The biopsychosocial model, originally proposed by Engel, was more concerned with psychosocial influences on illness experience—such as how patients interpret symptoms, adopt sick roles, seek care, and interact with doctors—than with the ontological nature of psychosocial causes. This article argues that Bolton and Gillett's reconceptualization focuses too narrowly on causal interactions between biological, psychological, and social factors. Comparing their account with an enactivist approach to mental disorder reveals that Bolton and Gillett incorporate elements of 4E cognition but combine them with an information-processing paradigm, whereas a fuller enactive account avoids reliance on information-processing altogether.
Psychiatry cannot rely solely on reductionism; it requires a plurality of approaches. Enactivism, rooted in cognitive science, dynamic systems theory, systems biology, and phenomenology, offers an integrative framework for psychiatry. This paper compares the enactive approach with two forms of explanatory pluralism: non-integrative pluralism, which tolerates coexisting incompatible systems, and integrative pluralism, which aims to unite different levels of understanding. The authors propose that enactivism is inherently a form of integrative pluralism but also part of a broader explanatory pluralism. Understanding these theoretical positions is important for quality clinical practice, and studying the entanglements between analytical pluralism and enactivist pluralism could be fruitful.