“Mixed Bag” is a series where I ask an expert to select 5 items to explore a particular topic: a book, a concept, a person, an article, and a surprise item (at the expert’s discretion). For each item, they have to explain why they selected it and what it signifies. — Awais Aftab
Kristopher Nielsen, PhD is an early career researcher and clinical psychologist based in Aotearoa-New Zealand. His recent book ‘Embodied, Embedded, and Enactive Psychopathology: Reimagining Mental Disorder’ (Palgrave Macmillan Cham, 2023) presents ‘3e Psychopathology’: a novel conceptual framework that understands mental disorders as recurring and unhelpful patterns in the way we perceive and engage with the world, maintained by complex processes that span brain, body, and environment. While primarily a conceptual endeavor, this book also explores implications of the developed approach for how we should seek to explain mental disorders at both research and individual levels.
Nielsen: Thank you very much for inviting me to be a part of this series, Awais. I have very much enjoyed the Mixed Bag entries to Psychiatry at the Margins and feel honored to be contributing alongside your previous guests. As an early career researcher I am deeply appreciative of the support and interest you have lent my work.
Rather than focus on my own work too much, in this mixed bag I have attempted to capture a ‘conceptual palette’ that reflects some of the underlying themes and influences that I see as woven through 3e Psychopathology. My hope is that this may offer readers a sense of the conceptual flavor of my framework whether or not they wish to find out more, while also offering those that are already familiar with my work something novel. Let’s see how we go.
Book—‘Collaborative and Indigenous Mental Health Therapy: Tātaihono - Stories of Māori Healing & Psychiatry’
Nielsen: While I considered a few close contenders, such as Giovanna Colombetti’s ‘The Feeling Body’ and Sandra Mitchell’s ‘Unsimple Truths’, I knew I had to choose this local gem. This remarkable and accessible book explores the complexity and value of working collaboratively across contrasting cultural worldviews within a mental health context. The primary authors are Wirimu Niania (a traditional Māori healer) and Alistair Bush (a psychiatrist), with their writing supported by David Epston (a therapist/academic and co-developer of narrative therapy). Through a series of case discussions these authors reveal the challenges and insights offered by working alongside someone grounded within a very different cultural-epistemological frame. I have chosen this book as, on my reading, it touches on multiple important threads within my own work including pluralism, socio-cultural embedment, and diagnosis as a pragmatic, complex, situated, and contextual evaluation. I have also chosen this book to reflect my own socio-cultural embedment within Aotearoa-New Zealand. I highly recommend this book for any clinicians wanting to consider their own cultural-epistemological commitments.
Paper—‘Natural Sources of Normativity’ by Wayne Christensen (2012)
Nielsen: The act of diagnosis is evaluatively loaded in that we are saying that something is wrong with someone. In psychiatry and clinical psychology this seems particularly important to consider as we are evaluating someone’s thoughts, feelings, and behaviors, which seem somehow more personal or closer to home than many bodily diagnoses. On what basis then do we claim that something has gone wrong when we make a diagnosis? There are many potential answers to this question, but many of them rely on socio-cultural judgments of what is right or normal. Something seems unsettling about this, and it is the basis for many arguments against the legitimacy of psychiatric diagnosis. This philosophical paper by Wayne Christensen outlines an understanding of how normativity (i.e., prescriptive notions of good or bad/should or shouldn’t), can be understood as naturally occurring — emerging from the persistence and functionality of autonomous systems/organisms. There is a deep similarity between this ‘functional normativity’ and enactive understandings of the mind. I utilize these ideas within 3e Psychopathology as a way to navigate the demarcation problem in psychiatry (i.e., what distinguishes disorder from non-disorder) with a focus on ‘what works’ for the individual being diagnosed (i.e., disorder is present when someone is persistently working against their own continued functioning). There are obviously some complexities to consider, but this is the gist of my approach to this issue. Christensen’s paper articulates this idea of natural normativity very clearly and it is accessible to those without an understanding of enactivism.
This philosophical paper by Wayne Christensen outlines an understanding of how normativity (i.e., prescriptive notions of good or bad/should or shouldn’t), can be understood as naturally occurring — emerging from the persistence and functionality of autonomous systems/organisms. There is a deep similarity between this ‘functional normativity’ and enactive understandings of the mind.
Surprise item – Uilleann Pipes
Nielsen: For my surprise item I have chosen the uilleann pipes. These are a variety of bagpipe native to Ireland, with a much quieter and sweeter sound than the bagpipes most will be familiar with. They are often seen in Irish music sessions playing comfortably alongside other traditional Irish instruments such as flutes and fiddles. Battling with this instrument is my chosen hobby. I say ‘battling with them’ because they are a notoriously complex and challenging instrument. They typically feature four double-bladed reeds similar to those found in an oboe, and three single-bladed drone reeds. These seven reeds sit hidden within a variety of tubes all plugged into a bag tucked under the left arm. Stable pressure is maintained with the left elbow squeezing on this bag, while air supply comes from pumping a set of ‘bellows’ with the right elbow (uilleann means elbow in Irish). Playing thus resembles a lopsided chicken-dance sort of movement, although the player is stuck sitting down. The melody is played with both hands on a ‘chanter’ which can achieve two octaves depending on the pressure supplied, while the right wrist can be moved independently to play some basic chordal accompaniment on the ‘regulators’ which sit across the lap. These regulators sit just above the ‘drones’ which provide a constant warm hum/buzz over which the music is played. For examples, see this air played by Mark Redmond, and this reinterpretation of Handel by Padraig McGovern.
I have chosen this rather bizarre instrument as my surprise item as, for me, it connects to many of the themes of 3e Psychopathology. Being played with both elbows, both hands, and the right wrist, all completing relatively independent tasks and responsive to multiple sources of sensory feedback, there is a sense in which one must be in lockstep with the instrument, to a degree that the experience of playing is one of body and instrument forming a self-regulating system with minimal ‘thought’ occurring. For me, this experience aligns with ideas of embodiment and embedment. Further, such a ridiculous yet extraordinary instrument was clearly not invented by a single individual but rather gradually added to over generations of culturally situated development. For me this connects not just to ideas of socio-cultural embedment, but to ideas of gradualism in scientific and technological progress. Finally, despite all of this complexity, the music produced by this instrument is relatively simple and easy for a listener to understand. To paraphrase Oliver Wendell Holmes, this idea of simplicity on the far side of complexity resonates with the broader intention of 3e Psychopathology — to begin to sketch out the complex processes inherent within mental disorders in a parsimonious and plausible fashion without falling into undue reductionism.
Such a ridiculous yet extraordinary instrument was clearly not invented by a single individual but rather gradually added to over generations of culturally situated development. For me this connects not just to ideas of socio-cultural embedment, but to ideas of gradualism in scientific and technological progress.
Concept – Sticky Tendencies
Nielsen: Sticking to this idea of simplicity on the far side of complexity, and despite my efforts to not focus too much on my own work, the concept I have chosen for my mixed bag is the idea of mental disorders as ‘sticky tendencies.’ This concept plays an important role within 3e Psychopathology, and refers to the idea of understanding mental disorders as ‘attractor basins’ or instances of ‘emergent stability’ within a complex system. 3e Psychopathology understands mental disorders as repetitive patterns in sense-making, supported by complex causal structures dispersed across the brain-body-environment system, and engaged with despite a negative impact on functioning. When we see a roughly similar pattern emerging across people (e.g., melancholic depression), this suggests that there may be a tendency within the human brain-body-environment system to fall into and get stuck in such a pattern — i.e., a sticky tendency.
This viewpoint connects well to dynamic systems perspectives and the idea of mental disorders as mechanistic property clusters as expressed by Kendler, Zachar, and Craver (2011), as well as to Peter Zachar’s notion of diagnostic concepts as pragmatic and historically contingent references to fuzzy MPC structures in the world. I have explored the idea of sticky tendencies further in this public communication piece for Aeon. If we understand mental disorders as such constitutionally complex and potentially emergent phenomena (rather than things that have gone wrong inside our brains), then this changes how we should go about trying to study and explain them — a major focus in the later parts of my book.
… the idea of understanding mental disorders as ‘attractor basins’ or instances of ‘emergent stability’ within a complex system. 3e Psychopathology understands mental disorders as repetitive patterns in sense-making, supported by complex causal structures dispersed across the brain-body-environment system, and engaged with despite a negative impact on functioning.
Person—The Explanation of Psychopathology and Crime Lab at Victoria University of Wellington, NZ
Nielsen: I’m not the biggest fan of person-centered narratives of scientific progress. The contribution of individuals is clearly important, but I’m a firm believer that progress in science is gradual and best supported when we understand knowledge gathering and generation as a globally distributed and collaborative process. Even theoretically-based work such as mine is greatly facilitated when it is developed within a community of engaged individuals. The lonely process of completing this book in my own time over the past two years has made me very aware of this! To reflect this understanding I have not chosen a single person to put in my mixed bag, but instead the lab mates who played such an important role in the development of 3e Psychopathology. The EPC lab at Victoria University of Wellington is headed by Tony Ward and focuses on theoretical issues in forensic and clinical psychology. While I unfortunately do not have room to touch on every lab member’s research, those that had the biggest influence on my own work include: Samuel Clack, whose research focuses on individual symptom/phenomena based explanations of psychopathology with a particular focus on depression; Annalisa Strauss-Hughes, whose research focuses on how to better understand the role of culture in explanations of human behavior; and Daniel Wegerhoff, whose research is on one level about how we might better conceptualize gangs, but on another level is a deep dive into how we might apply different kinds of pluralism within our understandings of human behavior. I am deeply appreciative of the entire lab for providing such a supportive and intellectually stimulating environment.
See previous posts in the “Mixed Bag” series.
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Western medicine can benefit so much from a paradigm shift in how the causes of mental illness are viewed. This will have to be a book I add to my wishlist.