An enactivist reconceptualization of the medical model

ABSTRACT

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.

KEYWORDS:

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

Disclosure statement

No potential conflict of interest was reported by the author(s).

Notes

1. Other versions of enactivism, not to be examined here, include ‘sensorimotor enactivism,’ ‘radical enactivism,’ and ‘computational enactivism.’

2. There are interesting questions here about which sociocultural norms are justified and which regional identities are worth forming. To take just one example, problematic norms surrounding what it means to be a “good employee” in late capitalist societies may be especially challenging for subjects with depression and deserve to be critiqued. In my view, this sort of social critique is compatible with the notion that depression counts as violation of norms at a biological scale, and thus likely is to disrupt someone’s functioning even in a more just society. However, a full discussion and interrogation of the sociocultural norms that influence our understanding of mental disorder is beyond the scope of this paper.

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Notes on contributors

Michelle Maiese

Michelle Maiese received her PhD in Philosophy from the University of Colorado, Boulder in 2005 and is now Professor of Philosophy at Emmanuel College in Boston, MA. Her research addresses issues in philosophy of mind, philosophy of psychiatry, and emotion theory. She has authored or co-authored four books:Embodied Minds in Action (co-authored with R. Hanna, OUP, 2009), Embodied, Emotion, and Cognition (Palgrave Macmillan, 2011), Embodied Selves and Divided Minds (OUP, 2015), and The Mind–Body Politic (co-authored with R. Hanna, Palgrave Macmillan, 2019).