The functional ambivalence of mental symptoms: organizational and temporal dimensions of dysfunction in Enactive Psychiatry

This paper introduces the concept of the functional ambivalence of mental symptoms as a contribution to Enactive Psychiatry. Drawing on the autonomy-centered foundations of the enactive approach, we argue that mental disorders are not purely dysfunctional, but complex, multi-scale patterns of organization that can display functional and dysfunctional aspects at once. Functionality is understood as graded and context-dependent, emerging from interactions among multiple domains of normativity and across temporal scales. In dialogue with Russell’s perspective problem, we argue that the ambiguity of functional evaluation is not a shortcoming but a predictable consequence of plural autonomy. Our proposal is intended to be complementary to related theses developed in other frameworks. These perspectives can help clarify why certain symptoms persist and which meaningful and self-regulatory roles they may serve. Using anorexia, self-harm, and dietary restraint as examples, we show how behaviors typically treated as dysfunctional can play functional roles even as they generate harm. Clinically, the framework supports interventions that identify what symptoms do for the person while fostering alternative and more sustainable forms of regulation. Ethically, it promotes a less pathologising understanding of mental disorder by integrating first-person perspectives that can disclose functional dimensions often missed by third-person evaluation.