Philosophy of psychiatry: theoretical advances and clinical implications

Work at the intersection of philosophy and psychiatry has an extensive and influential history, and has received increased attention recently, with the emergence of professional associations and a growing literature. In this paper, we review key advances in work on philosophy and psychiatry, and their related clinical implications. First, in understanding and categorizing mental disorder, both naturalist and normativist considerations are now viewed as important - psychiatric constructs necessitate a consideration of both facts and values. At a conceptual level, this integrative view encourages moving away from strict scientism to soft naturalism, while in clinical practice this facilitates both evidence-based and values-based mental health care. Second, in considering the nature of psychiatric science, there is now increasing emphasis on a pluralist approach, including ontological, explanatory and value pluralism. Conceptually, a pluralist approach acknowledges the multi-level causal interactions that give rise to psychopathology, while clinically it emphasizes the importance of a broad range of "difference-makers", as well as a consideration of "lived experience" in both research and practice. Third, in considering a range of questions about the brain-mind, and how both somatic and psychic factors contribute to the development and maintenance of mental disorders, conceptual and empirical work on embodied cognition provides an increasingly valuable approach. Viewing the brain-mind as embodied, embedded and enactive offers a conceptual approach to the mind-body problem that facilitates the clinical integration of advances in both cognitive-affective neuroscience and phenomenological psychopathology.

Predicting instabilities: an embodied perspective on unstable experiences with art and design

Predictive Processing (PP) provides a theoretical framework that describes perception as a process attempting to increase the predictability of stimulations by updating predictions or exploring new sensations. Moreover, perception and action are assumed to be closely linked within this process. While organisms seem to strive for predictability, we sometimes expose ourselves to objects and situations that challenge sense-making-such conditions often break perceptual habits or offer multiple possible meanings. This paper updates a previous qualification of these experiences of 'Semantic Instability' (SeIns) by following an embodied and situated understanding of perception and cognition. We suggest that art perception essentially differs from problem-solving as in engaging with art, we typically integrate contradictory elements dynamically and without the ultimate goal of resolving the contradictions-on the contrary, SeIns itself can generate aesthetic hedonics and interest. We discuss how current embodied accounts of PP might help understand what motivates such unstable yet insightful and pleasurable nonlinear sense-making processes. This article is part of the theme issue 'Art, aesthetics and predictive processing: theoretical and empirical perspectives'.

The biopsychosocial model is lost in translation: from misrepresentation to an enactive modernization

INTRODUCTION

There are increasing recommendations to use the biopsychosocial model (BPSM) as a guide for musculoskeletal research and practice. However, there is a wide range of interpretations and applications of the model, many of which deviate from George Engel's original BPSM. These deviations have led to confusion and suboptimal patient care.

OBJECTIVES

1) To review Engel's original work; 2) outline prominent BPSM interpretations and misapplications in research and practice; and 3) present an "enactive" modernization of the BPSM.

METHODS

Critical narrative review in the context of musculoskeletal pain.

RESULTS

The BPSM has been biomedicalized, fragmented, and used in reductionist ways. Two useful versions of the BPSM have been running mostly in parallel, rarely converging. The first version is a "humanistic" interpretation based on person- and relationship-centredness. The second version is a "causation" interpretation focused on multifactorial contributors to illness and health. Recently, authors have argued that a modern enactive approach to the BPSM can accommodate both interpretations.

CONCLUSION

The BPSM is often conceptualized in narrow ways and only partially implemented in clinical care. We outline how an "enactive-BPS approach" to musculoskeletal care aligns with Engel's vision yet addresses theoretical limitations and may mitigate misapplications.

The osteopath-parent-child triad in osteopathic care in the first 2 years of life: a qualitative study

Background

Enactivism and active inference are two important concepts in the field of osteopathy. While enactivism emphasizes the role of the body and the environment in shaping our experiences and understanding of the world, active inference emphasizes the role of action and perception in shaping our experiences and understanding of the world. Together, these frameworks provide a unique perspective on the practice of osteopathy, and how it can be used to facilitate positive change in patients. Since the neonatal period is a crucial time for development, osteopaths should aim to create a therapeutic relationship. Arguably, through participatory sense-making, osteopaths can help the baby build a generative model (with positive priors) to deal with stress and needs throughout their life.

Aim

Since the literature considers that interactions with the environment, which enact the patients' experiences, depending on contextual factors and communication between patient and caregiver, this research explored whether there is a correspondence between the indications in the literature and clinical practice in the management of the mother/parent-child dyad during osteopathic care on children aged 0 to 2 years old.

Methods

Semi-structured interviews were conducted with a purposive sample of nine osteopaths with experience in the field of pediatrics. Interviews were transcribed verbatim, and constructivist grounded theory was used to conceptualize, collect and analyze data. Codes and categories were actively constructed through an interpretive/constructionist paradigm.

Results

The core category was the idea of the pediatric osteopath as a support for the family, not only for the child. Four additional categories were identified: (1) Preparing a safe environment for both children and parents, (2) Communication, (3) Attachment and synchrony, and (4) Synchronization.

Conclusion

Through participatory sense-making, osteopaths manage contextual factors to establish an effective therapeutic alliance through the osteopath-parent-child triad to facilitate the construction of the child's internal generative model to promote healthy development. The therapeutic encounter is considered an encounter between embodied subjects, occurring within a field of affordances (ecological niche) that allows the interlocutors to actively participate in creating new meanings through interpersonal synchronization. Participatory sense-making and the establishment of a therapeutic alliance through the osteopath-parent-child triad are crucial to promote healthy development in the child.

Informational Resilience in the Human Cognitive Ecology

Resilience is a basic trait of cognitive systems and fundamentally connected to their autopoietic organization. It plays a vital role in maintaining the identity of cognitive systems in the face of external threats and perturbances. However, when examining resilience in the context of autopoiesis, an overlooked issue arises: the autopoietic theory formulated by Maturana and Varela (1980) renders traditional Shannon information obsolete, highlighting that information should not be ascribed a role in cognitive systems in a general sense. This paper examines the current situation and suggests a possible way forward by exploring an affordance-based view on information, derived from radical cognitive science, which is exempted from Maturana and Varela's critique. Specifically, it argues that the impact of social influence on affordance use is crucial when considering how resilience can manifest in informational relations pertaining to the human cognitive ecology.

Enactive artificial intelligence: subverting gender norms in human-robot interaction

Introduction

This paper presents Enactive Artificial Intelligence (eAI) as a gender-inclusive approach to AI, emphasizing the need to address social marginalization resulting from unrepresentative AI design.

Methods

The study employs a multidisciplinary framework to explore the intersectionality of gender and technoscience, focusing on the subversion of gender norms within Robot-Human Interaction in AI.

Results

The results reveal the development of four ethical vectors, namely explainability, fairness, transparency, and auditability, as essential components for adopting an inclusive stance and promoting gender-inclusive AI.

Discussion

By considering these vectors, we can ensure that AI aligns with societal values, promotes equity and justice, and facilitates the creation of a more just and equitable society.

Situating the KTA gap in clinical research: Foregrounding a discontinuity in practices

In this study, I will claim that we need to rearticulate the so-called "knowledge-to-action" (KTA) gap metaphor in clinical research as a discontinuity of practices. In clinical research, there is a significant delay between the production of research results and their application in policy and practice. These difficulties are normally conceptualized through the metaphor of the KTA gap between scientific knowledge and practical applications. I will advise that it is important to reformulate the terms of the problem, as they suggest the difficulty lies only in the results generated on one side (the laboratory), not reaching the other side (the clinic), and that crossing the gap requires us to simply optimize the transfer and exchange of knowledge. This perspective considers knowledge separate from the practices from which it was generated, making it into a thing that can be transported and transferred largely independently from the communities that produce or "possess" it. The paper then revises the terms of the problem, shifting the focus from knowledge understood as independent from practical circumstances to the situated practices of knowing. Knowledge will then be understood as enacted in practice, emerging as people interact recurrently in the context of established practices. When people coming from different domains and with different "ends-in-view" must coordinate, they have to deal with conceptual and practical tensions, different ways of doing things with their surroundings, and different normative practices. Considering that, the KTA gap will be revised, not as a gap between scientific results and their application in clinical practice, but as a discontinuity in how communities engage with their local contexts and what they perceive as relevant for their activities.

"Bringing new life in": Hope as a know-how of not knowing

We offer a theoretical and empirical exploration of parental or guardian hope through an enactive, ecological, and reflective lifeworld research framework. We examine hoping as a practice, or know-how, by exploring the shape of interviewees' lives as they prepare for lives to come. We pursue hoping as a necessarily shared practice-a social agency-rather than an individual emotion. One main argument is that hoping operates as a kind of languaging. An enactive-ecological approach shifts scholarly conversations around hope, in part by including voices of non-scholars and considering lifeworld factors like class privilege. We aim to identify particular impediments to or facilitators of hope, which may be thought of as classes of restrictive and generative thought-shapers, respectively. Results from our qualitative study indicate that uncertainty is deeply salient to hoping, not only because hope as a concept entails epistemic limits, but more vitally because not knowing, when done skillfully and when supported through education and some degree of socio-economic security, leaves room for others to reframe utterances, and so for the family or community to resist linguistic enclosure.

The Enactive and Interactive Dimensions of AI: Ingenuity and Imagination Through the Lens of Art and Music

Dualisms are pervasive. The divisions between the rational mind, the physical body, and the external natural world have set the stage for the successes and failures of contemporary cognitive science and artificial intelligence.1 Advanced machine learning (ML) and artificial intelligence (AI) systems have been developed to draw art and compose music. Many take these facts as calls for a radical shift in our values and turn to questions about AI ethics, rights, and personhood. While the discussion of agency and rights is not wrong in principle, it is a form of misdirection in the current circumstances. Questions about an artificial agency can only come after a genuine reconciliation of human interactivity, creativity, and embodiment. This kind of challenge has both moral and theoretical force. In this article, the authors intend to contribute to embodied and enactive approaches to AI by exploring the interactive and contingent dimensions of machines through the lens of Japanese philosophy. One important takeaway from this project is that AI/ML systems should be recognized as powerful tools or instruments rather than as agents themselves.

An Enactive-Ecological Model to Guide Patient-Centered Osteopathic Care

Osteopaths commonly face complexity and clinical uncertainty in their daily professional practice as primary contact practitioners. In order to effectively deal with complex clinical presentations, osteopaths need to possess well-developed clinical reasoning to understand the individual patient’s lived experience of pain and other symptoms and how their problem impacts their personhood and ability to engage with their world. We have recently proposed (En)active inference as an integrative framework for osteopathic care. The enactivist and active inference frameworks underpin our integrative hypothesis. Here, we present a clinically based interpretation of our integrative hypothesis by considering the ecological niche in which osteopathic care occurs. Active inference enables patients and practitioners to disambiguate each other’s mental states. The patients’ mental states are unobservable and must be inferred based on perceptual cues such as posture, body language, gaze direction and response to touch and hands-on care. A robust therapeutic alliance centred on cooperative communication and shared narratives and the appropriate and effective use of touch and hands-on care enable patients to contextualize their lived experiences. Touch and hands-on care enhance the therapeutic alliance, mental state alignment, and biobehavioural synchrony between patient and practitioner. Therefore, the osteopath–patient dyad provides mental state alignment and opportunities for ecological niche construction. Arguably, this can produce therapeutic experiences which reduce the prominence given to high-level prediction errors—and consequently, the top-down attentional focus on bottom-up sensory prediction errors, thus minimizing free energy. This commentary paper primarily aims to enable osteopaths to critically consider the value of this proposed framework in appreciating the complexities of delivering person-centred care.

Enacting Metaphors in Systemic Collaborative Therapy

What makes metaphors good therapeutic tools? In this paper, we provide an answer to this question by analyzing how metaphors work in systemic collaborative therapeutic practices. We look at the recent embodied, enactive and ecological proposals to metaphors, and provide our own, dialogical-enactive account, whereby metaphors are tools for enacting change in therapeutic dialogs. We highlight the role of enacting metaphors in therapy, which is concerned with how one uses the metaphors in shared process of communication. Our answer is that metaphors serve as good tools for connecting to action words, through which the client’s embodiment and agency can be explored. To illustrate our view, we analyze two examples of enacting metaphors in therapeutic engagements with adolescents. Our enactive proposal to metaphors is different from others as it does not rely on engaging in explicit performances but stays within a linguistic dialog. We take metaphoric engagement as an act of participatory sense-making, unfolding in the interaction. This insight stems from enactive ways of thinking about language as a process accomplished by embodied agents in interaction, and seeing talking also as a form of doing.

An Interaction Theory Account of (Mediated) Social Touch

Research on mediated social touch (MST) has, either implicitly or explicitly, built on theoretical assumptions regarding social interactions that align with "theory theory" or "simulation theory" of social cognition. However, these approaches struggle to explain MST interactions that occur outside of a laboratory setting. I briefly discuss these approaches and will argue in favor of an alternative, "interaction theory" approach to the study of MST. I make three suggestions for future research to focus on.

Sowing the seeds of intentionality: Motor intentions in plants

Motor intention/intentionality has been investigated from a wide variety of perspectives: some researchers have, for example, been focusing on the purely physical and mechanical aspects underlying the control of action, while others have been concentrating on subjective intentionality. Basically, all approaches ranging from the neuroscientific to phenomenological-inspired ones have been used to investigate motor intentions. The current study set out to examine motor intentions in connection to plant behavior utilizing the final goal of plant action as the definition of its motor intention. Taking a wide-angle approach, the first part of the review is dedicated to examining philosophical and psychological studies on motor intentions. Recent data demonstrating that plant behavior does indeed seem goal-directed will then be reviewed as we ponder the possibility of purposeful or intentional plant responses to stimuli and stress conditions in their environment. The article will draw to a close as we examine current theories attempting to explain plants' overt behavior and corresponding covert representations.

The Shared Origins of Embodiment and Development

As a domain of study centering on the nature of the body in the functioning of the individual organism, embodiment encompasses a diverse array of topics and questions. One useful organizing framework places embodiment as a bridge construct connecting three standpoints on the body: the form of the body, the body as actively engaged in and with the world, and the body as lived experience. Through connecting these standpoints, the construct of embodiment shows that they are not mutually exclusive: inherent in form is the capacity for engagement, and inherent in engagement is a lived perspective that confers agency and meaning. Here, we employ this framework to underscore the deep connections between embodiment and development. We begin with a discussion of the origins of multicellularity, highlighting how the evolution of bodies was the evolution of development itself. The evolution of the metazoan (animal) body is of particular interest, because most animals possess complex bodies with sensorimotor capacities for perceiving and acting that bring forth a particular sort of embodiment. However, we also emphasize that the thread of embodiment runs through all living things, which share an organizational property of self-determination that endows them with a specific kind of autonomy. This realization moves us away from a Cartesian machine metaphor and instead puts an emphasis on the lived perspective that arises from being embodied. This broad view of embodiment presents opportunities to transcend the boundaries of individual disciplines to create a novel integrative vision for the scientific study of development.

Bio-psycho-social interaction: an enactive perspective

What are the respective roles of physiological, psychological and social processes in the development of psychiatric disorders? The answer is relevant for deciding on interventions, prevention measures, and for our (self)understanding. Reductionist models assume that only physiological processes are in the end causally relevant. The biopsychosocial (BPS) model, by contrast, assumes that psychological and social processes have their own unique characteristics that cannot be captured by physiological processes and which have their own distinct contributions to the development of psychiatric disorders. Although this is an attractive position, the BPS model suffers from a major flaw: it does not tell us how these biopsychosocial processes can causally interact. If these are processes of such different natures, how then can they causally affect each other? An enactive approach can explain biopsychosocial interaction. Enactivism argues that cognition is an embodied and embedded activity and that living necessarily includes some basic form of cognition, or sense-making. Starting from an enactive view on the interrelations between body, mind, and world, and adopting an organizational rather than a linear notion of causality, we can understand the causality involved in the biopsychosocial processes that may contribute to the development of psychiatric disorders.

The Radically Embodied Conscious Cybernetic Bayesian Brain: From Free Energy to Free Will and Back Again

Drawing from both enactivist and cognitivist perspectives on mind, I propose that explaining teleological phenomena may require reappraising both "Cartesian theaters" and mental homunculi in terms of embodied self-models (ESMs), understood as body maps with agentic properties, functioning as predictive-memory systems and cybernetic controllers. Quasi-homuncular ESMs are suggested to constitute a major organizing principle for neural architectures due to their initial and ongoing significance for solutions to inference problems in cognitive (and affective) development. Embodied experiences provide foundational lessons in learning curriculums in which agents explore increasingly challenging problem spaces, so answering an unresolved question in Bayesian cognitive science: what are biologically plausible mechanisms for equipping learners with sufficiently powerful inductive biases to adequately constrain inference spaces? Drawing on models from neurophysiology, psychology, and developmental robotics, I describe how embodiment provides fundamental sources of empirical priors (as reliably learnable posterior expectations). If ESMs play this kind of foundational role in cognitive development, then bidirectional linkages will be found between all sensory modalities and frontal-parietal control hierarchies, so infusing all senses with somatic-motoric properties, thereby structuring all perception by relevant affordances, so solving frame problems for embodied agents. Drawing upon the Free Energy Principle and Active Inference framework, I describe a particular mechanism for intentional action selection via consciously imagined (and explicitly represented) goal realization, where contrasts between desired and present states influence ongoing policy selection via predictive coding mechanisms and backward-chained imaginings (as self-realizing predictions). This embodied developmental legacy suggests a mechanism by which imaginings can be intentionally shaped by (internalized) partially-expressed motor acts, so providing means of agentic control for attention, working memory, imagination, and behavior. I further describe the nature(s) of mental causation and self-control, and also provide an account of readiness potentials in Libet paradigms wherein conscious intentions shape causal streams leading to enaction. Finally, I provide neurophenomenological handlings of prototypical qualia including pleasure, pain, and desire in terms of self-annihilating free energy gradients via quasi-synesthetic interoceptive active inference. In brief, this manuscript is intended to illustrate how radically embodied minds may create foundations for intelligence (as capacity for learning and inference), consciousness (as somatically-grounded self-world modeling), and will (as deployment of predictive models for enacting valued goals).

Embodied Imagination and Metaphor Use in Autism Spectrum Disorder

This paper discusses different frameworks for understanding imagination and metaphor in the context of research on the imaginative skills of children with autism spectrum disorder (ASD). In contrast to a standard linguistic framework, it advances an embodied and enactive account of imagination and metaphor. The paper describes a case study from a systemic therapeutic session with a child with ASD that makes use of metaphors. It concludes by outlining some theoretical insights into the imaginative skills of children with ASD that follow from taking the embodied-enactive perspective and proposes suggestions for interactive interventions to further enhance imaginative skills and metaphor understanding in children with ASD.

Enactive Pragmatism and Ecological Psychology

A widely cited roadblock to bridging ecological psychology and enactivism is that the former identifies with realism and the latter identifies with constructivism, which critics charge is subjectivist. A pragmatic reading, however, suggests non-mental forms of constructivism that simultaneously fit core tenets of enactivism and ecological realism. After advancing a pragmatic version of enactive constructivism that does not obviate realism, I reinforce the position with an empirical illustration: Physarum polycephalum, a communal unicellular organism that leaves slime trails that form chemical barriers that it avoids in foraging explorations. Here, environmental building and sensorimotor engagement are part of the same process with P. polycephalum coordinating around self-created, affordance-bearing geographies, which nonetheless exist independently in ways described by ecological realists. For ecological psychologists, affordances are values, meaning values are external to the perceiver. I argue that agent-enacted values have the same status and thus do not obviate ecological realism or generate subjectivism. The constructivist-realist debate organizes around the emphasis that enactivists and ecological theorists respectively place on the inner constitution of organisms vs. the structure of environments. Building on alimentary themes introduced in the P. polycephalum example and also in Gibson’s work, I go on to consider how environment, brain, visceral systems, and even bacteria within them enter perceptual loops. This highlights almost unfathomable degrees of mutually modulating internal and external synchronization. It also shows instances in which internal conditions alter worldly configurations and invert values, in Gibson’s sense of the term, albeit without implying subjectivism. My aim is to cut across the somatic focus of enactive constructivism and the external environment-oriented emphasis of ecological realism and show that enactivism can enrich ecological accounts of value.

Enactivism and Ecological Psychology: The Role of Bodily Experience in Agency

This paper considers some foundational concepts in ecological psychology and in enactivism, and traces their developments from their historical roots to current preoccupations. Important differences stem, we claim, from dissimilarities in how embodied experience has been understood by the ancestors, founders and followers of ecological psychology and enactivism, respectively. Rather than pointing to differences in domains of interest for the respective approaches, and restating possible divisions of labor between them in research in the cognitive and psychological sciences, we call for a deeper analysis of the role of embodiment in agency that we also undertake. Awareness of the differences that exist in the respective frameworks and their consequences, we argue, may lead to overcoming some current divisions of responsibility, and contribute to a more comprehensive and complementary way of dealing with a broader range of theoretical and practical concerns. While providing some examples of domains, such as social cognition and art reception, in which we can observe the relative usefulness and potential integration of the theoretical and methodological resources from the two approaches, we demonstrate that such deeper synergy is not only possible but also beginning to emerge. Such complementarity, as we envisage, conceives of ecological psychology that allows felt experience as a crucial dynamical element in the explanations and models that it produces, and of an enactive approach that takes into consideration the ubiquitous presence of rich directly perceived relations among variables arising from enactments in the social and physical world.

Ecological∼Enactivism Through the Lens of Japanese Philosophy

The enactive and ecological approaches to embodied cognitive science are on a collision course. While both draw inspiration from similar views in psychology and phenomenology, the two approaches initially held seemingly contradictory views and points of focus. Early enactivists saw value in the ecological approach but insisted that the two schools remain distinct. While ecological psychology challenged the common foes of mental representation and mind-body dualism, it seemingly did so at the cost of the autonomy of the agent. This is evidence that the early enactive and ecological approaches told different stories about how agents and environments interact. Whereas the enactive approach broadly focuses on agency and the organism’s resilience to environmental perturbations, the ecological approach insists that organisms are best understood in terms of the organism–environment system and at the ecological scale. Historically, this tension created space for harsh criticisms from both sides and for some ecological psychologists to dismiss enactivism altogether. Despite their differences, both approaches use dynamic systems theory to explain the interactions between embodied agents and the environment or contextual milieu in which they are embedded. This has led some scholars to focus on the complementary elements of each approach and argue that the two schools are allies, thus rejecting the historical disagreements between the two approaches and calling for an ecological–enactive synthesis. The attempts to synthesize the approaches are noteworthy and should be considered steps in the right direction but are potentially problematic. If the two schools are merely synthesized to some form of ecological–enactivism, then something of value from both approaches could be lost. This is analogous to the hasty comparison between two seemingly similar schools of thought found in early attempts at East-West comparative philosophy. I argue that the relationship between the enactive and ecological approaches is both complementary and contrary and is thus best understood in terms of complementarity. Given the complexity of complementarity I will unpack the notion in steps. I will begin with the exploration of analogous concepts in Japanese Philosophy and gradually build a lens through which both agent environment and ecological enactive complementarities can be understood.

Ecological Psychology and Enactivism: A Normative Way Out From Ontological Dilemmas

Two important issues of recent discussion in the philosophy of biology and of the cognitive sciences have been the ontological status of living, cognitive agents and whether cognition and action have a normative character per se. In this paper I will explore the following conditional in relation with both the notion of affordance and the idea of the living as self-creation: if we recognize the need to use normative vocabulary to make sense of life in general, we are better off avoiding taking sides on the ontological discussion between eliminativists, reductionists and emergentists. Looking at life through normative lenses is, at the very least, in tension with any kind of realism that aims at prediction and control. I will argue that this is so for two separate reasons. On the one hand, understanding the realm of biology in purely factualist, realist terms means to dispossess it of its dignity: there is more to life than something that we simply aim to manipulate to our own material convenience. On the other hand, a descriptivist view that is committed to the existence of biological and mental facts that are fully independent of our understanding of nature may be an invitation to make our ethical and normative judgments dependent on the discovery of such alleged facts, something I diagnose as a form of representationalism. This runs counter what I take to be a central democratic ideal: while there are experts whose opinion could be considered the last word on purely factual matters, where value is concerned, there are no technocratic experts above the rest of us. I will rely on the ideas of some central figures of early analytic philosophy that, perhaps due to the reductionistic and eliminativist tendencies of contemporary philosophy of mind, have not been sufficiently discussed within post-cognitivist debates.

Extended Skill Learning

Within the ecological and enactive approaches in cognitive science, a tension exists in how the process of skill learning is understood. Skill learning can be understood in a narrow sense, as a process of bodily change over time, or in an extended sense, as a change in the structure of the animal-environment system. We propose to resolve this tension by rejecting the first understanding in favor of the second. We thus defend an extended approach to skill learning. An extended understanding of skill learning views bodily changes as being embedded in a larger process of interaction between the organism and specific structures in the environment. Such an extended approach is committed to the claims that (1) the appropriate unit of analysis for understanding skill learning is not the body but the activity and (2) learning consists in the establishment and adaptive organization of enabling constraints on that activity. We focus on two example cases: maintaining upright posture and walking. In both cases, environmental structures play a constitutive role in the activity throughout learning, but the specific environmental structures that are involved in the activity change over time. At an early stage, the child makes use of an environmental "support"-for example, holding onto furniture to maintain upright posture. Later, once further constraints have been established, the child is able to let go of the furniture and remain upright. We argue that adopting an extended understanding of skill learning offers a promising strategy for unifying ecological and enactive approaches and can also potentially ground a radically embodied approach to higher cognition.

A tale of two densities: active inference is enactive inference

The aim of this article is to clarify how best to interpret some of the central constructs that underwrite the free-energy principle (FEP) - and its corollary, active inference - in theoretical neuroscience and biology: namely, the role that generative models and variational densities play in this theory. We argue that these constructs have been systematically misrepresented in the literature, because of the conflation between the FEP and active inference, on the one hand, and distinct (albeit closely related) Bayesian formulations, centred on the brain - variously known as predictive processing, predictive coding or the prediction error minimisation framework. More specifically, we examine two contrasting interpretations of these models: a structural representationalist interpretation and an enactive interpretation. We argue that the structural representationalist interpretation of generative and recognition models does not do justice to the role that these constructs play in active inference under the FEP. We propose an enactive interpretation of active inference - what might be called enactive inference. In active inference under the FEP, the generative and recognition models are best cast as realising inference and control - the self-organising, belief-guided selection of action policies - and do not have the properties ascribed by structural representationalists.

Defining the Environment in Organism-Environment Systems

Enactivism and ecological psychology converge on the relevance of the environment in understanding perception and action. On both views, perceiving organisms are not merely passive receivers of environmental stimuli, but rather form a dynamic relationship with their environments in such a way that shapes how they interact with the world. In this paper, I suggest that while enactivism and ecological psychology enjoy a shared specification of the environment as the cognitive domain, on both accounts, the structure of the environment, itself, is unspecified beyond that of contingent relations with the species-typical sensorimotor capacities of perceiving organisms. This lack of specification creates a considerable gap in theory regarding the organization of organisms as coupled with their environments. I argue that this gap can be filled by drawing from resources in developmental systems theory, namely, specifying the environmental state-space as a developmental niche that shapes and is shaped by individual organisms over developmental and, on a population scale, evolutionary time. Defining the environment as an organism’s developmental niche makes it clearer how and why certain contingencies have arisen, in turn, strengthening a joint appeal to both enactivism and ecological psychology as theories asserting complementarity between organisms and their environments.

A tale of two densities: active inference is enactive inference

The aim of this article is to clarify how best to interpret some of the central constructs that underwrite the free-energy principle (FEP) - and its corollary, active inference - in theoretical neuroscience and biology: namely, the role that generative models and variational densities play in this theory. We argue that these constructs have been systematically misrepresented in the literature, because of the conflation between the FEP and active inference, on the one hand, and distinct (albeit closely related) Bayesian formulations, centred on the brain - variously known as predictive processing, predictive coding or the prediction error minimisation framework. More specifically, we examine two contrasting interpretations of these models: a structural representationalist interpretation and an enactive interpretation. We argue that the structural representationalist interpretation of generative and recognition models does not do justice to the role that these constructs play in active inference under the FEP. We propose an enactive interpretation of active inference - what might be called enactive inference. In active inference under the FEP, the generative and recognition models are best cast as realising inference and control - the self-organising, belief-guided selection of action policies - and do not have the properties ascribed by structural representationalists.

Between Ecological Psychology and Enactivism: Is There Resonance?

Ecological psychologists and enactivists agree that the best explanation for a large share of cognition is non-representational in kind. In both ecological psychology and enactivist philosophy, then, the task is to offer an explanans that does not rely on representations. Different theorists within these camps have contrasting notions of what the best kind of non-representational explanation will look like, yet they agree on one central point: instead of focusing solely on factors interior to an agent, an important aspect of cognition is found in the link or coupling between an agent and the external world. This link is fluid, dynamic, and active in a variety of ways, and we do not need to add any internal extra something in the perception-action-cognition process. At the same time, even devout defenders of ecological psychology and enactivism recognize that plenty happens inside an agent during cognition. In particular, no one denies that the brain plays an important role. What, then, is the role of the brain if it's not in the game of representing the environment? One possible option is to describe the brain as a resonant organ instead of a representational organ. In this paper we consider the history of resonance in more detail. Particular focus will be placed on two different sets of approaches that have developed the concept of resonance: a representational reading of resonance and a non-representational, dynamic account of resonance. We then apply these accounts to a case study on music performance, specifically in the context of standard tonal jazz. From this application, we propose that a non-representational resonance account consistent with both enactivism and ecological psychology is a viable way of explaining jazz performance. We conclude with future considerations on research regarding the brain as a resonant organ.

A phenomenological ethnography of radiology: exploring the enactive and intersubjective aspects of radiological praxis

This paper presents qualitative field research conducted at a radiology department in the USA. It examines 'the radiologist at work' and analyses the intersubjective ground for her individual diagnostic intentions and personalized strategies for enacting diagnostically-relevant experiences via imaging technology. The paper incorporates the radiologists' use of 'enactive proofs'-observations and professional memories made explicit through their interaction with medical imaging technology and other practitioners in the field. The observations strongly support the development of enactive phenomenology and provide a critique of representationalism and of the primacy of inference in cognition. The results demonstrate the crucial role of shared intentions, providing insight into expert performance in the form of concrete dealings with imaging technology, habituality, the origin of mistakes, multilayered communication, and discovering new ways for improving professional praxis. The findings have much to offer to philosophy, anthropology and radiological practice.

Agency From a Radical Embodied Standpoint: An Ecological-Enactive Proposal

Explaining agency is a significant challenge for those who are interested in the sciences of the mind, and non-representationalists are no exception to this. Even though both ecological psychologists and enactivists agree that agency is to be explained by focusing on the relation between the organism and the environment, they have approached it by focusing on different aspects of the organism-environment relation. In this paper, I offer a suggestion for a radical embodied account of agency that combines ecological psychology with recent trends in enactive cognitive science. According to this proposal, while enactivism focuses primarily on describing how our acquired sensorimotor schemes and habits mutually equilibrate, affecting our tendency to act upon some affordances instead of others, ecological psychology focuses on studying how perceptual information contributes to the actualization of the sensorimotor schemes and habits without mediating representations, inferences, and computations. The paper concludes by briefly exploring how this ecological-enactive theory of agency can account for how socio-cultural norms shape human agency.

Scale Matters: Temporality in the Perception of Affordances

In this paper I seek to unify enactive and ecological approaches to cognitive science by emphasizing the fact that both approaches view cognitive processes as being inherently temporally extended. My hypothesis is that characterizing the temporal scales in which perception of affordances occur, they can serve different purposes of explanation within the theories. Specifically, the paper brings together, on the one hand, Chemero’s (2009) dynamicist understanding of affordances, which he called affordances 2.0, with, on the other hand, a distinction originally made by Varela (1999), and later taken up by Shaun Gallagher (2011, 2017b), between three different timescales for understanding cognition: the elementary, the integrative, and the narrative. Varela’s three-fold distinction was originally intended as a way of identifying phenomenological events as being causally coupled to specific cellular events happening within the nervous system. The central claim of the present paper is that affordances, likewise, should be understood in terms of these three different timescales. I show that these temporal scales can be a useful toolkit for explaining the perception and learning of affordances and at the same time unifying enactivism and ecological psychology claiming that affordances serve a different explanatory role depending on which time scale you consider them at. If you are interested in explaining the embodied assemblies that form the always changing sensorimotor contingencies, then you see the elementary scale. If you’re interested in explaining perception at the integrative scale, then affordances are solicitations that get actualized and bear an umwelt at that same scale. The perception of affordances as such is constituted by the integration of these first two scales, and the experience of it can be characterized by the husserlian structure of experience with its intrinsic temporality. Finally, if you are interested in explaining change in the animal-environment system over developmental time, that is, learning, then affordances are roughly what Chemero proposed and they operate at the narrative scale. But it is important to say that the three scales are always intertwined because learning and perception are ongoing processes that in many senses are impossible to separate. Finally, I discuss the importance of scales from the macro to micro levels for understanding behavior through affordances, considering them as synergies, where abilities and aspects of the environment are understood as constraints on the potential trajectories of such systems.

Dynamic Touch as Common Ground for Enactivism and Ecological Psychology

The main purpose of this article is to show that enactivism and ecological psychology share more aspects than is often recognized. Rather than debating about differences, commonalities between the approaches are illustrated with the example of dynamic touch. Dynamic touch is a form of touch that implies muscles and tendons and that allows the perception of hand-held objects that are wielded but not seen. Given that perceivers perform the wielding movements with effort, dynamic touch necessarily implies active exploration. The strength of dynamic touch as an example lies in the fact that it has been formalized and analyzed in detail at the level of the laws that govern the organism-environment system. The example provides empirically supported instantiations of sensorimotor contingencies, in enactivist terms, and of intentional exploration and information detection, in ecological terms. Moreover, dynamic touch is a practical example of the enactivist concepts of bringing-forth the world and sense-making. As a second purpose, we use the example of dynamic touch to clarify key concepts of the ecological approach. Specifically, we analyze the concepts of invariance and affordance, indicating the crucial difference between perceiving and actualizing affordances, and highlighting the importance of these concepts for the dialogue between enactivism and ecological psychology.

Thinking avant la lettre: A Review of 4E Cognition

The "4E" approach to cognition argues that cognition does not occur solely in the head, but is also embodied, embedded, enacted, or extended by way of extra-cranial processes and structures. Though very much in vogue, 4E cognition has received relatively few critical evaluations. By reflecting on two recent collections, this article reviews the 4E paradigm with a view to assessing its strengths and weaknesses.

An Enactive-Ecological Approach to Information and Uncertainty

Information is a central notion for cognitive sciences and neurosciences, but there is no agreement on what it means for a cognitive system to acquire information about its surroundings. In this paper, we approximate three influential views on information: the one at play in ecological psychology, which is sometimes called information for action; the notion of information as covariance as developed by some enactivists, and the idea of information as a minimization of uncertainty as presented by Shannon. Our main thesis is that information for action can be construed as covariant information, and that learning to perceive covariant information is a matter of minimizing uncertainty through skilled performance. We argue that the agent’s cognitive system conveys information for acting in an environment by minimizing uncertainty about how to achieve intended goals in that environment. We conclude by reviewing empirical findings that support our view by showing how direct learning, seen as an instance of ecological rationality at work, is how mere possibilities for action are turned into embodied know-how. Finally, we indicate the affinity between direct learning and sense-making activity.

Mind After Uexküll: A Foray Into the Worlds of Ecological Psychologists and Enactivists

For several decades, a diverse set of approaches to embedded, embodied, extended, enactive and affective cognition has been challenging the cognitivist orthodoxy. Recently, the prospect of a combination of ecological psychology and enactivism has emerged as a promising candidate for a single unified framework that could rival the established cognitivist paradigm as "a working metatheory for the study of minds" (Baggs and Chemero, 2018, p. 11). One obstacle to such an ecological-enactive approach is the conceptual tension between the firm commitment to realism of those following James Gibson's ecological approach and the central tenet of enactivism that each living organism enacts its own world, interpreted as a constructivist or subjectivist position. Baggs and Chemero (2018) forward the concept of Umwelt, coined by the biologist Jakob von Uexküll, as a conceptual bridge between the two approaches. Inspired by Kant, Uexküll's Umwelt describes how the physiology of an organism's sensory apparatus shapes its active experience of the environment. Baggs and Chemero use this link between the subject and its objective surroundings to argue for a strong compatibility between ecological psychology and enactivism. Fultot and Turvey on the other hand view Umwelt as steeped in representationalism, the rejection of which is a fundamental commitment of radical embodied cognition (Fultot and Turvey, 2019). Instead, they advance Uexküll's "compositional theory of nature" as a conceptual supplement for Gibson's ecological approach (von Uexküll, 2010, p. 171; Fultot and Turvey, 2019). In this paper, I provide a brief overview of Uexküll's thought and distinguish a crucial difference between two ways of using his term Umwelt. I argue that only one of these ways, the one which emphasizes the role of subjective experience, is adequate to Uexküll's philosophical project. I demonstrate how the two ways of using Umwelt are employed in the philosophy of cognitive science, show how this distinction matters to recent debates about an ecological-enactive approach, and provide some critical background to Uexküll's compositional theory of meaning.

From Wide Cognition to Mechanisms: A Silent Revolution

In this paper, we argue that several recent ‘wide’ perspectives on cognition (embodied, embedded, extended, enactive, and distributed) are only partially relevant to the study of cognition. While these wide accounts override traditional methodological individualism, the study of cognition has already progressed beyond these proposed perspectives toward building integrated explanations of the mechanisms involved, including not only internal submechanisms but also interactions with others, groups, cognitive artifacts, and their environment. Wide perspectives are essentially research heuristics for building mechanistic explanations. The claim is substantiated with reference to recent developments in the study of “mindreading” and debates on emotions. We argue that the current practice in cognitive (neuro)science has undergone, in effect, a silent mechanistic revolution, and has turned from initial binary oppositions and abstract proposals toward the integration of wide perspectives with the rest of the cognitive (neuro)sciences.

Does Separating Intentionality From Mental Representation Imply Radical Enactivism?

Traditionally, intentionality is regarded as that feature of all and only mental states - paradigmatically beliefs and desires - in virtue of which they are directed at or are about something. The problem of intentionality is to explain how it fits into the natural order given the intuition that no physical entity can be intentionally directed in this sense. The basic assumption of this paper, proposed by enactivists, is that failure to naturalize intentionality and mental representation is partly due to the fact that most participants in the debate take intentionality and mental representation to be equivalent. In contrast, it is proposed to treat intentionality as a feature of whole embodied agents (paradigmatically organisms) who can be directed at objects and states of affairs in various ways, while representation should be regarded as a feature of mental states (and their respective vehicles or underlying mechanisms). The present paper develops and motivates the distinction, applies it to Metzinger's project of naturalizing phenomenal representation, and demonstrates the range of theoretical options with respect to a delineation of cognition given the enactive proposal. It is taken as problematic that enactivism takes the realm of cognition to be identical to the realm of biology. Instead, a constraint on a theory of intentionality and representation is that it should delineate the subject matter of cognitive science and distinguish it from other sciences, also to leave room for the possibility of artificial intelligence. One important implication of the present proposal is that there can be creatures which can be intentionally directed without having the capacity to represent. That is, their intentionality is restricted to being able to be directed at existent things. Only creatures in possession of the right kind of neurocognitive architecture can produce and sustain representations in order to be directed at non-existent things. It is sketched how this approach conceives of intentionality as a developmental and layered concept, allowing for a hierarchical model of varieties of intentionality, ranging from the basic pursuit of local environmental goals to thoughts about fictional objects.

How physiotherapists supervise to enhance practical skills in dedicated aides of toddlers with cerebral palsy: A qualitative observational study

BACKGROUND

Physiotherapy from an early age is considered important for children with cerebral palsy (CP). In preschool, dedicated aides are responsible for the daily follow-up and training under the supervision of a physiotherapist (PT). Knowledge is sparse regarding what is created and achieved in clinical practice involving triads (i.e. the PT, aide, and child) with respect to the enhancement of practical skills in dedicated aides. The study purpose was to explore form and content in supervision.

METHODS

Nonparticipating observations were performed on a purposive sample of seven triads, including seven PTs, seven dedicated aides, and seven preschool toddlers with CP with function level III-IV of the Gross Motor Function Classification System. Each triad was video-recorded once. Data consisted of 371 minutes of video recordings analyzed using content analysis and enactive theory on participatory sense-making.

RESULTS

From the analysis, three supervision approaches emerged: (1) the Cognitive Supervision approach; (2) the Joint Action Supervision approach; and (3) the Embodied Supervision approach. Each approach gives rise to different types of sense-making processes, ranging from merely reflective ways of knowing through verbal and visual conveyance to mutual embodied ways of knowing through joint actions and physical interplay. To make use of all approaches, PTs require incorporated handling skills and action competence.

CONCLUSION

Supervision is an emergent process where knowledge is transformed through interactions and shared sense-making processes.

IMPLICATIONS

Clinicians should be aware of the context-dependent and interactional factors that drive the supervision process.

Coordinated Interpersonal Behaviour in Collective Dance Improvisation: The Aesthetics of Kinaesthetic Togetherness

Collective dance improvisation (e.g., traditional and social dancing, contact improvisation) is a participatory, relational and embodied art form which eschews standard concepts in aesthetics. We present our ongoing research into the mechanisms underlying the lived experience of “togetherness” associated with such practices. Togetherness in collective dance improvisation is kinaesthetic (based on movement and its perception), and so can be simultaneously addressed from the perspective of the performers and the spectators, and be measured. We utilise these multiple levels of description: the first-person, phenomenological level of personal experiences, the third-person description of brain and body activity, and the level of interpersonal dynamics. Here, we describe two of our protocols: a four-person mirror game and a ‘rhythm battle’ dance improvisation score. Using an interpersonal closeness measure after the practice, we correlate subjective sense of individual/group connectedness and observed levels of in-group temporal synchronization. We propose that kinaesthetic togetherness, or interpersonal resonance, is integral to the aesthetic pleasure of the participants and spectators, and that embodied feeling of togetherness might play a role more generally in aesthetic experience in the performing arts.

The Clinical Concept of Opioid Addiction Since 1877: Still Wanting After All These Years

In 1877, the psychiatrist Edward Levinstein authored the first monograph on opioid addiction. The prevalence of opioid addiction prior to his publication had risen in several countries including England, France and Germany. He was the first to call it an illness, but doubted that it was a mental illness because the impairment of volition appeared to be restricted to opioid use: it was not pervasive, since it did not extend to other aspects of the individuals' life. While there has been huge progress in understanding the underlying neurobiological mechanisms, there has been little progress in the clinical psychopathology of addiction and in understanding how it relates to these neurobiological mechanisms. A focus on cravings has limited the exploration of other important aspects such as anosognosia and addiction-related behaviors like smuggling opioids into treatment and supporting the continued provision of co-patients. These behaviors are usually considered secondary reactions, but in clinical practice they appear to be central to addiction, indicating that an improved understanding of the complexity of the disorder is needed. We propose to consider an approach that takes into account the embodied, situated, dynamic, and phenomenological aspects of mental processes. Addiction in this context can be conceptualized as a habit, understood as a distributed network of mental, behavioral, and social processes, which not only shapes the addict's perceptions and actions, but also has a tendency to self-maintain. Such an approach may help to develop and integrate psychopathological and neurobiological research and practice of addictions.

Cognition from life: the two modes of cognition that underlie moral behavior

We argue that the capacity to live life to the benefit of self and others originates in the defining properties of life. These lead to two modes of cognition; the coping mode that is preoccupied with the satisfaction of pressing needs and the co-creation mode that aims at the realization of a world where pressing needs occur less frequently. We have used the Rule of Conservative Changes - stating that new functions can only scaffold on evolutionary older, yet highly stable functions - to predict that the interplay of these two modes define a number of core functions in psychology associated with moral behavior. We explore this prediction with five examples reflecting different theoretical approaches to human cognition and action selection. We conclude the paper with the observation that science is currently dominated by the coping mode and that the benefits of the co-creation mode may be necessary to generate realistic prospects for a modern synthesis in the sciences of the mind.

Enactive account of pretend play and its application to therapy

This paper informs therapeutic practices that use play, by providing a non-standard philosophical account of pretense: the enactive account of pretend play (EAPP). The EAPP holds that pretend play activity need not invoke mental representational mechanisms; instead, it focuses on interaction and the role of affordances in shaping pretend play activity. One advantage of this re-characterization of pretense is that it may help us better understand the role of shared meanings and interacting in systemic therapies, which use playing to enhance dialog in therapy rather than to uncover hidden meanings. We conclude with bringing together findings from therapeutic practice and philosophical considerations.