A critical comment on Thomas Fuchs’s Psychiatry as a Relational Medicine

Thomas Fuchs's book argues for an ecological-integrative paradigm in psychiatry, presenting it as a medicine of relation. Drawing on philosophy of mind, biology, psychology, and psychiatry, it integrates systemic theory, autopoiesis, enactivism, synergetics, and phenomenology. The analysis defends that psychiatric disorders are disorders of embedded subjectivity, arising from disruptions in self-understanding and interaction, explained through vertical and horizontal circular causality. This framework unifies the 5e cognition paradigm with systemic and phenomenological models, offering a coherent approach to understanding mental illness as relational rather than purely biological.

Study at a glance

Abstract

The book Psychiatrie als Beziehungsmedizin – Ein ökologisches Paradigma (Fuchs, 2023) is an essential work in the field of phenomenological psychiatry. Thomas Fuchs manages, in a clear and pedagogical way, to offer the reader an argumentative path that weaves together different domains (philosophy of mind, biology, psychology and psychiatry) and multiple theories (systemic theory, autopoiesis, enactivism, synergetics and phenomenology), showing their coherence in an ecological-integrative paradigm. We propose a critical analysis of the main arguments presented in the book and based on an integrative ecological model, to defend that psychiatry is a medicine of relation. We emphasize the possibility of integrating the 5e paradigm and the systemic and phenomenological model with the theory of causal circularity, vertical and horizontal, which allows us to understand the disorders of embedded subjectivity as disorders of self-understanding and interaction of the person.