Meeting Epistemic Challenges in Psychiatry With Embodied Cognition

Abstract

Psychiatry faces epistemic problems because of its roughly dualist philosophy of mind. Theory and practice that implicitly or explicitly separate mind and body challenge psychiatry’s ability to describe, meet and treat its patients. This is particularly problematic because psychiatry has a tendency to reify diagnoses and over-medicalize patients. Reliance on inferential modes of knowing downplays the role of intuitions in the diagnostic process. Embodied cognition offers a theoretical remedy for psychiatry. The argument proceeds in three parts. The first part provides background, in the form of brief overviews of several relevant positions and issues. First is psychiatric theory’s dualism, and connected problems of epistemic access. Next, the roles of antirealism and realism are related to research trends and the political stance of psychiatry. Third, the current state of affairs is entrenched by psychiatric pedagogy and arises from psychiatric history. Last, the standard model of cognition used in psychiatry is described. The second part reviews work in embodied cognition, which rejects, or at least modifies, the standard view of cognition. Theories established by Michelle Maiese and Andy Clark are used to generate a concept of an agent as an affectively framed predictive processor. The third and final part of the argument illustrates how an embodied understanding of cognition informs the clinical work of the psychiatrist. Intersubjective knowing is defined and shown to reflect an embodied understanding, which privileges intuition as epistemically valuable. Adopting an embodied view of cognition changes the process of diagnosis in psychiatry, in particular by altering the definitions psychiatry employs for disorder and normality. On a deeper level, the etiology of psychiatric disorders is shown to be more causally embodied. Embodiment is posited as being a specific focus for psychiatric treatment, especially in the realm of psychotherapy. The argument demonstrates the theoretically narrow position of current standard psychiatry and presents an additive theoretical stance, in the form of embodied psychiatry. This stance opens up areas for practice and research that are likely to be beneficial to the treatment of patients.