Sanneke de Haan

Enactive Psychiatry

Ideas from Chapter 1: "The Need for a Model"

... the hardest thing, according to Dew, is ‘to imagine all of the causes happening together, responding to each other, making each other worse, compensating for each other, benefiting the person, harming the person, comforting the person, killing the person’ (p. 17)

making sense of someone else’s brain

Psychiatry is the hardest specialty

Need for a comprehensive view, a model

Medicine

Psychiatry

tension between the patient as a person in his life-world and the patient as a body for scientific and medical investigation

way of perceiving, thinking, feeling, behaving: experiences that make us who we are

Organism

Person

disease

disorder

Brain diseases

Unresolved inner conflicts

Existential struggles

Social problem expressed in an individual

phrenology, neurobiological psychiatry

psychoanalysis

anthropology

social and anti-psychiatry

What research gets funded

How we treat a problem

How we understand and use research

Beyond brain correlates, to experiences and interactions

The problem of integration

Why make an explicit integrative framework

Orientation

Communication

Justification

Keep an eye on all aspects during treatment

Relate biological/phenomenological/social psychiatry

Treatment rationale

Between different fields and approaches

With patients and family

For insurance companies (?!)

For the political decision of funding health care and research

Dimensions of psychiatry

Experiential

Existential

Physiological

Sociocultural

Patients' experiences

Genetic, anatomical, biochemical, and neurological

Outside our awareness

Sociocultural communities, family, friends, acquaintances

Norms, habits, and (self-)interpretations

Socioeconomical: jobs, finances, housing, discrimination

Development of the above

Political question of normal vs. abnormal

Existential & stance-taking

Latin ex sistere or ex stare: ... being or standing outside of something

Evaluative

Unreflective and implicit

Affects the "person qua person"

e.g. panic disorder

e.g. norms of feminity

e.g. estrangement, anxiety

primary

part of a disorder

modulatory

relationship to diagnosis

may be

e.g. anxiety disorder

e.g. depression

e.g. OCD, or seeking help

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By Sébastien Lerique

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