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

Fabio Caprio Leite de Castro

Psicopatologia Fenomenológica Contemporânea September 13, 2025 DOI: 10.37067/rpfc.v14i1.1243 (opens in new tab)

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Characteristics Theoretical or philosophical paper Peer reviewed
Keywords Ecological paradigm Paradigm5e cognition Cognitionenactivism Circular causality
Key points Proposes that psychiatry can be understood as a medicine of relation by integrating the 5e paradigm, systemic theory, and phenomenological models with a theory of causal circularity.

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.

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