The existential dimension in psychiatry: an enactive framework

ABSTRACT

In his paper Psychiatry and religion: Consensus reached!, Verhagen advocates the relevance of spirituality and religion for the “origins, understanding, and treatment of psychiatric disorders”. In this comment, I argue for the broader claim that the existential dimension is important for understanding psychiatric disorders – of which religion can, but must not necessarily be, part. The existential dimension refers to our ability to relate to ourselves, our experiences, and our situation. This evaluative relation can play an important role in psychiatry: it can co-constitute the disorder, be affected by the disorder, and/or modulate the course of the disorder. Given this importance, it makes sense to explicitly recognize the existential dimension in our explanatory model of psychiatric disorders. The biopsychosocial model goes a long way in providing an integrative model, but there is room for improvement, especially when it comes to integration of its aspects, and acknowledging the existential aspect. I briefly introduce the research paradigm of enactivism, and suggest that an enactive framework is well-suited to incorporate this existential dimension – along with the traditional dimensions of the biopsychosocial model.

KEYWORDS:

• Psychiatry
• spirituality
• existential dimension
• biopsychosocial model
• enactivism
• existential sense-making

Disclosure statement

No potential conflict of interest was reported by the author.

Notes

1 My use of the term “existential” thus follows the literal meaning of the Latin “ex sistere” or “ex stare”: to being or standing outside of something.

2 Note that there is a difference between detecting food and detecting something as food. Sense-making in its most basic forms does entail the first but not the second. That is: a bacteria can sense a sucrose gradient – but that does not imply that it senses it as a sucrose gradient or as being food. In other words: sensing something does not necessarily include being aware of sensing something. These are of course complicated issues and this is not the place to get into them, but see de Haan (in press).

3 Human beings are typically capable of reflection and stance-taking, but there is no principled reason why this has to be an exclusively human capacity. That is: I am not interested here in setting apart humans from other organisms, but only in distinguishing reflexive organisms (at least comprising human persons) from non-reflective organisms.