended Sex: An Account of Sex for a More Just Society
We propose an externalist understanding of sex that builds upon extended and distributed approaches to cognition, and contributes to building a more just, diversity-sensitive society. Current sex categorization practices according to the female/male dichotomy are not only inaccurate and incoherent, but they also ground moral and political pressures that harm and oppress people. We argue that a new understanding of sex is due, an understanding that would acknowledge the variability and, most important, the flexibility of sex properties, as well as the moral and political meaning of sex categorization. We propose an externalist account of sex, elaborating on extended and distributed approaches to cognition that capitalize on the natural capacity of organisms to couple with environmental resources. We introduce the notion of extended sex, and argue that properties relevant for sex categorization are neither exclusively internal to the individual skin, nor fixed. Finally, we spell out the potential of extended sex to support an active defense of diversity and an intervention against sex-based discrimination.
The Declaration of Interdependence! Feminism, Grounding and Enactivism
This paper explores the issue whether feminism needs a metaphysical grounding, and if so, what form that might take to effectively take account of and support the socio-political demands of feminism; addressing these demands I further propose will also contribute to the resolution of other social concerns. Social constructionism is regularly invoked by feminists and other political activists who argue that social injustices are justified and sustained through hidden structures which oppress some while privileging others. Some feminists (Haslanger and Sveinsdóttir, Feminist metaphysics. In E. N. Zalta (Ed.), Stanford encyclopedia of philosophy. Stanford: Stanford University, 2011) argue that the constructs appealed to in social constructivism are real but not metaphysically fundamental because they are contingent. And this is exactly the crux of the problem—is it possible to sustain an engaged feminist socio-political critique for which contingency is central (i.e., that things could be otherwise) and at the same time retain some kind of metaphysical grounding. Without metaphysical grounding it has been argued, the feminist project may be rendered nonsubstantive (Sider, Substantivity in feminist metaphysics. Philosophical Studies, 174(2017), 2467–2478, 2017). There has been much debate around this issue and Sider (as an exemplar of the points under contention) nuances the claims expressed in his earlier writings (Sider, Writing the book of the world. Oxford: Clarendon Press, 2011) and later presents a more qualified account (Sider, Substantivity in feminist metaphysics. Philosophical Studies, 174(2017), 2467–2478, 2017). Nonetheless, I propose the critiques and defences offered by the various parties continue to depend on certain erroneous assumptions and frameworks that are challengeable. I argue that fundamentality as presented in many of these current accounts, which are underpinned by the explicit or implicit ontologies of monism and dualism and argued for in purely rationalist terms which conceive of subjects as primarily reason-responding agents, reveal basic irresolvable problems. I propose that addressing these concerns will be possible through an enactivist account which, following phenomenology, advances an ontology of interdependence and reconceives the subject as first and foremost an organism immersed in a meaningful world as opposed to a primarily reason-responding agent. Enactivism is thus, I will argue, able to legitimize feminist socio-political critiques by offering a non-reductive grounding in which not only are contingency and fundamentality reconciled, but in which fundamentality is in fact defined by radical contingency. My paper proceeds in dialogue with feminists generally addressing this ‘metaphysical turn’ in feminism and specifically with Sally Haslanger and Mari Mikkola.
The Mind in the Body: Feminist and Neurocognitive Perspectives on Embodiment
From the introduction: The body’s epistemic significance is a shared preoccupation for both feminist theory and neurophilosophy, two fields that rarely interact. Neurocognitive theories of embodied mind seek to identify the features of embodiment that inform cognition and consciousness. They share with feminist epistemologies a view that consciousness is inextricably linked to lived embodiment and situated in the environment, and they each offer powerful challenges to the disembodied, abstract Cartesian subject. This convergence bears deeper consideration. In this chapter I address claims of their compatibility, and also how feminist concerns trouble neurophilosophical interpretations of the embodied mind. I begin with a brief introduction to neurobiologically informed views of mind that embrace reductive physicalism, and then I describe the non-reductive physicalism of embodied mind theories. Later, I take up feminist epistemology and its parallels and tensions with this subfield of neurophilosophy. I raise the question of epistemic difference as an opening for critical engagement. (p. 1 – online version)