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
