Enactive psychiatry

A pragmatic and pluralistic approach to mental health and disease

Abstract

Enactive psychiatry offers a pragmatic and pluralistic rethinking of mental health by challenging the reductionist assumptions of the biomedical model. Rather than viewing psychiatric disorders as mere biological dysfunctions, enactivism understands them as persistent, counterproductive patterns in an individual’s sense-making processes. By integrating multiple dimensions while emphasising both the role of the agent and of social context, enactivism offers an approach that is both structured and adaptable. Perspectives from de Haan, Maiese, and Nielsen illustrate how enactivist psychiatry fosters a holistic and patient- centred model of care. However, while enactivism offers a compelling framework, it also raises challenges regarding diagnostic clarity, clinical implementation, and the reconciliation of diverse evaluative perspectives. Particular attention is given to tensions between individual autonomy, relational dynamics, and social norms. This analysis assesses enactivism’s potential to bridge theory and practice in psychiatric care, while stressing the need for further refinement of its account of normativity.