What kind of science for dual diagnosis? A pragmatic examination of the enactive approach to psychiatry.
Jonathan Led Larsen, Katrine Schepelern Johansen, Mimi Yung Mehlsen
Frontiers in psychology January 1, 2022 Peer reviewed DOI: 10.3389/fpsyg.2022.825701 via PubMed
Summary
An integrative framework for communicating about dual diagnosis across disciplines is lacking. Enactive Psychiatry may bridge this theoretical gap. A historical perspective describes how the gap developed. Applying Enactive Psychiatry to longitudinal data on cannabis use in psychosis disorders suggests it may help achieve a pragmatic grip on the field. The enactive approach is one of several new theories drawing on systems thinking and ecological psychiatry. Its potential for a wider progressive problemshift is less strong unless complexity similar to dual diagnosis is demonstrated in other clinical fields.
Study at a glance
| Design | theoretical or philosophical paper |
|---|---|
| Key finding | Enactive Psychiatry may provide a pragmatic framework for integrating disciplines in dual diagnosis, but its broader potential depends on demonstrating similar complexity in other clinical fields. |
Abstract
The recommended treatment for dual diagnosis - the co-occurrence of substance use and another mental disorder - requires seamless integration of the involved disciplines and services. However, no integrative framework exists for communicating about dual diagnosis cases across disciplinary or sectoral boundaries. We examine if Enactive Psychiatry may bridge this theoretical gap. We evaluate the enactive approach through a two-step pragmatic lens: Firstly, by taking a historical perspective to describe more accurately how the theoretical gap within the field of dual diagnosis initially developed. Secondly, by applying the Enactive Psychiatry approach to data from a longitudinal study on the trajectory of cannabis use in psychosis disorders. By applying the theory rather than simply presenting it, we position ourselves better to evaluate whether it may assist the purpose of achieving a more expedient pragmatic "grip" on the field of dual diagnosis. In our discussion, we suggest that this may very well be the case. Finally, we consider the enactive approach as one of a small handful of new theories of mental disorders that draw on systems thinking and ecological psychology, and discuss whether they have the potential for a wider progressive problemshift within psychiatry. The case in favor of such potential, we argue, is less strong unless the role of complexity, similar to that seen within the dual diagnosis field, may be demonstrated for other fields of clinical practice.