Agency, Embodiment and Enactment in Psychosomatic Theory and Practice

Article Summary by Laurence Kirmayer and Ana Gómez-Carrillo

I know so little about the activity of the pineal gland

Really, what do I have in common

with my body.

— Anna Swir (1996, p. 62)

This quote from a poem by Anna Swir speaks to the problem of agency in illness experience: What can we know? What do we cause? What is under our control? And what are we held responsible for? These questions, which center on the problem of agency, are everyday concerns in medicine, especially in relation to those conditions viewed as “psychosomatic”. Efforts to articulate an integrative biopsychosocial approach aim to move beyond the dualism implicit in a term like “psychosomatic”—yet dualism persists in everyday practice. Moral attitudes toward patients are often based on dualistic ascriptions of causality, responsibility and blame with serious consequences. In this paper, we explore the ways that causality is assigned in psychosomatic conditions using the example of Resignation Syndrome among refugee children in Sweden. We build on ideas from embodied and enactive cognitive science to argue for a more nuanced view of agency as an interactional process shaped by social and cultural contexts. Given the ecosocial embedding of agency and its moral economy, we suggest that even if more integrative theories of illness are advanced, patients and clinicians will continue to struggle with the social and moral meanings of affliction. These moral conundrums call for a more socially and politically informed framework for the practice of psychiatry and psychosomatic medicine.

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