From analytic to synthetic-organizational pluralisms: A pluralistic enactive psychiatry.

Introduction: Reliance on sole reductionism, whether explanatory, methodological or ontological, is difficult to support in clinical psychiatry. Rather, psychiatry is challenged by a plurality of approaches. There exist multiple legitimate ways of understanding human functionality and disorder, i.e., different systems of representation, different tools, different methodologies and objectives. Pluralistic frameworks have been presented through which the multiplicity of approaches in psychiatry can be understood. In parallel of these frameworks, an enactive approach for psychiatry has been proposed. In this paper, we consider the relationships between the different kinds of pluralistic frameworks and this enactive approach for psychiatry. Methods: We compare the enactive approach in psychiatry with wider analytical forms of pluralism. Results: On one side, the enactive framework anchored both in cognitive sciences, theory of dynamic systems, systems biology, and phenomenology, has recently been proposed as an answer to the challenge of an integrative psychiatry. On the other side, two forms of explanatory pluralisms can be described: a non-integrative pluralism and an integrative pluralism. The first is tolerant, it examines the coexistence of different potentially incompatible or untranslatable systems in the scientific or clinical landscape. The second is integrative and proposes to bring together the different levels of understanding and systems of representations. We propose that enactivism is inherently a form of integrative pluralism, but it is at the same time a component of the general framework of explanatory pluralism, composed of a set of so-called analytical approaches. Conclusions: A significant number of mental health professionals are already accepting the variety of clinical and scientific approaches. In this way, a rigorous understanding of the theoretical positioning of psychiatric actors seems necessary to promote quality clinical practice. The study of entanglements between an analytical pluralism and a synthetic-organizational enactivist pluralism could prove fruitful.