Though predictive processing approaches to the mind were originally applied to exteroceptive perception, i.e., vision and action, recent work has started to explore the role of interoceptive perception, i.e., emotion and affect. This article builds on this work by extending PP beyond emotion to the construction of emotional dispositions. I employ principles from dynamical systems theory and PP to provide a model of how dispositional anger can develop in response to early experiences of psychosocial stress. The model is then deployed (...) to explain the established link between psychosocial stress in early life and the appearance of certain organic disease phenotypes in later life. This phenomenon can appear mysterious when viewed through the standard biomedical explanatory lens, which has difficulty accounting for the causal influence of subjective perceptions and evaluations of the social and material environment on the development of organic disease processes. The model provided presents such cases as instances of developmental mismatch. They occur when an organism develops an emotional disposition that leads them to make habitually-biased appraisals of what the social environment affords. The model provides a novel explanation of certain organic disease phenotypes with top-down and developmental causes, and demystifies one class of cases involving apparently spooky ‘mind-to-matter’ causation. (shrink)

We propose a new conceptualization of pain by incorporating advancements made by phenomenologists and cognitive scientists. The biomedical understanding of pain is problematic as it inaccurately endorses a linear relationship between noxious stimuli and pain, and is often dualist or reductionist. From a Cartesian dualist perspective, pain occurs in an immaterial mind. From a reductionist perspective, pain is often considered to be “in the brain.” The biopsychosocial conceptualization of pain has been adopted to combat these problematic views. However, when considering (...) pain research advancements, paired with the work of phenomenologists’ and cognitive scientists’ advanced understanding of perception, the biopsychosocial model is inadequate in many ways. The boundaries between the biological, psychological, and social are artificial, and the model is often applied in a fragmented manner. The model has a limited theoretical foundation, resulting in the perpetuation of dualistic and reductionist beliefs. A new framework may serve to better understand and treat pain. In this paper, we conceptualize pain as a 5E process, arguing that it is: Embodied, Embedded, Enacted, Emotive, and Extended. This perspective is applied using back pain as an exemplar and we explore potential clinical applications. With enactivism at the core of this approach, pain does not reside in a mysterious immaterial mind, nor is it an entity to be found in the blood, brain, or other bodily tissues. Instead, pain is a relational and emergent process of sense-making through a lived body that is inseparable from the world that we shape and that shapes us. (shrink)

This paper disputes the theoretical assumptions of mainstream approaches in philosophy of pain, representationalism and imperativism, and advances an enactive approach as an alternative. It begins by identifying three shared assumptions in the mainstream approaches: the internalist assumption, the brain-body assumption, and the semantic assumption. It then articulates an alternative, enactive approach that considers pain as an embodied response to the situation. This approach entails the hypothesis of the sociocultural embeddedness of pain, which states against the brain-body assumption that the (...) intentional character of pain depends on the agent’s sociocultural background. The paper then proceeds to consider two objections. The first questions the empirical basis of this hypothesis. It is argued based on neuroscientific evidence, however, that there is no empirical reason to suppose that the first-order experience of pain is immune to sociocultural influences. The second objection argues that the mainstream approaches can account for sociocultural influences on pain by drawing on the conceptual distinction between narrow and wide content. In response, the semantic conception of pain underpinning the proposal is challenged. Pain experience can occur in pre-reflective, affectively reflective, or cognitively reflective forms, but the semantic conception at most only applies to the last form. The paper concludes that the enactive approach offers a promising alternative framework in philosophy of pain. (shrink)

Osteopathy is a person-centred healthcare discipline that emphasizes the body’s structure-function interrelationship—and its self-regulatory mechanisms—to inform a whole-person approach to health and wellbeing. This paper aims to provide a theoretical framework for developing an integrative hypothesis in osteopathy, which is based on the enactivist and active inference accounts. We propose that osteopathic care can be reconceptualised under active inference as a unifying framework. Active inference suggests that action-perception cycles operate to minimize uncertainty and optimize an individual’s internal model of the (...) lived world and, crucially, the consequences of their behaviour. We argue that active inference offers an integrative framework for osteopathy, which can evince the mechanisms underlying dyadic and triadic exchanges and osteopathic care outcomes. We propose that this theoretical framework can underpin osteopathic care across the lifespan, from preterm infants to the elderly and those with persistent pain and other physical symptoms. In situations of chronicity, as an ecological niche, the patient-practitioner dyad provides the osteopath and the patient with a set of affordances, i.e., possibilities for action provided by the environment, that through shared intentionally, can promote adaptations and restoration of productive agency. Through a dyadic therapeutic relationship, as they engage with their ecological niche’s affordances—a structured set of affordances shared by agents—osteopath and patient actively construct a shared sense-making narrative and realise a shared generative model of their relation to the niche. In general, touch plays a critical role in developing a robust therapeutic alliance, mental state alignment, and biobehavioural synchrony between patient and practitioner. However, its role is particularly crucial in the fields of neonatology and paediatrics, where it becomes central in regulating allostasis and restoring homeostasis. We argue that from an active inference standpoint, the dyadic shared ecological niche underwrites a robust therapeutic alliance, which is crucial to the effectiveness of osteopathic care. Considerations and implications of this model—to clinical practice and research, both within- and outside osteopathy—are critically discussed. (shrink)