4.1 Article

An enactivist reconceptualization of the medical model

Journal

PHILOSOPHICAL PSYCHOLOGY
Volume 34, Issue 7, Pages 962-988

Publisher

ROUTLEDGE JOURNALS, TAYLOR & FRANCIS LTD
DOI: 10.1080/09515089.2021.1940119

Keywords

Enactivism; psychiatry; medical model; sense-making; affordance

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Mental disorder is seen as an illness according to the prevailing medical model in the Western world, yet understanding of it is influenced by cultural norms and values. It is important to recognize the real difficulties faced by individuals with mental disorders and to revise the medical model using enactivist insights rather than rejecting it entirely. This approach can help to address the normative aspect of mental disorder and integrate its neurobiological, social, and existential dimensions.
According to the medical model that prevails in the Western world, mental disorder is a form of illness, parallel to bodily illness, which can be diagnosed by a doctor on the basis of symptoms and administered treatments designed to cure it. However, it seems clear that how we understand disorder is influenced by cultural norms and values. Theorists associated with the so-called anti-psychiatry movement have gone so far as to claim that 'mental illness' simply is the accepted term for behaviors and experiences that are problematic or do not fit the cultural norm. In my view, however, this social-constructionist view downplays and obscures the very real difficulties encountered by subjects with mental disorder. I argue that rather than rejecting the medical model altogether, we should revise the model by utilizing insights from the enactivist approach in philosophy of mind. An appeal to the enactivist notions of autonomy, sense-making, and adaptivity, I propose, can help us to (a) account for mental disorder's normative aspect, so that we can navigate a middle way between the medical model and an anti-psychiatry stance; and (b) understand the way in which the neurobiological, social, and existential dimensions of mental disorder are integrated.

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