Toward a computational enactive, extended, embedded, emotive, and embodied (5E) psychiatry

ABSTRACT

Introduction: Psychiatry is challenged by a plurality of complementary approaches. These challenges stem from the existence of multiple levels of understanding, i.e. systems of representations, tools, methodologies and objectives in psychiatry–ranging from computational approaches and systems dynamics to the multiplicity of emerging nosographies, such as the NIMH Research Domain Criteria project or staging models. In this plurality, a significant number of clinicians have adopted the biopsychosocial model. However, such a model has been widely criticized for more than twenty years. In parallel, science has declined a set of different pluralistic frameworks. Thus, through the challenges of computational modeling in psychiatry, we will see how the enactive approach of psychiatry could respond to this multiplicity. Indeed, such an enactive approach considers that perception is a (predictive) activity, which gives sense to the environment (i.e., sense making). Perception and, by extension, cognitive processes are not internal representations of the outside world, but they are deployed according to the 5E approach, i.e., an embodied, embedded, enacted, emotive and extended approach. Methods: In this article, we first study the pluralist framework in psychiatry, in order to show its contributions in the clinical practice. Secondly, we analyze the contributions of the enactive approach for clinical practice in psychiatry. Results: Two forms of pluralisms can be described a non-integrative pluralism and an integrative pluralism. The first examines the coexistence of different potentially incompatible or untranslatable systems in the scientific or clinical landscape. The second proposes the development of a general framework, bringing together the different levels of understanding and systems of representations. However, pluralism has many pitfalls and limitations. Especially by allowing computational modeling, the enactive framework, anchored both in cognitive sciences, theory of dynamic systems, systems biology and phenomenology, has recently been proposed as an answer to the challenge of integrative psychiatry. Conclusions: A significant number of mental health professionals are already working accepting such a variety of clinical and scientific approaches. We show that the enactive approach allows psychiatry (1) to consider the subjectivity and the patient's experience, (2) to articulate different “granularities” within the clinical consultation, (3) to explain the benefits the creation of meaning for the patient, (4) to provide concrete models, (5) to support pedagogy in psychiatry. The enactive approach provides a conception for understanding psychiatric disorders as embodied, embedded, enacted, emotional and extended. In that way, the manifestations experienced by the patients are sense making experiences and can be conceived according to various levels of granularity.