Digital Twins are conceptualised in the academic technical discourse as real-time realistic digital representations of physical entities. Originating from product engineering, the Digital Twin quickly advanced into other fields, including the life sciences and earth sciences. Digital Twins are seen by the tech sector as the new promising tool for efficiency and optimisation, while governmental agencies see it as a fruitful means for improving decision-making to meet sustainability goals. A striking example of the latter is the European Commission who wishes (...) to delegate a significant role to Digital Twins in addressing climate change and supporting Green Deal policy. As Digital Twins give rise to high expectations, ambitions, and are being entrusted important societal roles, it is crucial to critically reflect on the nature of Digital Twins. In this article, we therefore philosophically reflect on Digital Twins by critically analysing dominant conceptualisations, the assumptions underlying them, and their normative implications. We dissect the concept and argue that a Digital Twin does not merely fulfil the role of being a representation, but is in fact a steering technique used to direct a physical entity towards certain goals by means of multiple representations. Currently, this steering seems mainly fuelled by a reductionist approach focused on efficiency and optimisation. However, this is not the only direction from which a Digital Twin can be thought and, consequently, designed and deployed. We therefore set an agenda based on a critical understanding of Digital Twins that helps to draw out their beneficial potential, while addressing their potential issues. (shrink)

We challenge Gallagher’s distinction between the sense of ownership (SO) and the sense of agency (SA) as two separable modalities of experience of the minimal self and argue that a careful investigation of the examples provided to promote this distinction in fact reveals that SO and SA are intimately related and modulate each other. We propose a way to differentiate between the various notions of SO and SA that are currently used interchangeably in the debate, and suggest a more gradual (...) reading of the two that allows for various blends of SO and SA. Such an approach not only provides us with a richer phenomenology but also with a more parsimonious view of the minimal self. (shrink)

Bioregionalists have championed the utility of the concept of the watershed as an organizing framework for thought and action directed to understanding and implementing appropriate and respectful human interaction with particular pieces of land. In a creative analogue to the watershed, permaculturist Arthur Getz has recently introduced the term “foodshed” to facilitate critical thought about where our food is coming from and how it is getting to us. We find the “foodshed” to be a particularly rich and evocative metaphor; but (...) it is much more than metaphor. Like its analogue the watershed, the foodshed can serve us as a conceptual and methodological unit of analysis that provides a frame for action as well as thought. Food comes to most of us now through a global food system that is destructive of both natural and social communities. In this article we explore a variety of routes for the conceptual and practical elaboration of the foodshed. While corporations that are the principal beneficiaries of a global food system now dominate the production, processing, distribution, and consumption of food, alternatives are emerging that together could form the basis for foodshed development. Just as many farmers are recognizing the social and environmental advantages to sustainable agriculture, so are many consumers coming to appreciate the benefits of fresh and sustainably produced food. Such producers and consumers are being linked through such innovative arrangements as community supported agriculture and farmers markets. Alternative producers, alternative consumers, and alternative small entrepreneurs are rediscovering community and finding common ground in municipal and community food councils. Recognition of one's residence within a foodshed can confer a sense of connection and responsibility to a particular locality. The foodshed can provide a place for us to ground ourselves in the biological and social realities of living on the land and from the land in a place that we can call home, a place to which we are or can become native. (shrink)

The need for a model -- Currently available models in psychiatry -- Introduction to enactivism -- Body and mind - and world -- The existential dimension and its role in psychiatry -- Enriched enactivism : existential sense-making, values, and socio-cultural worlds -- Enactive psychiatry : psychiatric disorders are disorders of sense-making -- An enactive approach to causes, diagnosis and treatment of psychiatric disorders.

Gilbert et al. argue that the concerns about the influence of Deep Brain Stimulation on – as they lump together – personality, identity, agency, autonomy, authenticity and the self are due to an ethics hype. They argue that there is only a small empirical base for an extended ethics debate. We will critically examine their claims and argue that Gilbert and colleagues do not show that the identity debate in DBS is a bubble, they in fact give very little evidence (...) for that. Rather they show the challenges of doing research in a field that is stretched out over multiple disciplines. In that sense their paper is an important starting point for a discussion on methodology and offers valuable lessons for a future research agenda. (shrink)

In this chapter we give an overview of current and historical conceptions of the nature of obsessions and compulsions. We discuss some open questions pertaining to the primacy of the affective, volitional or affective nature of obsessive-compulsive disorder (OCD). Furthermore, we add some phenomenological suggestions of our own. In particular, we point to the patients’ need for absolute certainty and the lack of trust underlying this need. Building on insights from Wittgenstein, we argue that the kind of certainty the patients (...) strive for is unattainable in principle via the acquisition of factual knowledge. Moreover, we suggest that the patients’ attempts to attain certainty are counter-productive as their excessive conscious control in fact undermines the trust they need. (shrink)

In their target article, Moore and colleagues offer a valuable overview of the various ambivalence-related phenomena that may impede swift clinical decision-making. They argue that patients...

We propose to understand social affordances in the broader context of responsiveness to a field of relevant affordances in general. This perspective clarifies our everyday ability to unreflectively switch between social and other affordances. Moreover, based on our experience with Deep Brain Stimulation for treating obsessive-compulsive disorder (OCD) patients, we suggest that psychiatric disorders may affect skilled intentionality, including responsiveness to social affordances.

According to the traditional Western concept of freedom, the ability to exercise free will depends on the availability of options and the possibility to consciously decide which one to choose. Since neuroscientific research increasingly shows the limits of what we in fact consciously control, it seems that our belief in free will and hence in personal autonomy is in trouble. -/- A closer look at the phenomenology of Obsessive-Compulsive Disorder (OCD) gives us reason to doubt the traditional concept of freedom (...) in terms of conscious control. Patients suffering from OCD experience themselves as unfree. The question is whether their lack of freedom is due to a lack of will power. Do they have too little conscious control over their thoughts and actions? Or could it be the opposite: are they exerting too much conscious control over their thoughts and actions? -/- In this chapter, we will argue that OCD patients testify to the general condition that exercising an increased conscious control over actions can in fact diminish the sense of agency rather than increase the experience of freedom. The experiences of these patients show that the traditional conception of freedom in terms of ‘free will’ has major shortcomings. There is an alternative, however, to be found in the work of Hannah Arendt. She advocates a conception of freedom as freedom in action. Combined with phenomenological insights on action, Arendt’s account of freedom helps us to get a more adequate understanding of the role of deliberation in the experience of freedom. We argue that the experience of freedom depends on the right balance between deliberate control and unreflective actions. (shrink)

This article is based on an online ethnographic study of Dutch women who use YouTube as a medium to document their contested illness experiences. During 13 months of observations between 2017 and 2019, we followed a sample of 16 YouTubers, and conducted an in-depth analysis of 30 YouTube videos and of 7 interviews. By adopting a ‘praxiographic’ approach to social media, and by utilising insights from phenomenological theory, this study teases out how bodies are ‘done’ in (the making of) these (...) YouTube videos. We describe three types of bodies: (1) inert bodies, (2) experienced bodies, and (3) authentic bodies. Ultimately, this study shows how vlogging about contested illness is a practice in which bodies are continually (re)configured, and through which the ‘invisibility’ of a sufferer’s condition can obtain social visibility. (shrink)

People suffering from Obsessive-Compulsive Disorder (OCD) do things they do not want to do, and/or they think things they do not want to think. In about 10 percent of OCD patients, none of the available treatment options is effective. A small group of these patients is currently being treated with deep brain stimulation (DBS). Deep brain stimulation involves the implantation of electrodes in the brain. These electrodes give a continuous electrical pulse to the brain area in which they are implanted. (...) It turns out that patients may experience profound changes as a result of DBS treatment. It is not just the symptoms that change; patients rather seem to experience a different way of being in the world. These global effects are insufficiently captured by traditional psychiatric scales, which mainly consist of behavioural measures of the severity of the symptoms. In this article we aim to capture the changes in the patients’ phenomenology and make sense of the broad range of changes they report. For that we introduce an enactive, affordance-based model that fleshes out the dynamic interactions between person and world in four aspects. The first aspect is the patients’ experience of the world. We propose to specify the patients’ world in terms of a field of affordances, with the three dimensions of broadness of scope (‘width’ of the field), temporal horizon (‘depth’), and relevance of the perceived affordances (‘height’). The second aspect is the person-side of the interaction, that is, the patients’ self-experience, notably their moods and feelings. Thirdly, we point to the different characteristics of the way in which patients relate to the world. And lastly, the existential stance refers to the stance that patients take towards the changes they experience: the second-order evaluative relation to their interactions and themselves. With our model we intend to specify the notion of being in the world in order to do justice to the phenomenological effects of DBS treatment. (shrink)

Deep Brain Stimulation (DBS) is a relatively new, experimental treatment for patients suffering from treatment-refractory Obsessive Compulsive Disorder (OCD). The effects of treatment are typically assessed with psychopathological scales that measure the amount of symptoms. However, clinical experience indicates that the effects of DBS are not limited to symptoms only: patients for instance report changes in perception, feeling stronger and more confident, and doing things unreflectively. Our aim is to get a better overview of the whole variety of changes that (...) OCD patients experience during DBS treatment. For that purpose we conducted in-depth, semi-structured interviews with 18 OCD patients. In this paper, we present the results from this qualitative study.We list the changes grouped in four domains: with regard to (a) person, (b) (social) world, (c)characteristics of person-world interactions, and (d) existential stance. We subsequently provide an interpretation of these results. In particular, we suggest that many of these changes can be seen as different expressions of the same process; namely that the experience of anxiety and tension gives way to an increased basic trust and increased reliance on one’s abilities. We then discuss the clinical implications of our findings, especially with regard to properly informing patients of what they can expect from treatment, the usefulness of including CBT in treatment, and the limitations of current measures of treatment success. We end by making several concrete suggestions for further research. (shrink)

Psychiatry is enormously complex. One of its main difficulties is how to connect the wide diversity of factors that may cause or contribute to the problems at hand, factors ranging from traumatic experiences, dysfunctional neurotransmitters, existential worries, economic deprivation, and social exclusion, to genetic bad luck. Interventions are also diverse, with options including chemical or electrical treatment, therapies aimed at behavior change and those promoting insight. Much is still unknown: what are the causal pathways, which interventions work best for which (...) patients and why?In practice, many mental health care professionals work holistically in a pragmatic and eclectic way. Without using any explicit... (shrink)

Does DBS change a patient’s personality? This is one of the central questions in the debate on the ethics of treatment with Deep Brain Stimulation (DBS). At the moment, however, this important debate is hampered by the fact that there is relatively little data available concerning what patients actually experience following DBS treatment. There are a few qualitative studies with patients with Parkinson’s disease and Primary Dystonia and some case reports, but there has been no qualitative study yet with patients (...) suffering from psychiatric disorders. In this paper, we present the experiences of 18 patients with Obsessive-Compulsive Disorder (OCD) who are undergoing treatment with DBS. We will also discuss the inherent difficulties of how to define and assess changes in personality, in particular for patients with psychiatric disorders. We end with a discussion of the data and how these shed new light on the conceptual debate about how to define personality. (shrink)

Auditory verbal hallucinations (AVHs) are a highly complex and rich phenomena, and this has a number of important clinical, theoretical and methodological implications. However, until recently, this fact has not always been incorporated into the experimental designs and theoretical paradigms used by researchers within the cognitive sciences. In this paper, we will briefly outline two recent examples of phenomenologically informed approaches to the study of AVHs taken from a cognitive science perspective. In the first example, based on Larøi and Woodward (...) (Harv Rev Psychiatry 15:109–117, 2007), it is argued that reality monitoring studies examining the cognitive underpinnings of hallucinations have not reflected the phenomenological complexity of AVHs in their experimental designs and theoretical framework. The second example, based on Jones (Schizophr Bull, in press, 2010), involves a critical examination of the phenomenology of AVHs in the context of two other prominent cognitive models: inner speech and intrusions from memory. It will be shown that, for both examples, the integration of a phenomenological analysis provides important improvements both on a methodological, theoretical and clinical level. This will be followed by insights and critiques from philosophy and clinical psychiatry—both of which offer a phenomenological alternative to the empiricist–rationalist conceptualisation of AVHs inherent to the cognitive sciences approach. Finally, the paper will conclude with ideas as to how the cognitive sciences may integrate these latter perspectives into their methodological and theoretical programmes. (shrink)

Psychiatric disorders involve changes in how you feel, think, perceive, and/or act—and the same goes for psychotropic medication. How then do you know whether certain thoughts or feelings are genuine expressions of yourself, or whether they are colored by your psychiatric illness, or by the medication you take? Or, as Karp nicely sums up the problem: “if I experience X, is it because of the illness, the medication, or is it “just me’?” Such “self-illness ambiguity” seems to be quite an (...) ubiquitous problem in psychiatry. It is a very unsettling problem, moreover, and not easy to resolve.In their... (shrink)

The notion of embodiment is central to the phenomenological approach to schizophrenia. This paper argues that fundamental concepts for the understanding of schizophrenia have a bodily dimension. We present two single cases of first-onset schizophrenic patients and analyze the reports of their experiences. Problems such as loss of self, loss of common sense, and intentionality disorders reveal a disconnectedness that can be traced back to a detachment from the lived body. Hyperreflectivity and hyperautomaticity are used as coping mechanisms, but reflect (...) the same problem of the split between body and mind. It is argued that the sole focus on cognitive impairments leads to a distorted image of schizophrenia, and that the acknowledgment of its fundamental bodily roots enables one to see the coherence between the diverse symptoms. As for the practical implications of the phenomenological approach, further research is needed to investigate if and how body- and movement-oriented therapies might strengthen the embodiment of schizophrenic patients. (shrink)

We challenge Gallagher’s distinction between the sense of ownership and the sense of agency as two separable modalities of experience of the minimal self and argue that a careful investigation of the examples provided to promote this distinction in fact reveals that SO and SA are intimately related and modulate each other. We propose a way to differentiate between the various notions of SO and SA that are currently used interchangeably in the debate, and suggest a more gradual reading of (...) the two that allows for various blends of SO and SA. Such an approach not only provides us with a richer phenomenology but also with a more parsimonious view of the minimal self. (shrink)

The relevance and potential value of insights from enactivism for the field of psychiatry have been recognized for some time now. Recently, two overarching frameworks have been proposed, one by Nielsen, and one by me.1 As mentioned by Nielsen, we developed our approaches largely in parallel: I was not aware of Nielsen’s work, and he only became aware of my work in the last phase of his PhD. Nielsen compares our approaches and concludes that our frameworks are ‘largely compatible, do (...) different work to one another, and are best understood as complimentary’. I think, however, that the differences between our... (shrink)

ABSTRACT‘If I experience X, is it because of the illness, the medication, or is it ‘just me’?’ (Karp 2009) [Is it me or my Meds? Living with Antidepressants. Harvard University Press]. This issue is known as self-illness ambiguity (SIA) (Sadler 2007) ["The Psychiatric Significance of the Personal Self." Psychiatry: Interpersonal and Biological Processes 70 (2): 113–129]. In her paper Know Thyself: Bipolar Disorder and Self-concept, Carls-Diamante (2022) [“Know Thyself: Bipolar Disorder and Self-Concept.” Philosophical Explorations, 1–17] offers a taxonomy of different (...) ways in which Bipolar Disorder can be related to one’s self and self-concept. In contrast to the essentialist model of mental disorders she seems to adopt, I propose a different outlook on SIA, following an enactive approach to psychiatric disorders as disorders of sense-making. One’s way of making sense of the world and/or oneself can become stuck in a rigid pattern that is stronger than oneself and at odds with how one would want to be. I argue that it is helpful to distinguish between the experiential SIA of specific experiences (Am I over/underreacting?) and the long term concerns of existential SIA (How to live my life in accordance with what matters to me despite/while having certain vulnerabilities?). I conclude that knowing oneself is not an intra-individual matter, nor primarily a matter of reflection: it is rather a relational and material practice of trying to live your life in accordance with what matters to you. (shrink)

We whole-heartedly agree with Mecacci and Haselager(2014) on the need to investigate the psychosocial effects of deep brain stimulation (DBS), and particularly to find out how to prevent adverse psychosocial effects. We also agree with the authors on the value of an embodied, embedded, enactive approach (EEC) to the self and the mind–brain problem. However, we do not think this value primarily lies in dissolving a so-called “maladaptation” of patients to their DBS device. In this comment, we challenge three central (...) claims of the authors on the basis of our direct experience with psychosocial effects of DBS in 45 obsessive- compulsive disorder (OCD) patients treated at the AMC in Amsterdam, The Netherlands, and our indepth qualitative interviews with 18 of them (de Haan et al. 2013). We end our comment by sketching out our perspective on the practical merits of an EEC approach to DBS. (shrink)

García’s and Oblak’s reviews of my book Enactive Psychiatry open up some fundamental debates with regard to my use of the term “enactive” for the kind of approach that I develop. Is my account still properly “enactive” (García) and how does my approach compare to the extended mind theory on the one hand and to constructivism on the other hand (Oblak? In this response, I argue that (a) adding an existential dimension to enactivism is necessary to do justice to our (...) way of being in the world and our specific sense-making and its problems; and (b) that this dimension can be incorporated within enactivism without giving up on either enactivism’s commitment to naturalism or the enactive life-mind continuity thesis. My “existentialized” enactivism is very much enactive in that it adopts the thoroughly relational perspective that forms the core of enactivism. This relational perspective is also what distinguishes enactive theory from both extended mind theory and constructivism. Erratum: In §1, the name of the first commentator is misspelled: Her name is “Enara García” rather than “Elena García.”. (shrink)

How we think about the mind affects how we think about mental disorders: about what they are, how they develop and how we should best treat them. How we think about the mind and its relation to both body and world will typically be implicit though. One commonly assumed 'mind-world topology' regards the mind as internal and the world as external, and gives the mind the task of properly representing the outer world. This leads to a division of labor in (...) which perception provides input from world to mind, cognition processes this input and generates output from mind to world in the form of actions. From such a perspective, psychiatric... (shrink)

Auditory verbal hallucinations (AVHs) are a highly complex and rich phenomena, and this has a number of important clinical, theoretical and methodological implications. However, until recently, this fact has not always been incorporated into the experimental designs and theoretical paradigms used by researchers within the cognitive sciences. In this paper, we will briefly outline two recent examples of phenomenologically informed approaches to the study of AVHs taken from a cognitive science perspective. In the first example, based on Larøi and Woodward (...) (Harv Rev Psychiatry 15:109–117, 2007 ), it is argued that reality monitoring studies examining the cognitive underpinnings of hallucinations have not reflected the phenomenological complexity of AVHs in their experimental designs and theoretical framework. The second example, based on Jones (Schizophr Bull, in press, 2010 ), involves a critical examination of the phenomenology of AVHs in the context of two other prominent cognitive models: inner speech and intrusions from memory. It will be shown that, for both examples, the integration of a phenomenological analysis provides important improvements both on a methodological, theoretical and clinical level. This will be followed by insights and critiques from philosophy and clinical psychiatry—both of which offer a phenomenological alternative to the empiricist–rationalist conceptualisation of AVHs inherent to the cognitive sciences approach. Finally, the paper will conclude with ideas as to how the cognitive sciences may integrate these latter perspectives into their methodological and theoretical programmes. (shrink)

Although the enactive approach has been very successful in explaining many basic social interactions in terms of embodied practices, there is still much work to be done when it comes to higher forms of social cognition. In this article, we discuss and evaluate two recent proposals by Shaun Gallagher and Daniel Hutto that try to bridge this ‘cognitive gap’ by appealing to the notion of narrative practice. Although we are enthusiastic about these proposals, we argue that (i) it is difficult (...) to see them as continuous with the enactivist notion of direct coupling, and (ii) the failure to account for folk psychological action interpretation suggests that the enactive approach should adopt a broader notion of coupling. (shrink)

We thank Sanneke de Haan for her thoughtful response. We agree with what she says and consider it as a further specification of our intentions. We particularly endorse the two main points she raises, that is, that dealing with self-illness ambiguity requires a relational perspective; and that relying on reflection solely is problematic since it plays an only modest role in the resolution of self-illness ambiguity. We discuss both points in reverse order.With respect to the role of reflection, we (...) have, as a matter of fact, been very explicit: “we should not overemphasize the importance of reflection”; and “self-ambiguity is more likely to be a diachronic process”, with a “back and forth between narrative... (shrink)

Chronic pain is one of the most disabling conditions globally, yet we are still missing a satisfying theoretical framework to guide research and clinical practice. This is highly relevant as research and practice are not taking place in a vacuum but are always shaped by a particular philosophy of pain, that is, a set of implicitly or explicitly prevailing assumptions about what chronic pain is and how it is to be addressed. In looking at recent history, we identify a promising (...) trend from neuro-centrism to the application of the biopsychosocial model. Unfortunately, due to its limited theoretical foundation, the biopsychosocial model is too often implemented in a reductionist, fragmented, and linear manner. In particular, it remains too vague concerning the relationship between involved biological, psychological, and social processes. Sanneke de Haan prominently labeled this the integration problem. In this paper, we introduce five different facets of the integration problem that every philosophy of pain needs to address: (i) ontological, (ii) conceptual, (iii) explanatory, (iv) methodologicalMethodological, and (v) therapeutic. We develop an enactive theory of chronic pain and outline how far it provides solutions to these different integration challenges. (shrink)