Giulio Ongaro

The extended mind thesis states that the mind is not brain-bound but extends into the physical world. The philosophical debate around the thesis has mostly focused on extension towards epistemic artefacts, treating the phenomenon as a special capacity of the human organism to recruit external physical resources to solve individual tasks. This paper argues that if the mind extends to artefacts in the pursuit of individual tasks, it extends to other humans in the pursuit of collective tasks. Mind extension to other humans corresponds essentially to the ‘we-mode’ of cognition, the unique power of human minds to be jointly directed at goals, intentions, states of affairs, or values (which, importantly, differs from having a ‘group mind’). Because the capacity for collective intentionality holds evolutionary and developmental primacy over human-epistemic artefacts relations, the extended mind should not be seen as a special phenomenon, but as a central aspect of the human condition. The original extended mind thesis carried important implications for how the cognitive sciences should proceed. In a version of the thesis that accommodates collective intentionality, these implications would go far deeper than originally assumed.

Any progress in shaping up an externalist psychiatry, so previous discussion suggested, must begin from questions about the ontology of social causation. So far, research and theory have adhered to a naturalistic approach to the social causes of illness, concentrating mostly on the ‘social determinants of mental health’ (inequality, discrimination, housing insecurity, etc.). The paper starts with an assessment of ‘social determinants’ through the lens of epidemiology and critical psychiatry. It illustrates existing practical and political approaches that fight these constraints and it highlights their therapeutic value. It argues, though, that a focus on social determinants is not sufficient for fully realizing externalism because a great portion of sociogenic illness remains causally indeterminate. Alongside political action, externalism requires a social etiology that is established by virtue of the meaning that it holds for patients, rather than by virtue of its capacity to identify objective social causes of illness. This entails abandoning naturalism about social causation and embracing constructivism. The paper shows that this methodological shift is less contradictory and more effective than it is commonly imagined. Drawing from further anthropological evidence, it concludes that only by lending support to projects that balance a focus on constraints with social construction will psychiatry be truly externalist. At stake is a prospect of effective treatment for sociogenic illness for the countless in struggle.

The biopsychosocial (BPS) model in psychiatry has come under fire for being too vague to be of any practical use in the clinic. For many, its central flaw consists in lack of scientific validity and philosophical coherence: the model never specified how biological, psychological and social factors causally integrate with one another. Recently, advances in the cognitive sciences have made great strides towards meeting this very ‘integration challenge.’ The paper begins by illustrating how enactivist and predictive processing frameworks propose converging accounts of biopsychosocial integration that are far superior to those of previous theories. It argues, however, that the main problem of implementing the BPS model has less to do with integration than with the lack of a social etiology. Psychiatric practice leans heavily towards ‘bio’ and ‘psycho’ approaches, without an equally developed set of explanatory and therapeutic resources for dealing with the ‘social’ dimension of illness. This leaves psychiatry essentially internalist in orientation. As illustrated most poignantly by conditions such as functional neurological disorders, internalism comes with the risks of stigma and the curtailment of therapeutic possibilities. The paper argues that the answer to the failings of the BPS model lies in combining the integration challenge with the development of an ‘externalist psychiatry,’ which casts both causes and treatment of psychiatric illness onto the social environment. The following two papers explore the conditions that might make this idea a reality.

Philosophical speculation about how psychiatric externalism might function in practice has yet to fully consider the multitude of externalist psychiatric systems that exist beyond the bounds of modern psychiatry. Believing that anthropology can inform philosophical debate on the matter, the paper illustrates one such case. The discussion is based on 19 months of first-hand ethnographic fieldwork among Akha, a group of swidden farmers living in highland Laos and neighboring borderlands. First, the paper describes the Akha set of medicinal, ritual, and shamanic practices, analyzing issues of stigma and medical pluralism within it. Second, it makes the case that the Akha realize a functioning biopsychosocial system which comes with a well-developed set of resources for treating the social dimension of illness. Externalism among the Akha re-frames psychiatric illness as a ‘problem in living,’ which becomes manageable as such. The paper claims that, in so doing, the Akha system succeeds in many of the areas where modern internalist psychiatry falls short, and that it does so because Akha society is structured in such a way so that its practitioners can shift the social environment around the patient. As a takeaway for philosophers, it suggests that the development of an externalist psychiatry must begin from questioning the accepted ontology of the social causes of psychiatric illness.

The extended mind thesis states that the mind is not brain-bound but extends into the physical world. The philosophical debate around the thesis has mostly focused on extension towards epistemic artefacts, treating the phenomenon as a special capacity of the human organism to recruit external physical resources to solve individual tasks. This paper argues that if the mind extends to artefacts in the pursuit of individual tasks, it extends to other humans in the pursuit of collective tasks. Mind extension to other humans corresponds essentially to the ‘we-mode’ of cognition, the unique power of human minds to be jointly directed at goals, intentions, states of affairs, or values (which, importantly, differs from having a ‘group mind’). Because the capacity for collective intentionality holds evolutionary and developmental primacy over human-epistemic artefacts relations, the extended mind should not be seen as a special phenomenon, but as a central aspect of the human condition. The original extended mind thesis carried important implications for how the cognitive sciences should proceed. In a version of the thesis that accommodates collective intentionality, these implications would go far deeper than originally assumed.

Placebos are commonly defined as ineffective treatments. They are treatments that lack a known mechanism linking their properties to the properties of the condition on which treatment aims to intervene. Given this, the fact that placebos can have substantial therapeutic effects looks puzzling. The puzzle, we argue, arises from the relationship placebos present between culturally meaningful entities, our intentional relationship to the environment and bodily effects. How can a mere attitude toward a treatment result in appropriate bodily changes? We argue that an ‘enactive’ conception of cognition accommodates and renders intelligible the phenomenon of placebo effects. Enactivism depicts an organism’s adaptive bodily processes, its intentional directedness, and the meaningful properties of its environment as co-emergent aspects of a single dynamic system. In doing so it provides an account of the interrelations between mind, body and world that demystifies placebo effects.