An Enactive Approach to Psychiatry

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.