In this article we offer a two-part commentary on Bolton and Gillett’s reconceptualization of Engel’s biopsychosocial model. In the first section we present a conceptual and historical assessment of the biopsychosocial model that differs from the analysis by Bolton and Gillett. Specifically, we point out that Engel in his vision of the biopsychosocial model was less concerned with the ontological possibility and nature of psychosocial causes, and more concerned with psychosocial influences in the form of illness interpretation (...) and presentation, sick role, seeking or rejection of care, the doctor-patient therapeutic relationship, and role of personality factors and family relationships in recovery from illness, etc. On the basis of this assessment, we then question Bolton and Gillett’s restricted focus on accounting for biopsychosocial causal interactions. The second section compares Bolton and Gillett’s account with a recent enactivist account of mental disorder that tackles similar conceptual problems of causal interactions. Bolton and Gillett’s utilize elements of the 4E cognition, but they combine these proto-ideas with an information-processing paradigm. Given their explicit endorsement of 4E approaches to mind and cognition, we illustrate some key ways in which a more fleshed out enactive account, particularly one that doesn’t rely on notions of information-processing, differs from the account proposed by Bolton and Gillett. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:George Engel’s Legacy for the Philosophy of Medicine and PsychiatryBradley Lewis (bio)KeywordsBiopsychosocial model, George Engel, pragmatism, philosophy of medicine, philosophy of psychiatryEach of the respondents to this paper raises critical and important concerns. I am grateful for the quality of their insights. David Brendel’s response, along with his recent book, Healing Psychiatry: Bridging the Science/Humanism Divide, resembles my efforts in several ways. Like Brendel, I too believe (...) that the American pragmatic philosophy can be helpful in healing the splits and divisions within psychiatry. And, like Brendel, I believe that psychiatry would benefit from what he calls the “four ps” of pragmatism. Where we differ with regard to George Engel and his biopsychosocial model seems to be less about philosophy and more about strategy. Brendel argues that Engel was too scientistic in his manifest reasoning to be considered a pragmatist. I agree with this description of Engel. But, strategically, we can go beyond Engel’s manifest reasoning to draw out the implications of Engel’s writings in a pragmatic fashion. I am not saying that Engel did this himself; I am only saying that it is very possible to reinterpret Engel along these lines.Brendel also argues that the biopsychosocial model itself needs improvement. But, just as it is possible to update Engel’s theoretical scaffold, we can also update Engel’s biopsychosocial model. Along the lines of Brendel’s concerns, we can easily revise the model so that we remember that not all problems need complex analysis and interventions. Some problems are relatively simple and can have a simple solution. We can also revise the model so we include questions of consumer participation and the provisional nature of the clinical encounter. I see nothing in the biopsychosocial model that contradicts either of these concerns. Yes, the biopsychosocial model needs to be updated, refurbished, expanded, and reimagined. That is my point in the paper.The traction of Brendel’s concerns is not can we reinterpret Engel? or can we refresh the biopsychosocial model?—of course we can. The traction of his concern seems to be “should we?” To this strategic question, Brendel’s answer is no and my answer is yes. I argue that it is a good idea to refresh and refurbish Engel and his biopsychosocial model because it helps to create a connection with an important tradition within both medicine and psychiatry: the tradition of balanced, broadminded, nuanced, patient-centered and anti-reductionistic [End Page 327] care. This tradition is important because medicine and psychiatry seem perpetually vulnerable to the temptations of reductionist approaches and to what Engel, and Nassir Ghaemi more recently, call “dogmatism” (Engel 1977, 130; Ghaemi, 2003, 301). Whether reductionism and dogmatism take the form of biopsychiatry, or psychoanalysis, or antipsychiatry, or cognitive-behavioral therapy, the problems of dogmatism are the same.I am sure Brendel would agree with this, which is why he raises pluralism to such a prominent position in his own reasoning. The difference is that Brendel believes we can better get to this kind of balanced clinical care by letting go of the past figures like Engel and moving into the bright light of the twenty-first century. Maybe so. But my thinking when I wrote the paper goes the other way around. For me, if clinical medicine and psychiatry more carefully tended to its history and tradition, it would be less likely to fall sway to the next Johnny-come-lately reductionistic model.Jeffery Spike’s memories of George Engel during the years they worked together at the University of Rochester School of Medicine provide a good sense of why Engel is an important figure to remember and to pay homage. As Spike puts it, Engel was not only a “legendary figure” with an “almost mythical diagnostic ability,” Engel “probably had more influence on the philosophy of medicine in the United States than any other person, physician, or philosopher.” Both of these accomplishments help to explain why Engel is worth remembering.Those of us in medicine and psychiatry all know mythical clinicians and teachers—the ones who seem like Michael Jordan used to seem on the basketball court, able to somehow make even... (shrink)

This open access book is a systematic update of the philosophical and scientific foundations of the biopsychosocial model of health, disease and healthcare. First proposed by George Engel 40 years ago, the Biopsychosocial Model is much cited in healthcare settings worldwide, but has been increasingly criticised for being vague, lacking in content, and in need of reworking in the light of recent developments. The book confronts the rapid changes to psychological science, neuroscience, healthcare, and philosophy that have (...) occurred since the model was first proposed and addresses key issues such as the model’s scientific basis, clinical utility, and philosophical coherence. The authors conceptualise biology and the psychosocial as in the same ontological space, interlinked by systems of communication-based regulatory control which constitute a new kind of causation. These are distinguished from physical and chemical laws, most clearly because they can break down, thus providing the basis for difference between health and disease. This work offers an urgent update to the model’s scientific and philosophical foundations, providing a new and coherent account of causal interactions between the biological, the psychological and social. (shrink)

The biopsychosocial model, which was deeply influential on psychiatry following its introduction by George L. Engel in 1977, has recently made a comeback. Derek Bolton and Grant Gillett have argued that Engel’s original formulation offered a promising general framework for thinking about health and disease, but that this promise requires new empirical and philosophical tools in order to be realized. In particular, Bolton and Gillett offer an original analysis of the ontological relations between Engel’s biological, social, and psychological (...) levels of analysis. I argue that Bolton and Gillett’s updated model, while providing an intriguing new metaphysical framework for medicine, cannot resolve some of the most vexing problems facing psychiatry, which have to do with how to prioritize different sorts of research. These problems are fundamentally ethical, rather than ontological. Without the right prudential motivation, in other words, the unification of psychiatry under a single conceptual framework seems doubtful, no matter how compelling the model. An updated biopsychosocial model should include explicit normative commitments about the aims of medicine that can give guidance about the sorts of causal connections to be prioritized as research and clinical targets. (shrink)

: The article outlines some similarities between the perspectives adopted by Shaun Gallagher and William James. In particular, assuming that the issue of representation in cognitive systems provides a valuable starting point and testing ground for verifying James’ possible contribution to enactivism, we argue that there is a considerable degree of similarity between Gallagher’s and James’ non-representational models of direct perception. Furthermore, we propose that by combining James’s theory of time and spatial perception with Gallagher’s Husserlian-inspired theory of retentional-protentional structure, (...) we can strengthen the theoretical assumptions of enactivism, integrating elements taken from phenomenology and aspects of Jamesian pragmatics. Understood in this way, James’ enactive theory of action and perceptual causality provides a promising opportunity for an innovative and coherent enactivist research program. Keywords: Enactivism; Pragmatism; 4E Cognition; William James; Shaun Gallagher Rendere l’enattivismo ancora più pragmatico: l’eredità jamesiana nell’approccio enattivista alla cognizione di Shaun Gallagher Riassunto: In questo lavoro si pongono in evidenza alcune somiglianze tra la prospettiva enattivista di Shaun Gallagher e la psicologia di William James. In particolare, assumendo che il tema della rappresentazione nei sistemi cognitivi fornisca un valido punto di partenza e un terreno di prova per verificare il possibile contributo di James all’enattivismo, ritengo che esista una notevole assonanza tra l’anti-rappresentazionalismo di Gallagher e la teoria della percezione diretta di James. Sostengo inoltre che attraverso una combinazione della teoria del tempo e della percezione spaziale di James con la teoria di Gallagher della struttura ritentivo-protensiva di ispirazione husserliana sia possibile rafforzare i presupposti teorici dell’enattivismo, integrando elementi tratti dalla fenomenologia con aspetti pragmatisti. La teoria jamesiana dell’azione e della causalità percettiva sembra fornire una promettente opportunità per un innovativo programma di ricerca in ambito enattivista. Parole chiave: Enattivismo; Pragmatismo; 4E Cognition; William James; Shaun Gallagher. (shrink)

How physicians approach patients and the problems they present is much influenced by the conceptual models around which their knowledge is organized. In this paper the implications of the biopsychosocial model for the study and care of a patient with an acute myocardial infarction are presented and contrasted with approaches used by adherents of the more traditional biomedical model. CiteULike Connotea Del.icio.us What's this?

The biopsychosocial (BPS) model in psychiatry has come under fire for being too vague to be of any practical use in the clinic. For many, its central flaw consists in lack of scientific validity and philosophical coherence: the model never specified how biological, psychological and social factors causally integrate with one another. Recently, advances in the cognitive sciences have made great strides towards meeting this very ‘integration challenge.’ The paper begins by illustrating how enactivist and predictive processing frameworks propose (...) converging accounts of biopsychosocial integration that are far superior to those of previous theories. It argues, however, that the main problem of implementing the BPS model has less to do with integration than with the lack of a social etiology. Psychiatric practice leans heavily towards ‘bio’ and ‘psycho’ approaches, without an equally developed set of explanatory and therapeutic resources for dealing with the ‘social’ dimension of illness. This leaves psychiatry essentially internalist in orientation. As illustrated most poignantly by conditions such as functional neurological disorders, internalism comes with the risks of stigma and the curtailment of therapeutic possibilities. The paper argues that the answer to the failings of the BPS model lies in combining the integration challenge with the development of an ‘externalist psychiatry,’ which casts both causes and treatment of psychiatric illness onto the social environment. The following two papers explore the conditions that might make this idea a reality. (shrink)

George Engel designed his biopsychosocial model to be a broad framework for medicine and psychiatry. Although the model met with great initial success, it now needs conceptual attention to make it relevant for future generations. Engel articulated the model as a version of biological systems theory, but his work is better interpreted as the beginnings of a richly nuanced philosophy of medicine. We can make this reinterpretation by connecting Engel’s work with the tradition of American pragmatism. Engel initiates (...) inquiry like a pragmatist, he understands theory and philosophy like a pragmatist, he justifies beliefs like a pragmatist, and he understands the world like a pragmatist. By drawing out these similarities, medical and psychiatric scholars can revitalize the biopsychosocial model, and they can open medicine and psychiatry to a rich philosophic heritage and a flourishing interdisciplinary tradition. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Better to Have No Deep Cut Anywhere in the Biopsychosocial SystemDerek Bolton, PhD (bio)It is very good to see theoretical work on the biopsychosocial model, acknowledging the causal role of these three kinds of factors in health and disease. I think Ongaro is right to argue that the biopsychosocial model requires an account of these three also being one—integrated—and that systems theoretic concepts such as dynamic, (...) nonlinear causation are helpful for capturing this. In a recent paper (Bolton, 2023) I have described Engel’s original (1997) paper as visionary but programmatic: visionary in seeing radical theory change afoot, citing von Bertalanffy’s new general system theory, but programmatic because the changes had not happened. The systems theoretic approach applies across the life, behavioral and social sciences, and typically envisages multiple interacting systems and causal pathways, including feedback and feedforward mechanisms, within and between systems. However, linear mechanisms are less complicated to research, and early social epidemiology used standard linear regression models (e.g., see the Whitehall II study [Marmot et al., 1991]). Such models do not capture non-linear connections in which the dependent variable also functions over time as an independent variable. However, the background theory typically would not exclude nonlinear dynamic causation, but on the contrary envisages it. Lower social status raises risk of ill health in a linear model, but it is also a plausible hypothesis that ill health in turn raises risk of lowering social status, which is testable in another or in a composite linear model. As well as social epidemiology, another large-scale theory change was underway at the time Engel wrote, the so-called cognitive revolution in psychology. Axiomatic in this shift was the idea that behavior is a response to the environment as perceived, thus merging the psychological/behavioral with the environmental, including the social. This latter point bears on Ongaro’s main proposal that the biopsychosocial model should envisage social causes as externalist, distinguished from the bio-psychological orientation of current psychiatry—and will be picked up below.Paper 2 makes some bold claims about the positive therapeutic value of construing causes [End Page 321] of mental health problems in external terms that have shared social meaning. These claims are made for functional neurological problems, but with extension to other kinds, in relation to a culture in which the shared social meanings refer to spirit possession, which, as a general type, is found in many non-modern Western cultures, as well as now, in our globalized world, in subcultures worldwide. One of the author’s claims is that within the spirit possession framework the shared framework of external causes enables society to adapt to the problem of living, to make it manageable, by shifting the social environment around the patient. As appropriate for ethnomethodology, there is no reference to controlled studies of outcome or mechanisms and I follow this immersed observational methodology here, with an experiential story that illustrates absence of personal and social acceptance and manageability of problematic conditions. While wandering recently with a friend in the mountains in the northern part of Africa, the local guide, in conversation in the local language and in English, having found out that two of us worked in “psychiatry/psychology,” asked us what we knew about; our brief reply included “obsessive-compulsive disorder” (OCD) and “anxiety”; the guide responded by asking whether OCD was washing hands a lot, and then wanted to discuss with us two people he knew well. One was a relation engaged, since many years, for many hours a day washing and cleaning, avoiding many daily tasks, sometimes childcare; friends and wider kinship structures had tried everything, except modern Western psychiatry (which was unavailable anyway), and, to put it briefly and colloquially, they were not at all happy about the person’s state and wished the person would get better. This person lived at a distance and we could not see them, so we do not know their view, but to judge by people with definite or probable OCD that we are familiar with, they may or may not have been happy in their reclusive state. Also to mention that the local healer had investigated... (shrink)

Recently, some authors have begun to raise questions about the potential unity of 4E (enactive, embedded, embodied, extended) cognition as a distinct research programme within cognitive science. Two tensions, in particular, have been raised:(i) that the body-centric claims embodied cognition militate against the distributed tendencies of extended cognition and (ii) that the body/environment distinction emphasized by enactivism stands in tension with the world-spanning claims of extended cognition. The goal of this paper is to resolve tensions (i) (...) and (ii). The proposal is that a form of ‘wide computationalism’can be used to reconcile the two tensions and, in so doing, articulate a common theoretical core for 4E cognition. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Adolph Meyer’s Psychobiology in Historical Context, and Its Relationship to George Engel’s Biopsychosocial ModelEdwin R. Wallace IV (bio)Keywordspsychobiology, integrative models of psychiatry, biopsychosocial modelBefore addressing the importance of Adolf Meyer and the question of his impact on the biopsychosocial model of the psychoanalytical internist George Engel, let us tersely sketch the history of functionalism in medicine/psychiatry, and of the nineteenth/early twentieth century’s progressive abandonment (...) of it in favor of basic science reductive models of “disease,” not illness.FunctionalismWhereas Hippocratic physicians diagnosed diatheses in terms of humoral excesses or deficiencies, their primary emphasis was on the ill person. They began with careful histories of the patient’s complaints and his or her daily life course, customary activities, typical foods and beverages imbibed, and the exacerbation or relief of symptoms associated with any or all of these. They also asked questions about his physical and social environment. They carefully looked for any clinically pertinent signs, and might physically examine the patient or his excretions. When they arrived at a diagnosis (say, an excess of yellow or black bile, or of blood or phlegm), they would educate the patient about it and discuss possible approaches. Although leeching, emetics, or purgatives might be prescribed, “dietetics” was the core of the treatment. Much more than recommendations about dietary intake, this involved conversations about “lifestyle” management in general: exercise, fresh air, habit changes, and perhaps bathing in mineral waters or spas. If the patient were “melancholic” (which then included what we would now consider a variety of psychiatric disorders), he or she might be prescribed daily swimming and other forms of vigorous exercise, conversations with a philosopher, [End Page 347] attendance at theatrical comedies, or even referral to an Asklepian temple for “incubation sleep” and priestly dream interpretation. Often doctors worked closely with physical trainers, to whom they sent their patients. In short, their orientation was holistic (“mind”/”body” integration), directed first and foremost toward an individual ill person.In the second century, C.E. Galen, despite his humoral and anatomical pathologies, was similarly holistic or functionalist. He resorted to a variety of physical examinational methods while also attending to the patient’s mental/emotional status. He described one case where he was attending a woman for syncopal episodes. His examinations of her included his customary attention to the pulse. During one evening session, a servant entered and happened to mention that he had just seen the handsome Pylades dancing. Suddenly her pulse became irregular and she fainted straight away. This led Galen to consider love sickness, and perhaps not humoral or organ pathology. He tested his hypothesis during subsequent visits. Whenever another dancer or actor was mentioned, her pulse remained regular and her sensorium alert, but when Pylades was mentioned the irregular pulse and fainting recurred. Because she was married, Galen realized her insoluble conflict, and treated her accordingly.From the fall of Rome until the rise of University Medicine in the later Middle Ages, medical lore and doctoring was in monastic hands—each monastery had its clerical medic, who might also attend outsiders. They were attuned to the traditional triad of major mental disorders—mania, melancholia, and phrenitis—which they explained somatically. However, they also encountered lesser mental/emotional disorders for which they developed their own nosology. “Scrupulosity,” for example, characterized a committed monk with an unrealistic sense of sinfulness and guilt—which often drove him to self-mortification such as flagellation, hair shirts with chains underneath, and so forth, for which the remedy was kindly pastoral counseling. “Accedia” was akin to our “dysthymia,” whose sufferer was affected by sadness, lassitude, and impaired capacity to carry out the monastic routine. This was viewed as straddling the boundary between sickness and sin. Routine physical labor (“occupational therapy”) and prayers, confession, penance, and “pep talks” were prescribed.When universities with medical schools arose in the latter Middle Ages, students’ educations were mostly bookish and theoretical. Hippocratic and Galenic somatic orientations were still preeminent. (Vesalius would not publish his illustrated anatomical text until 1543.) Dietetics and purgatives, bloodletting, and so on were still favored treatments. Nevertheless, doctors gave considerable time and attention to their patients as ill... (shrink)

The biopsychosocial (BPS) model has been of considerable utility to those researching health and illness. This has been particularly the case for critical realists and those with a systemic orientation to their work. Whilst the strengths of the model are conceded in this article, its limitations are also examined. These relate to its ontological sophistication being compromised by its proneness to epistemological naivety. It is a model to explain the emergence of disease and disability, not a reflexive theory applicable (...) to the whole field of health research. This tension is linked to the emergence of a re-orientation of medical knowledge away from bio-medical reductionism. From the outset the model was not about a general critique, or a grand theory, of health and illness. Instead it was a useful intervention, on the part of medical practitioners, like George Engel and Adolf Meyer, to create a reformed medical model on behalf of their profession. Case studies of the problematics of diagnosis and medicalization are offered to illuminate the limitations of the BPS model for health researchers. (shrink)

I respond to the 4 commentaries by Awais Aftab & Kristopher Nielsen, Hane Htut Maung, Diane O’Leary and Kathryn Tabb under 3 main headings: “What is the BPSM really?” & Why update it?; “Is our approach foundationally compromised?”, and finally, “Antagonists or fellow travellers?”.

Twenty years ago, the biopsychosocial model was proposed by George Engel to be the new paradigm for medicine and psychiatry. The model assumed a hierarchical structure of the biological, psychological and social system and simple interactions between the participating systems. This article holds the thesis that the original biopsychosocial model cannot depict psychiatry's reality and problems. The clinical validity of the biopsychosocial model has to be questioned. It is argued that psychiatric interventions can only stimulate but (...) not determine their target systems, because intervention and outcome are only loosely coupled. Thus, psychiatric interventions have in principle limited ranges which differ according to the type of intervention and according to the system to be stimulated. Psychosocial interventions face far more obstacles to be overcome than psychopharmacogical therapy. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Psychiatric Practice and the Living Force of the Social in the BiopsychosocialGeorge Ikkos, BSc, FRCPsych (bio) and Giovanni Stanghellini, MD, DPhil (HC) (bio)One of the handful of universally acknowledged founders of his discipline, sociologist Emile Durkheim (1857–1917; see Fournier, 2013) is best known to psychiatrists for his seminal “Suicide: A Study in Sociology” (1897/2002). Arguably, he should have been at least as well known for his last completed work (...) “The Elementary Forms of Religious Life” (1912/1995), the best book of sociology ever written according to some (Bellah, 1995). In this magisterial work, through a comprehensive survey of the anthropological evidence available at the time and fine conceptual analysis, Durkheim came to define from a strictly secular perspective phenomena such as the sacred and the profane, soul and magic, but also “mana” (a penetrating and connecting force) and collective “effervescence” (wild gesticulating, copulating, or aggressing when aboriginal family groups came together). The last two concepts can help us to understand the origin and persistence of the living force of the social in our daily experience, that is, what it is, what it feels like and how it plays itself out in relationships (Ikkos & McQueen, 2019). Although he makes no reference to Durkheim, nor to mana nor effervescence, social anthropologist Ongaro’s welcome ambition is to lift the social out of the shadow of the dominating bio- and psychological in the use of the biopsychosocial model and, thus, bring it to bear as an immediately experienced and enacted living force akin to mana and effervescence in contemporary psychiatric practice.In this commentary, we first review issues relating to the biopsychosocial model, Ongaro’s externalist foundations, and predictive processing and functional neurological, somatic and mental symptoms. We then discuss our formulation of contemporary anorexia nervosa and hysteria as examples of our attempts at enhanced engagement with the social. We conclude by suggesting the work of social historian and cultural critic Walter Benjamin (1892–1940) as a vital resource for better engagement with the social in biopsychosocial practice in the future. [End Page 325]The Biopsychosocial ModelMany find that in current practice the biopsycho-social model is simply the biomedical cloaked in another name (Mohtashemi et al., 2016). Those most expert in it acknowledge doubts about what it is exactly (Bolton, 2022). Most would agree with Ongaro and Williamson that though not yet dead, if it is to survive as a clinical force in practice, it needs clarification and revival (Williamson, 2022). Bolton suggests that “we can make use of the term ‘biopsychosocial model’ as a shorthand for methodological assumptions that causes and/or cures of specific conditions at specific stages, including matters of adjustment and quality of life, will generally—across a wide range of conditions—include biological, psychological and social factors, and interactions between them. The contrast here is with the ‘biomedical model’, which deals with biological factors only” (Bolton, 2022). Bolton then discusses the utility and advantages of his definition of the model specifically in relation to research on the social determinants of disease and on pain. That is fine, as far as it goes, that is, research methodology and clinical theory. Ongaro, however, wants to ensure that the social is understood as a more immediately experienced and directly enacted force in clinical encounters. To achieve his aim, he argues, we need a more balanced and persuasive integration of all three components of the model: bio-psycho-social. In effect what he proposes is to vitalize psychiatry with something related to Durkheim’s ideas of mana and effervescence.Externalist FoundationsIn his first paper, Ongaro argues that he can partly achieve his aims by using the tools provided by our contemporary neuroscience research on “predictive processing” and philosophical theories of “enactivism” (Ongaro, 2024a). In his second paper he reports on his anthropological experience of living for 19 months with the Akha, a group of swidden farmers in highland Laos. Here he investigated how they respond to functional neurological disorders (FNDs), functional somatic symptoms (FSS) (Burton et al., 2020), also to what Western medicine defines as (functional) mental disorders (FMDs) and what the Akha and he sometimes conceive as spiritual... (shrink)

We propose a new conceptualization of pain by incorporating advancements made by phenomenologists and cognitive scientists. The biomedical understanding of pain is problematic as it inaccurately endorses a linear relationship between noxious stimuli and pain, and is often dualist or reductionist. From a Cartesian dualist perspective, pain occurs in an immaterial mind. From a reductionist perspective, pain is often considered to be “in the brain.” The biopsychosocial conceptualization of pain has been adopted to combat these problematic views. However, when (...) considering pain research advancements, paired with the work of phenomenologists’ and cognitive scientists’ advanced understanding of perception, the biopsychosocial model is inadequate in many ways. The boundaries between the biological, psychological, and social are artificial, and the model is often applied in a fragmented manner. The model has a limited theoretical foundation, resulting in the perpetuation of dualistic and reductionist beliefs. A new framework may serve to better understand and treat pain. In this paper, we conceptualize pain as a 5E process, arguing that it is: Embodied, Embedded, Enacted, Emotive, and Extended. This perspective is applied using back pain as an exemplar and we explore potential clinical applications. With enactivism at the core of this approach, pain does not reside in a mysterious immaterial mind, nor is it an entity to be found in the blood, brain, or other bodily tissues. Instead, pain is a relational and emergent process of sense-making through a lived body that is inseparable from the world that we shape and that shapes us. (shrink)

11 essays by international specialists open up the research field of distributed cognition and the cognitive humanities in the Enlightenment and Romantic periods - The third book in an ambitious four-volume set looking at distributed cognition in the history of thought - Brings together essays on literature, history, philosophy, art, archaeology, medicine, science and material culture - Includes a general and a period-specific introduction to distributed cognition and the cognitive humanities - For students and scholars in Enlightenment (...) and Romantic studies, cognitive humanities and philosophy of mind - Draws out what was distinctive about Enlightenment and Romantic insights into the cognitive roles of the body and environment - Examines how humanities topics are affected by new insights from the cognitive sciences This collection explores how Enlightenment and Romantic practices and ideas reveal the diverse ways that cognition was seen as spread over brain, body and world in the long 18th century. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:The Philosophy of George Engel and the Philosophy of MedicineJeffrey P. Spike (bio)KeywordsGeorge Engel, psychosocial medicine, medical education, medical humanities, interviewing skills, philosophy of medicine, scientific methodDoctor Brad Lewis has encouraged us to consider George Engel’s philosophy with his excellent essay on Engel and Pragmatism. As a philosopher teaching full time in a medical school, it is refreshing to have an opportunity to analyze the work of (...) two physicians at this level of reflection and abstraction. It is even more of a pleasure because I knew Dr. Engel personally while I was teaching at the University of Rochester School of Medicine. I will make some observations of the philosophy behind Dr. Engel’s work, both published and practical, that is, as reflected in his writing but also in his influence in the medical curriculum at the institution that he called home for some thirty years (as seems appropriate when considering someone’s bona fides as a pragmatist).Engel’s Philosophy and Medicine’s PhilosophyGeorge Engel’s primary philosophical concern was to fight the powerful belief (or perhaps delusion) that medicine was evolving into a pure physical science, an extension of biochemistry and cell biology, or as we would now call them, proteomics and genomics. There is little evidence that he espoused any one methodology for basic science, so much as he opposed any one methodology for medicine. So to say he was a pragmatist seems underdetermined by his words, if that is taken to mean he advocated for changing the methodological model for scientific research. Rather the question is whether his preferred medical methodology is best characterized as pragmatic, or by some other description. On that score I agree with Lewis wholeheartedly.Of course, it might be that the claim of pragmatism is not meant to suggest a change in method for basic science, but to advocate for retaining an appreciation for the whole range of approaches to knowledge, from experimental science to epidemiology, and from epidemiology to acculturation. By that definition of pragmatism, Engel was indeed a pragmatist. Interpreted this way, he wanted medicine to stop worshipping the scientific method and appreciate that there are many paths to knowledge besides through the wet lab.It might be said that there are different scientific methods for different sciences, and Engel wanted us to appreciate that the reductionist methods [End Page 315] appropriate to the sciences of the small are not necessarily methods that can be applied to all sizes of objects we study, or all levels of reality (like the psychological and social). This is the truth about the world, although I am not sure that this is what Engel meant. As Lewis notes, Engel’s writing does sometimes sound as if he worshipped at the alter of science, as if all subjects of importance can be studied scientifically. But if he believed that, he was not correct. It might be, if all the subjects of the university that Lewis mentions are important, that some will turn out to be able to be studied in academically rigorous methods that are not scientific in any of the usual meanings of the word. Consider philosophy itself, for example.To the degree that it may stretch the evidence to say that Engel would have advocated for a pragmatic scientific method, it is still the case that pragmatism as outlined by Lewis and Engel’s biopsychosocial model can both be used to help medicine understand itself and overcome the temptation to idolize science. Medicine is not a science, or at least it is not just a science; in fact, I would suggest that it never was a science, and it will never be a science. Medicine is about health and illness, and uses whatever science it can to promote health and to treat (ameliorate or cure) illness.None of this should necessarily lead us to idolize pragmatism either. If each subject has its own ideal methodology for study, then it may be that pragmatism is the preferred method for, say, clinical judgment, whereas the scientific method is the best for the ‘hard’ sciences, and logic for philosophy. Or perhaps pragmatism and inductive logic are competing models for clinical... (shrink)

The hypothesis of extended cognition (HEC) casts human cognition as constitutively dependent on its bodily and environmental context. Drawing on recent empirical work on ‘cognitive offloading’, HEC’s defenders claim that information processing offloaded onto such brain-external resources is sometimes ‘genuinely’ cognitive. But while debates about offloading have a high profile in philosophy of cognitive science, surprisingly little attention has been paid to the fact that paradigm cases of offloading are intentional actions. As a result, opposition to HEC is (...) driven in part by unarticulated intuitions about the metaphysics of human agency. Thinking of action as a kind of interface between separately constituted intentions and bodily movements can make HEC look problematic. But while this view of agency has been popularised – most prominently by Donald Davidson – as analytic philosophy of action’s ‘standard story’, it has come under pressure from philosophers influenced by Elizabeth Anscombe’s very different account. According to this, actions express an agent’s intention only in so far as they fit into the right kind teleologically structured worldly context. In this paper, I’ll argue that HEC’s supporters should adopt an Anscombean model of action. That is, they should understand cognitive offloading as a manifestation of human agency’s general dependence on its bodily and environmental setting. (shrink)

Open peer commentary on the article “Body Awareness to Recognize Feelings: The Exploration of a Musical Emotional Experience” by Alejandra Vásquez-Rosati. Upshot: While generally supportive of the aims of Vásquez-Rosati’s target article, I suggest that it contains some theoretical and methodological shortcomings that could be addressed in future work. I also argue that if the author wishes to produce research that properly engages the enactivist perspective, then a number of additional dimensions are required. With this in mind, I outline the (...) basics of the 4E approach to cognition, suggesting that it may provide a useful framework for empirical research. (shrink)

Organizational learning, at the broadest levels, as it has come to be understood within the organization theory and management literatures, concerns the experientially driven changes in knowledge processes, structures, and resources that enable organizations to perform skillfully in their task environments (Argote and Miron–Spektor, 2011). In this chapter, we examine routines and capabilities as an important micro–foundation for organizational learning. Adopting a micro–foundational approach in line with Barney and Felin (2013), we propose a new model for explaining how routines and (...) capabilities play a causal role in transforming experience into repertoires of (actual or potential) organization–level behavior. More specifically, we argue that routines and capabilities are built out of capacities for shared – both joint and collective – intentionality (Tomasello, 1999, 2014; Bratman, 1999a, 2014) that enable individuals to engage in complex forms of collaboration in conjunction with multiple layers of scaffolds that encompass material and symbolic resources, social processes, and cultural norms and practices (Weick, 1995; Hutchins, 1995; Clark, 1997, 2008; Orlikowski, 2007). In short, we outline what we call the ‘scaffolded joint action’ model and suggest its potential as a micro–foundation of organizational learning. (shrink)

According to the biopsychosocial model, developed by the late Dr. George Engel, how physicians approach patients and the problems they present is very much ...

Hutto and Myin defend, on the basis of their “radically enactive” approach to cognition, the contention that there are certain forms of imaginative activity that are entirely devoid of representational content. In a recent Thought article, Roelofs argues that Hutto and Myin’s arguments fail to recognise the role of representation in maintaining the structural isomorphisms between mental models and things in the world required for imagination be action-guiding. This reply to Roelofs argues that his objection fails because it fails (...) to fully appreciate the resources radical enactivists have at their disposal in characterising basic imaginings. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Beyond EngelClinical Pragmatism as the Foundation of Psychiatric PracticeDavid H. Brendel (bio)Keywordsbiopsychosocial model, pluralism, pragmatism, psychiatryFor many years now, there has been growing recognition of the powerful role of pragmatic reasoning in numerous disciplines, including bioethics, medicine, law, political science, and philosophy (Dickstein 1998; Rosenthal, Hausman, and Anderson 1999). But until recently, philosophical pragmatism was neglected by scholars exploring the clinical challenges and theoretical underpinnings of psychiatry. In his (...) noteworthy article The Biopsychosocial Model and Philosophic Pragmatism: Is George Engel a Pragmatist?, Bradley Lewis offers a significant contribution to the small but gradually increasing literature in this area. Lewis appropriately presents Engel as a major figure in twentieth-century American medicine and psychiatry, a critic and a visionary who dared to question the dominant paradigm of biomedical reductionism (Engel 1977)—a paradigm that led to important scientific advances, but also restricted the physician’s understanding of the patient as a complex individual with an inner world and interpersonal relationships. Lewis argues that medicine and psychiatry a generation after Engel’s seminal 1977 paper can be revitalized by reinterpreting Engel in the intellectual tradition of classical American pragmatism and neo-pragmatism. Placing Engel in the pragmatic tradition, Lewis suggests, could enhance the biopsychosocial model and have substantial benefits for both individual patients and society as a whole.There is no disputing Lewis’s argument that a pragmatic philosophy of medicine and psychiatry is a noble goal. In fact, in my book Healing Psychiatry: Bridging the Science/Humanism Divide (Brendel 2006), I present philosophical pragmatism as the most compelling theoretical approach to clinical psychiatry in the twenty-first century—the approach that is most likely to empower the clinician and the patient to collaboratively develop a treatment plan that heeds the multidimensional complexity of the patient’s life, recognizes the confusion and uncertainty that grows out of this complexity, and aims for a favorable therapeutic outcome. Drawing on work of the classical American pragmatists and contemporary pragmatic bioethicists, I identify four dimensions of philosophical pragmatism that provide a sound foundation for clinical work, which I call the “four ps”: (1) diagnostic formulations and treatment plans in psychiatry are practical insofar as they focus on results rather than a commitment to any particular theory; (2) they are pluralistic [End Page 311] insofar as they incorporate explanatory concepts that span the biopsychosocial spectrum; (3) they are participatory and collaborative, not imposed authoritatively by the clinician; and (4) they are provisional, open-ended, and malleable to newly acquired information and evolution of the patient’s condition.Lewis casts Engel as a philosophical pragmatist who battled the Goliath of biomedical reductionism that had come to dominate American medicine and psychiatry in the latter half of the twentieth century. Unfortunately, however, regardless of how elegantly Lewis reinterprets Engel, he cannot render him a full-blown pragmatist for the medicine and psychiatry of the twenty-first century. Lewis provides quotations to suggest that Engel valued a results-oriented clinical sensibility, for example “the value of a scientific model is measured not by whether it is right or wrong but by how useful it is” (Engel 1980). But Engel was not fully committed to clinical outcome as the supreme judge of theory in medicine and psychiatry. Lewis notes that Engel understood the biopsychosocial model as less “a matter of compassion and humanity” and more a matter of “rigorous application of the principles and practices of science”; he was a man of his time who could not fully escape the scientism of the day. Working within this scientistic world, he distinguished himself by reintroducing psychological, sociological, and humanistic concepts into clinical medicine, which had become obsessed with the power and robustness of the natural sciences but had neglected the suffering human subject and the social context of illness. Engel undoubtedly hoped the biopsychosocial model would lead to better clinical results but, unlike the classical American pragmatists and contemporary pragmatic bioethicists, he did not make a systematic case for privileging clinical outcome above strict adherence to scientific theory.In fact, Engel’s biopsychosocial model runs the risk of becoming a reified end in itself; those who unquestioningly espouse its basic tenets are in danger of... (shrink)

_Abstract_: In this paper we carve out a _reformist_ agenda within the debate on the foundations of cognitive science, incorporating some important ideas from the 4E cognition literature into the computational-representational framework. We are deeply sympathetic to this reformist program since we think that, despite strong criticism of the concept of computation and the related notion of representation, computational models should still be at the core of the study of mind. At the same time, we recognize the need for (...) a liberalization of the computational and representational framework that can address deep dissatisfaction with the anti-biologism and radical internalism of classical cognitive science. However, reform is a difficult task, so in this article we focus on two open questions within the reformist agenda. The first concerns the possibility of combining mechanistic-computational and dynamical explanations. The second concerns related changes in the notion of representation and its use (with special attention to Andy Clark’s radical predictive processing). _Keywords_: Continuum of Representational Genera;_ _Enactivism; Predictive Processing; Radical Embodied Cognition Thesis; Representationalism _ Due problemi aperti nell’agenda riformista della filosofia della scienza cognitiva _ _Riassunto_: In questo lavoro identifichiamo un’agenda _riformista_ nel dibattito sui fondamenti della scienza cognitiva che incorpora alcune idee centrali provenienti dalla letteratura sulla cognizione 4E all’interno di una cornice computazionalista e rappresentazionalista. Tale agenda considera il quadro computazionalista e rappresentazionalista ancora imprescindibile ai fini dello studio integrato della mente e del cervello, ma ne persegue una liberalizzazione nell’intento di renderlo idoneo ad accogliere alcuni importanti spunti emersi dalla letteratura sulla cognizione delle 4E. Tuttavia, riformare è un compito difficile. In questo articolo ci concentriamo su due problemi aperti nell’agenda riformista. Il primo riguarda la possibilità di mettere assieme le spiegazioni meccaniciste e computazionaliste con quelle dinamiche. Il secondo riguarda i cambiamenti relativi alla nozione di rappresentazione e al suo impiego (con particolare attenzione all’elaborazione predittiva radicale di Andy Clark). _Parole chiave_: Continuum dei generi rappresentazionali;_ _Elaborazione predittiva; Enattivismo; Tesi della cognizione incarnata radicale; Rappresentazionalismo. (shrink)

The enactive approach is becoming increasingly influential within the philosophy of cognition, to the extent that it is now one of the dominant models of embodied cognition—an umbrella term for a varied set of discourses sharing the view that our minds don’t just happen to be ‘in’ bodies, but are enabled, shaped and (at least partly) constituted by the specifics of our physicality. This chapter will argue that the rise of enactivism is particularly relevant to transhumanist discourses, and (...) vice versa, because their concerns intersect and conflict in vital ways. The discussion will use three core enactivist themes—organisational integrity, embodiment, and precarity—to draw out the kinds of tensions and intersections that enable enactivism and transhumanism to problematise one another. Enactivism defines life and cognition in terms of autonomy; that is, it posits that living systems generate and maintain themselves as porous yet bounded self-unities. This sets up a delicate balance—both for the enacting system and for enactivism itself—between the dual imperatives of adaptive self-creation and homeostasis. The system must change constantly in order to sustain itself, yet there is a limit to the system’s flexibility. Beyond a certain point, change means disintegration, and disintegration means death. This balance itself resonates within transhumanist discourses, in the tension between the promise of radical self-transformation and the concern about taking this too far. These discourses, however, also challenge enactivism’s potential to capture the full potential of the kinds of systems it describes. How do we determine the limits of morphological flexibility for cognisers as complex as ourselves? Are those limits fixed or malleable—and must integration always mean death, or can it facilitate redefinition? (shrink)

12 essays by international specialists in classical antiquity create a period-specific interdisciplinary introduction to distributed cognition and the cognitive humanities - The first book in an ambitious 4-volume set looking at distributed cognition in the history of thought - Includes essays on archaeology, art history, rhetoric, literature, philosophy, science, medicine and technology -For students and scholars in classics, cognitive humanities, philosophy of mind and ancient philosophy -Includes essays by international specialists in classics, ancient history and archaeology This collection (...) explores how cognition is explicitly or implicitly conceived of as distributed across brain, body and world in Greek and Roman technology, science, medicine, material culture, philosophy and literary studies. A range of models emerge, which vary both in terms of whether cognition is just embodied or involves tools or objects in the world. As many of the texts and practices discussed have influenced Western European society and culture, this collection reveals the historical foundations of our theoretical and practical attempts to comprehend the distributed nature of human cognition. (shrink)

4E cognition is the defining feature of second-generation cognitive science, which replaces a computer-like cognitive processing model with one that highlights the interactive dynamism between the mind, the body and the environment. Research on literary reading in light of 4E cognition has piqued scholarly interest in the theoretical and empirical study of embodied reading. Karin Kukkonen’s 4E Cognition and Eighteenth Century Fiction is the first monograph in this field that proposes a historical approach to cognitive literary studies (...) and examines how the novel finds its “feet” as well as its “body” in the process of becoming a mature literary genre in the... (shrink)

This chapter evaluates which approach within 4E cognition is in a better position to offer a research program and a scientific framework for the embodied and situated cognitive sciences that could outcompete cognitivism once and for all. The main thesis of this work is that ecological psychology is in a better position to develop that scientific framework. This is because enactivism can be defined as a philosophy of nature rather than a scientific framework with its own research program (following (...) Gallagher, 2017). This means that enaction did not develop its own scientific methods, models, and metrics for human in vivo experimentation, which are key aspects in order to offer a whole new scientifically feasible foundation of a new science of the mind from a purely embodied and situated perspective. Although I agree that a philosophy of nature is a necessary aspect for any general theory of cognition, it is not enough: we also need a research program and a scientific framework in order to establish a fully-fledged science of the mind. Ecological psychology, as I show in this work, includes a philosophy of nature and a research program, which makes it suitable to settle the foundations for a fully embodied and situated cognitive science. In conclusion, I think that everyone working on embodiment and situated cognition should follow the ecological lead. (shrink)

In The Biopsychosocial Model of Health and Disease, Derek Bolton and Grant Gillett argue that a defensible updated version of the biopsychosocial model requires a metaphysically adequate account of disease causation that can accommodate biological, psychological, and social factors. This present paper offers a philosophical critique of their account of biopsychosocial causation. I argue that their account relies on claims about the normativity and the semantic content of biological information that are metaphysically contentious. Moreover, I suggest that (...) these claims are unnecessary for a defence of biopsychosocial causation, as the roles of multiple and diverse factors in disease causation can be readily accommodated by a more widely accepted and less metaphysically contentious account of causation. I then raise the more general concern that they are misdiagnosing the problem with the traditional version of the biopsychosocial model. The challenge when developing an explanatorily valuable version of the biopsychosocial model, I argue, is not so much providing an adequate account of biopsychosocial causation, but providing an adequate account of causal selection. Finally, I consider how this problem may be solved to arrive at a more explanatorily valuable and clinically useful version of the biopsychosocial model. (shrink)

While loneliness has been linked to various mental and physical health problems, the sense in which loneliness is a cause of these conditions has so far attracted little philosophical attention. This paper aims to fill this gap by analyzing research on health effects of loneliness and therapeutic interventions through current approaches to causality. To deal with the problem of causality between psychological, social, and biological variables, the paper endorses a biopsychosocial model of health and disease. I will investigate how (...) three main approaches to causality used in psychiatry and public health apply to loneliness: interventionism, mechanisms, and dispositional theories. Interventionism can specify whether loneliness causes specific effects, or whether a treatment works, incorporating results from randomized controlled trials. Mechanisms help explain how loneliness brings about negative health effects, spelling out psychological processes involved in lonely social cognition. Dispositional approaches help stress particular features of loneliness connected to negative social interactions, such as defensiveness. I will conclude by showing that previous research alongside emerging approaches to health effects of loneliness lend themselves to analysis in terms of the causal models under discussion. (shrink)

Recent years have seen increased interest among 4E cognition scholars in physical disability, leading to the development of the EE-model of disability. This paper contributes to the literature on disability and 4E cognition in three key ways. First, it examines the relationship between the EE-model and social constructivist views that address the bodily reality of disablement, highlighting commonalities and distinctions. Second, it critiques the EE-model’s focus on individual strategies for expanding disabled persons’ affordance landscapes, arguing that disability policy (...) should integrate insights from both the EE-model and social constructivist approaches. Finally, it assesses the EE-model against the 'dogma of harmony'. We argue that while the EE-model’s focus on active human-environment collaboration is valuable, it can inadvertently perpetuate this dogma. We contend that integrating certain social constructivist insights can help the EE-model avoid the dogma of harmony. (shrink)

Chronic pain is one of the most disabling conditions globally, yet we are still missing a satisfying theoretical framework to guide research and clinical practice. This is highly relevant as research and practice are not taking place in a vacuum but are always shaped by a particular philosophy of pain, that is, a set of implicitly or explicitly prevailing assumptions about what chronic pain is and how it is to be addressed. In looking at recent history, we identify a promising (...) trend from neuro-centrism to the application of the biopsychosocial model. Unfortunately, due to its limited theoretical foundation, the biopsychosocial model is too often implemented in a reductionist, fragmented, and linear manner. In particular, it remains too vague concerning the relationship between involved biological, psychological, and social processes. Sanneke de Haan prominently labeled this the integration problem. In this paper, we introduce five different facets of the integration problem that every philosophy of pain needs to address: (i) ontological, (ii) conceptual, (iii) explanatory, (iv) methodologicalMethodological, and (v) therapeutic. We develop an enactive theory of chronic pain and outline how far it provides solutions to these different integration challenges. (shrink)

Cognitive science is experiencing a pragmatic turn away from the traditional representation-centered framework toward a view that focuses on understanding cognition as "enactive." This enactive view holds that cognition does not produce models of the world but rather subserves action as it is grounded in sensorimotor skills. In this volume, experts from cognitive science, neuroscience, psychology, robotics, and philosophy of mind assess the foundations and implications of a novel action-oriented view of cognition. Their contributions and supporting experimental (...) evidence show that an enactive approach to cognitive science enables strong conceptual advances, and the chapters explore key concepts for this new model of cognition. The contributors discuss the implications of an enactive approach for cognitive development; action-oriented models of cognitive processing; action-oriented understandings of consciousness and experience; and the accompanying paradigm shifts in the fields of philosophy, brain science, robotics, and psychology. ContributorsMoshe Bar, Lawrence W. Barsalov, Olaf Blanke, Jeannette Bohg, Martin V. Butz, Peter F. Dominey, Andreas K. Engel, Judith M. Ford, Karl J. Friston, Chris D. Frith, Shaun Gallagher, Antonia Hamilton, Tobias Heed, Cecilia Heyes, Elisabeth Hill, Matej Hoffmann, Jakob Hohwy, Bernhard Hommel, Atsushi Iriki, Pierre Jacob, Henrik Jörntell, Jürgen Jost, James Kilner, Günther Knoblich, Peter König, Danica Kragic, Miriam Kyselo, Alexander Maye, Marek McGann, Richard Menary, Thomas Metzinger, Ezequiel Morsella, Saskia Nagel, Kevin J. O'Regan, Pierre-Yves Oudeyer, Giovanni Pezzulo, Tony J. Prescott, Wolfgang Prinz, Friedemann Pulvermüller, Robert Rupert, Marti Sanchez-Fibla, Andrew Schwartz, Anil K. Seth, Vicky Southgate, Antonella Tramacere, John K. Tsotsos, Paul F. M. J. Verschure, Gabriella Vigliocco, Gottfried Vosgerau. (shrink)

George Engel’s biopsychosocial model was associated with the critique of biomedical dogmatism and acknowledged the historical precedence of the work of Adolf Meyer. However, the importance of Meyer’s psychobiology is not always recognized. One of the reasons may be because of his tendency to compromise with biomedical attitudes. This paper restates the Meyerian perspective, explicitly acknowledging the split between biomedical and biopsychological approaches in the origin of modern psychiatry. Our present-day understanding of this conflict is confounded by reactions (...) to ‘anti-psychiatry.’ Neo-Meyerian principles can only be reestablished by a challenge to biomedicine that accepts, as did Meyer, the inherent uncertainty of medicine and psychiatry. (shrink)

While 4E approaches to cognition are increasingly introduced in educational contexts, little has been said about how 4E commitments can inform pedagogy aimed at fostering ethical competencies. Here, we evaluate a 4E-inspired ethics exercise that we developed at a technical university to enliven the moral imagination of engineering students. Our students participated in an interactive tinkering workshop, during which they materially redesigned a healthcare artifact. The aim of the workshop was twofold. Firstly, we wanted students to experience how material (...) choices at the levels of design and functionality can enable morally significant reimaginings of the affordances commonly associated with existing artifacts. We term this type of reimagining world-directed moral imagination. Secondly, through the design process, we wanted students to robustly place themselves in the lived embodied perspectives of (potential) users of their selected artifacts. We term this person-directed moral imagination. While student testimonies about the exercise indicate that both their world-directed and person-directed moral imagination were enlivened, we note that the fostering of robust person-directed moral imagination proved challenging. Using 4E insights, we diagnose this challenge and ask how it might be overcome. To this end, we engage extensively with a recent 4E-informed critique of person-directed moral imagination, raised by Clavel Vázquez and Clavel-Vázquez (2023). They argue that person-directed moral imagination is profoundly limited, if not fundamentally misguided, particularly when exercised in contexts marked by emphatic embodied situated difference between the imaginer and the imagined. Building upon insights from both the 4E field and testimonies from critical disability studies, we argue that, while their critique is valuable, it ultimately goes too far. We conclude that a 4E approach can take on board recent 4E warnings regarding the limits of person-directed moral imagination while contributing positively to the development of moral imagination in engineering ethics education. (shrink)

This thesis argues that Heidegger’s accounts of practice and temporality in Being and Time are inseparable, and demonstrates the importance of temporality for contemporary dialogues between Heideggerian phenomenology and cognitive science. It proposes that enactive and action-oriented models of cognition are best suited to engaging with a Heideggerian view of the temporality of practice, and will benefit from the latter’s capacity to explain the purposive self-concern, possibility-directedness, and varying complexity of cognition in richly temporal terms. I begin by (...) showing that Heidegger’s account places temporality and practice in a complex reciprocity in which each fundamentally shapes and permeates the other. The Heidegger of Being and Time conceptualises practice as fundamentally temporal and temporality as intrinsically purposive, meaning that we cannot adequately understand or utilise his analysis of either structure without acknowledging the role of the other. In outlining and defending this reading, I draw out two characteristics of Heidegger’s model of temporality; these features, which affect and are affected by the interconnection of temporality and purposiveness, are an inherent connection to the self-concern of the entity and an emphasis upon a radically indeterminate futurity. I then consider which contemporary approaches in cognitive science represent the most promising interlocutors for this temporality-oriented Heideggerian perspective. After rejecting selected in principle objections to the pursuit of a collaborative, rather than primarily critical, dialogue between Heideggerian phenomenology and cognitive science, I put forward two candidates for participation in a ‘temporality-oriented Heideggerian cognitive science’: the enactivist tradition and Michael Wheeler’s model of cognition. I set out each approach’s connections to Heideggerian thought (which involves arguing for as-yet unexplored links as well as defending existing ones) before showing how and why a Heideggerian conception of temporality can be integrated into both. I suggest that the structures of a Heideggerian model of temporality already resonate with and operate in enactivists’ and Wheeler’s analyses of cognition, and outline how I think each framework benefits from explicitly taking up and developing these connections. Rather than ultimately choosing one of these perspectives over the other, I conclude by proposing that they cooperate with one another. A Heideggerian conception of temporality opens up a space for enactivism and Wheeler’s approach to contribute distinct and complementary insights in the pursuit of a collaborative temporality-oriented Heideggerian cognitive science. (shrink)

Enactivism is a branch of embodied cognition theory that argues for a highly distributed model of cognition as a sense‐making process involving brain, body, environment, and subjective experience. It is a theoretical framework with potential value for nursing since it offers an integrated framework for human sense‐making that includes physiological and psychological factors as well as the primary experience of subjective perceptions. This paper presents an introduction to the background and main tenets of enactivist theory. These are discussed (...) in relation to nursing, and mental health nursing to argue for the relevance of enactivism in nursing knowledge. (shrink)

This paper targets the constitutive basis of social cognition. It begins by describing the traditional and still dominant cognitivist view. Cognitivism assumes internalism about the realisers of social cognition; thus, the embodied and embedded elements of intersubjective engagement are ruled out from playing anything but a basic causal role in an account of social cognition. It then goes on to advance and clarify an alternative to the cognitivist view; namely, an enactive account of social cognition. It (...) does so first by articulating a diachronic constitutive account for how embodied engagement can play a constitutive role in social cognition. It then proceeds to consider an objection; the causal-constitutive fallacy (Adams & Aizawa 2001, 2008; Block 2005) against enactive social cognition. The paper proceeds to deflate this objection by establishing that the distinction between constitution and causation is not co-extensive with the distinction between internal constitutive elements and external causal elements. It is then shown that there is a different reason for thinking that an enactive account of social cognition is problematic. We call this objection the ‘poverty of the interactional stimulus argument’. This objection turns on the role and characteristics of anticipation in enactive social cognition. It argues that anticipatory processes are mediated by an internally realised model or tacit theory (Carruthers 2015; Seth 2015). The final part of this paper dissolves this objection by arguing that it is possible to cast anticipatory processes as orchestrated as well as maintained by sensorimotor couplings between individuals in face-to-face interaction. (shrink)

Meaning-making processes, understood hierarchically, in line with the Semiotic Hierarchy framework, change on various timescales. To account for and predict these changes, one can take a cognitive view on semiosis. I adopt an interdis-ciplinary approach combining semiotic studies and cognitive studies in an attempt to account for meaning-making activity and to predict the course of semiosis. In this context, I consider meaning-making activity as shaped by both “external” (to a semiotic system) as well as “internal” factors. I also show how (...) both the “external” and “internal” sources of the dynamicity of meaning-making should be framed in terms of studies on cognition.I start with a non-standard, 4e approach to meaning-making. According to this framework, meaning-making processes are constituted by (and not just depen-dent on) environmental and bodily factors. The dynamicity of semiosis can be accounted for in terms of an experiencing, embodied subject (agent) enacting her/his/its own domain of meaningful phenomena. As I argue, this perspective on meaning-making is the cognitive foundation of the first two levels of the Semiotic Hierarchy. In the following sections I present the Peircean view on signs and semiosis, according to which semiosis is a result of the very nature of a sign and a sign system. In this view, the dynamicity of semiosis has primarily “internal” sources: it stems from the unavoidable fallibility of interpretation and synechism of signs. As I show, this aspect of semiosis can be addressed by means of standard (cognitivist) cognitive science and by means of cognitive modelling. Ultimately, I sketch a proposal of an attempt to develop a uniform cognitive framework allowing for integration of the above-mentioned aspects of semiosis – a framework based on Rowlands’ idea of the Amalgamated Mind. (shrink)

The neurodiversity movement has called for a rethinking of autistic mindedness. It rejects the commonplace tendency to theorize autism by foregrounding a set of deficiencies in behavioural, cognitive, and affective areas. Instead, the idea is, our conception of autistic mindedness ought to foreground that autistic persons, often in virtue of their autism, experience the world in manners that can be immensely meaningful to themselves and to human society at large. In this paper I presuppose that the idea of neurodiversity is (...) worth taking seriously and I explore to what extent it can be accommodated within a 4E cognition framework by scrutinizing two 4E approaches to autistic mindedness: Shaun Gallagher's interactionism (2004; 2008) and Hanne De Jaegher's autopoietic enactivism (2013). Although these accounts share a number of theoretical commitments, they are also marked by different points of emphasis. Though seemingly innocuous, I show that these differences end up having a significant impact on how autistic mindedness is brought in view and how, correspondingly, the idea of neurodiversity can get a foothold. (shrink)

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. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Models of Psychopathology and ReligionSuffering, Psychosis, and NeurodiversityKate Finley, PhD (bio)To draw out some implications of Scrutton’s paper, I will address a few points of clarification and objection as well as connections to empirical literature and topics for further research. Scrutton frames her discussion as an exploration of ‘both–and’ (BA) accounts, according to which “someone might experience both a religious experience and psychopathology” in contrast to an ‘either/or’ account, (...) which “presupposes that a person’s experience can be either psychopathological, or else a genuine religious experience” and focuses on instances of ‘voice hearing’ which may be a religious experience (i.e., God talking to you) and/or an instance of psychopathology (i.e., an auditory hallucination). She then defines religious experience as one which “comes from God... [specifically as] an instance of special divine action” and mental illness as dys-functional emotional, cognitive, and/or perceptual processes resulting in suffering that is in need of healing and/or treatment.1One potentially ambiguous point concerns the potential causes of psychopathology—while in some places, Scrutton seems to assume that psychopathology can only be caused by natural (biopsychosocial) causes, in others, she highlights “conjunctive causal explanations” on which divine action can occur within and through ‘natural’ (e.g., psychological, neurological) phenomena and processes. It is important to note that this latter approach is needed in order to truly entertain BA accounts which posit both natural and supernatural causes for the psychopathological experience in question. Relatedly, although Scrutton cites an intuitive view that a hallucination is a “distorted perception of reality,” instead an account of hallucination which allows for veridical as well as non-veridical hallucinations is needed.2 Without these assumptions, the categories of religious experience and psychopathology may seem to be mutually exclusive and thus an either/or account trivially true. For example, one might think that an instance of ‘hearing voices,’ if it is an auditory hallucination (and thus results from solely natural causes and is non-veridical), then cannot also be a religious experience (brought about by divine [End Page 261] action and veridical). These are friendly clarifications of Scrutton’s setup which also highlight the need for further explanation of the relationship between human and divine causation in such cases.There is also some ambiguity about what counts as a singular experience for Scrutton’s purposes—for example, ‘hearing voices over the course of a few minutes or hours’ or ‘hearing voices off and on over a period of a few months and reflecting on these occurrences.’ Scrutton seems to favor the latter, using ‘experience’ in a “diachronic and holistic sense,” and sees the former as too narrowly focused on only part of an experience. On Scrutton’s understanding, much more, perhaps even all of what is recounted about Abeo would count as parts of her experience—thus, a BA account of this experience being correct would mean that all of the individual instances of voice hearing would be both psychopathological and genuine religious experiences (in some sense). In contrast, on the former more circumscribed understanding, each instance in which Abeo “seem[ed] to hear God talk to her” would count as a distinct experience—and thus, a BA account might be correctly applied to only some of these instances. While Scrutton’s approach can sidestep skeptical worries stemming from this view—what to make of the fact that Abeo may genuinely hear God speak to her on one day, but only seem to hear God speaking to her on another—I believe the former understanding of ‘experience’ allows for important nuance and specificity when addressing these issues. As a friendly clarification, this point mainly draws attention to the different implications of understanding Scrutton’s models as employing either the first or the second understanding of ‘experience.’In objecting to the Mysterium Tremendum Model 1, she claims that because Christians (qua Christians) “do not undergo suffering pointlessly [(i.e., in a way that does not further their spiritual life)],” genuine (salutary) religious experience would not lead to psychopathology (presumably pointless suffering). Notably, the claim that psychopathology results in pointless suffering is seemingly challenged both by Scrutton’s preferred Model 4... (shrink)

After nearly fifty years of mea culpas and explanatory additions, the biopsychosocial model is no closer to a life of its own. Bolton and Gillett give it a strong philosophical boost in The Biopsychosocial Model of Health and Disease, but they overlook the model’s deeply inconsistent position on dualism. Moreover, because metaphysical confusion has clinical ramifications in medicine, their solution sidesteps the model’s most pressing clinical faults. But the news is not all bad. We can maintain the merits (...) of holism as we let go of the inchoate bag of platitudes that is the biopsychosocial model. We can accept holism as the metaphysical open door that it is, just a willingness to recognize the reality of human experience, and the sense in which that reality forces medicine to address biological, psychological, and social aspects of health. This allows us to finally characterize Engel’s driving idea in accurate philosophical terms, as acceptance of consciousness in the context of medical science. This will not entirely pin down medicine’s stance on dualism, but it will position it clearly enough to readily improve patient care. (shrink)

This article is intended to revive, through a critical reinterpretation, the bio-psychosocial model of George Engel. Engel’s first description in 1977, was very broad, encompassing too many aspects of medicine. In his later work, he focused his model as an epistemology for clinical medicine. However, what medicine mostly retained were minor aspects of the 1977 article, namely a multi-factorial approach to the etiology of diseases and a call to complement biomedicine with a psychosocial concern in order to re-humanize medicine. (...) We suggest that, properly understood as a clinical epistemology, Engel’s model retains its transformative potential for contemporary medicine.Our discussion begins with a.. (shrink)

Improvisation is ubiquitous in life. It deserves, we suggest, to occupy a more central role in cognitive science. In the current paper, we take the case of jazz improvisation as a rich model domain from which to explore the nature of improvisation and expertise more generally. We explore the activity of the jazz improviser against the theoretical backdrop of Dreyfus’s account of expertise as well as of enactivist and 4E accounts of cognition and action. We argue that enactivist and (...) 4E accounts provide a rich source of insights on improvisation that go beyond Dreyfus’s notion of skilled coping, for example, through the central enactivist notion of “sense-making”. At the same time, however, we see improvisation also as suggesting an extension of enactivist theory. We see expert improvisers, in music and in life, as walking on a path of open-ended expansion of their mindful experiential relation with their doing. At the heart of an improviser’s expertise, we propose, lies a form of “higher-level inner sense-making” that spontaneously creates novel forms of agentive goal-directedness in the moment. Our account thus supplants Dreyfus’s idea of the ego-less absorbed expert by that of a mindful improviser enacting spontaneous expressions of herself, in music or in life. (shrink)

This book re-examines the roles of causation and cognition in early modern philosophy. The standard historical narrative suggests that early modern thinkers abandoned Aristotelian models of formal causation in favor of doctrines that appealed to relations of efficient causation between material objects and cognizers. This narrative has been criticized in recent scholarship from at least two directions. Scholars have emphasized that we should not think of the Aristotelian tradition in such monolithic terms, and that many early modern thinkers did (...) not unequivocally reduce all causation to efficient causation. -/- In line with this general approach, this book features original essays written by leading experts in early modern philosophy. It is organized around five guiding questions: -/- What are the entities involved in causal processes leading to cognition? What type(s) or kind(s) of causality are at stake? Are early modern thinkers confined to efficient causation or do other types of causation play a role? What is God's role in causal processes leading to cognition? How do cognitive causal processes relate to other, non-cognitive causal processes? Is the causal process in the case of human cognition in any way special? How does it relate to processes involved in the case of non-human cognition? -/- The essays explore how fifteen early modern thinkers answered these questions: Francisco Suárez, René Descartes, Louis de la Forge, Géraud de Cordemoy, Nicolas Malebranche, Thomas Hobbes, Baruch de Spinoza, Gottfried Wilhelm Leibniz, Ralph Cudworth, Margaret Cavendish, John Locke, John Sergeant, George Berkeley, David Hume, and Thomas Reid. The volume is unique in that it explores both well-known and understudied historical figures, and in that it emphasizes the intimate relationship between causation and cognition to open up new perspectives on early modern philosophy of mind and metaphysics. (shrink)