This post is by Pablo Andrés López Silva (University of Valparaíso) and Miguel Núñez de Prado-Gordillo (University of Granada). It draws on their paper “A Roadmap to 4E Mental Health,” published in Philosophy, Psychiatry, & Psychology, where they develop a 4E (embodied, embedded, enactive, and extended) framework for understanding mental health and psychopathology.
Miguel Núñez de Prado-Gordillo (University of Granada) Pablo Andrés López Silva (University of Valparaíso)
As a teenager, I (Miguel) spent a significant amount of my weekend nights compulsively collecting all the trash left in the parks where I used to get trashed with my friends. Back home, I
would then spend some more time aligning all the stuff in my massively misaligned desk in
straight angles. And I did so out of fear that a nasty, omnipotent Karmic force—whose existence
I deemed almost certainly impossible—could hurt my then-partner in retaliation for my past
misbehavior. Fortunately, I eventually escaped the grip of my Karmic obsessions by forcing
myself to do the exact opposite of what they commanded: throwing trash at the park and
untidying my already untidy room—a rather dangerous, not-to-try-at-home (and definitely not-
ecofriendly) self-application of Exposure and Response Prevention, a behavioral treatment that
intervenes directly on the person-environment relation.
Other than a tasteless bit of unrequested autobiography, this case contains many of the elements
that 4E Cognition approaches to Mental Health (henceforth 4E Mental Health) have increasingly
pointed out as crucial for our understanding of mental health and disorder. In a recent article in
Philosophy, Psychiatry, and Psychology, we delineate the main differences and similarities
among the various, not-always-loving members of the 4E Mental Health family.
All share a
negative thesis: the rejection of traditional cognitivist accounts of mental health, which conceive it in
terms of inner, brain-based computational (dys)functions. As an alternative, 4E Mental Health
advances the positive thesis that mental health should be understood as embodied and situated,
i.e., as radically dependent on the agent’s body and environment. Miguel’s obsessions and
compulsions would be unintelligible without reference to his embodied experience of sheer terror
and loss of self-control, or his interactions with environmental elements such as the trash in the
park or his irregularly arranged desk.
Family issues begin with how exactly to develop this positive thesis. In our paper, we roughly
distinguish two main trends: strongly situated views, based on classical and social versions of the
extended mind hypothesis, and strongly embodied views, namely involving autonomous enactive
proposals. We assess their differential consequences for two main conceptual issues: the location
problem—concerning whether mental disorders should be predicated of individuals, their
environments, or their relation—and the boundary problem—concerning the limits between
pathological and non-pathological deviance from social norms. Both carry crucial practical
implications, ranging from intervention priorities to sociopolitical questions about who counts as
mentally ill.
Extended views argue that mental health is extended: features of an agent’s environment can play
a constitutive role in (e.g., be “part and parcel of”) mental disorders/symptoms. This puts
pressure on individualist definitions of mental disorders in terms of internal dysfunctions (e.g.,
the DSM). If some conditions do not stem from internal dysfunctions, we face two options:
either reconsider their status as disorders or reject individualism in favor of a extended notion of
disorder, predicable of groups or collective dynamics rather than individuals. Perhaps what was
wrong in Miguel’s case was not something (entirely) internal to him, but rather a broader system
of social relations and mental institutions that had made ideas of divine punitive forces and
salvation rituals—along with the thought that even the most implausible possibilities warrant
careful consideration—salient for him in the first place.
By contrast, (some) enactivists see extendedness, at least in its traditional functionalist
formulation, as incompatible with a properly embodied approach: mental health cannot be
reduced to patterns of computational, representationally mediated interaction between a system
and their environment that could equally apply to biological or artificial agents. (LLMs may
induce psychosis, but their own “hallucinations” cannot be, properly speaking, mental health
issues.) Conversely, enactivists understand mental disorders in relational terms, as “sticky”,
“loopy”, self-defeating patterns of sense-making, i.e., the way living agents perceive and interact with
their environment in essentially evaluative terms, as offering them life-relevant opportunities for
action.
Psychopathology (vs. mere social deviance) is thus characterized by patterns of interaction
that systematically run counter to the agent’s own valued courses of thought and action (vs.
externally imposed ones). You may believe implausibly vengeful Karmic forces cannot exist or
desire to spend your weekends happily trashing yourself, and yet still find yourself collecting
everyone else’s trash to escape divine punishment. On this view, as Sanneke de Haan (2020) puts
it, mental disorders “dissolve if one succeeds in changing one’s way of interacting with the world”
(p. 201)—just like Miguel eventually managed to dissolve his sticky Karmic loony loops.
In sum, both 4E Mental Health trends propose crucial conceptual innovations with significant
potential for mental health research, intervention, and policymaking. Part 2 of this post addresses
these questions through the lens of the Neurodiversity movement and its demand for more
inclusive, neurodiversity-affirming theories of mind.