How philosophy can help medical science

What you do determines what you perceive. If I close my eyes, my world goes dark. If I move from a darkened room to a room filled with light, what I see changes, sometimes dramatically. However, what you do may in fact also ‘constitute’ (be the realiser of) what you perceive. This claim is much more controversial, at least within the confines of philosophy. It is a shibboleth within much contemporary philosophy of mind that perception must be representational, that is, in order to perceive, you must first have a representational state(s) in your mind or brain that ‘stands in’ or ‘stands for’ some feature of the world.

Enactivists however demur. For enactivists, mind and experience are not heady affairs. Perceiving (and thinking, feeling, even imagining) are all things we do, rather than things that happen inside of us. And whilst enactivists disagree about how to characterize the enacted nature of perception (some think it involves know-how, others think it a fully embodied and embedded affair), they all insist that perception requires focusing on action.

So what, you might think. This is just a lot of philosophical talk. Yet the reach of enactivism extends far beyond the doors of the academy. A case in point is the following.

During a colonoscopy, the patient is lying on their side and the doctor places the endoscope inside the patient. The progress of the scope is, counter-intuitively, not determined by looking directly at the patient, but rather by monitoring changes to an image on a screen. Junior doctors however often have great difficulty making sense of what they are seeing on the screen, since the image can be both inverted and reversed at different times. Moreover, the doctor has to learn how their physical manipulation of the endoscope affects the image on the screen, and not how their manipulation of the scope affects the progress of the scope inside the patient.

Enactivism could help explain this difficulty. The doctor has to learn how their physical manipulation of the endoscope affects the image on the screen. The enactivist explanation of this is that the doctor has to learn a new set of what are called ‘sensorimotor contingencies’, lawful relations whereby perception changes with bodily movement. These contingencies will be unique to the using of an endoscope, hence the need for training. However, it may be the case that individuals with greater experience of altering images on screens (e.g. gamers) may learn how to use endoscopes faster. If so, then the training with endoscopes could potentially be done with the use of software alone. It need not be done in the presence of a patient.

This illustrates how beneficial a philosophical idea like enactivism can be. If doctors can get better in the use of endoscopes without first having to train on patients, then patients need not be exposed to the sorts of difficulties that every doctor is likely to encounter when they first use an endoscope. Enactivism, in this instance, can be used to help improve patient care.