On the use and misuse of externalist approaches in psychiatry

Walter (2013) argues in that a bunch of externalist approaches examined in the theory of mind is interesting for psychiatry—especially for biological psychiatry. The externalist approaches state that mental states are not only constituted by internal but also by external factors. He subsumes them under the so-called 4E-thesis: embodied, embedded, extended, enacted. His example is concerned with ADHD such that ADHD is only existent “in an environment that favors attentional distraction and punishes hyperactivity.” First, using the 4E-thesis seems to be explanatorily attractive: There are factors of the disorder that can be grouped as external constituents and these constituents are not named by internalist vocabulary. For example, punishment is for sure not part of internalist vocabulary. But there is a figure of a principal argument against using the 4E-thesis in psychiatry. Consider this cookbook theory of the 4E-thesis: Cookbook theory for the 4E-thesis in accord with Henrik Walter’s multilevelapproach: