From Engel to Enactivism

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.

Study at a glance

Abstract

In this article we offer a two-part commentary on Bolton and Gillett’s reconceptualization of Engel’s biopsychosocial model. In the first section we present a conceptual and historical assessment of the biopsychosocial model that differs from the analysis by Bolton and Gillett. Specifically, we point out that Engel in his vision of the biopsychosocial model was less concerned with the ontological possibility and nature of psychosocial causes, and more concerned with psychosocial influences in the form of illness interpretation and presentation, sick role, seeking or rejection of care, the doctor-patient therapeutic relationship, and role of personality factors and family relationships in recovery from illness, etc. On the basis of this assessment, we then question Bolton and Gillett’s restricted focus on accounting for biopsychosocial causal interactions. The second section compares Bolton and Gillett’s account with a recent enactivist account of mental disorder that tackles similar conceptual problems of causal interactions. Bolton and Gillett’s utilize elements of the 4E cognition, but they combine these proto-ideas with an information-processing paradigm. Given their explicit endorsement of 4E approaches to mind and cognition, we illustrate some key ways in which a more fleshed out enactive account, particularly one that doesn’t rely on notions of information-processing, differs from the account proposed by Bolton and Gillett.