Are All Mental Disorders Affective Disorders?

that some


Introduction
In recent years, philosophical and phenomenological investigations of psychopathology have devoted more attention to ways in which affective dynamics may be involved in the etiology and symptomology of mental illness (Bortolan and Salice 2018). Still, there is a general tendency to suppose that some conditions (e.g. mood disorders) centre primarily around disruptions to affectivity, whereas others centre primarily around disruptions to cognition. But what if all mental "disorders" are affective, in an important etiological sense, and even symptoms involving thought, language, and executive control result (at least in part) from an affective disturbance? Do existing conceptualisations of mental disorder support such a view? A growing number of theorists have looked to the enactivist approach in philosophy of mind or the affordance-based approach from ecological psychology to make sense of a wide variety of phenomena; some theorists believe that these theoretical accounts can offer rich insights about the nature of disorders, their etiology, and their disruptions to neurobiological functioning that make it difficult for subjects to adapt to, and fare well in, their surroundings.
In addition, while the title of this paper refers to "disorders," it is important to acknowledge that the labels we use to refer to these conditions likely don't pick out natural kinds, and that conditions given the same label often manifest in quite heterogeneous ways. My focus is on certain symptoms commonly believed to be indicative of some sort of neurocognitive impairment or disruption to cognitive processing. While such symptoms may appear to have little to do with affectivity, at least at first glance, my central claim is that they centrally involve disruptions to selective attention that can be traced to an affective disturbance. If so, the alleged distinction between disorders of thought and disorders of mood needs to be rethought. Those committed to enactivist or affordance-based accounts of mental disorder, in particular, ought to embrace the claim that there is an important sense in which all mental disorders are affective disorders.
But why have I chosen to focus on enactivist and affordance-based accounts of mental disorder? The first reason for this is simply that such accounts are highly influential, and that more and more theorists have begun to appeal to these conceptual frameworks to account for key symptoms of various mental disorders.
The second reason is that both accounts highlight the importance of selective attention and the notion that skilful worldly engagement depends on the ability to highlight some considerations while ignoring others. 1 Given that both accounts also emphasise the importance of affectivity and how it contributes to perception and action, the idea that selective attention depends on affectivity follows quite naturally. This is why I believe that theorists who are committed to these approaches, in particular, should endorse the claim that all mental disorders are affective disorders. Ultimately, however, I suspect that any account of mental disorder that points to disruptions to selective attention and responsiveness will need to acknowledge the important role of affectivity.

Enactivism and Disordered Sense-Making
There are a range of different accounts that fall under the label "enactivism." Here, I focus on the version of enactivism sometimes termed "autopoietic," or "autonomic," enactivism, articulated by theorists such as Thompson (2007) and Weber and Varela (2002). These accounts highlight the link between mindedness and biology and emphasise that mind is in life. What enactivists call "sense-making" involves embodied action and engagement, and is a matter of being intentionally directed toward the world; thus, it is a mode of gauging meaning that is fundamentally embodied and relational. At a basic biological level, it can be understood as the process whereby living organisms interpret environmental stimuli in terms of their "vital significance" (Thompson 2007). To regulate and sustain themselves, organisms need to maintain an ongoing exchange of matter and energy with their environment. What counts as a useful resource depends on their structure, needs, and their mode of coupling with their surroundings. Physical and chemical phenomena take on meaning only to the extent that they relate positively or negatively to the "norm of the maintenance of the organism's integrity" (Thompson 2007, 70). Thus, at a basic level, sense-making has an integral normative dimension and is directed at survival: normativity arises from the self-production and self-maintenance of a precarious system, and, "through its ongoing individuation, the system intrinsically determines" which interactions support its continued existence and well-being, or threaten its survival (Buhrmann and Di Paolo 2017, 219). By defining itself, and by distinguishing between self and world, "the organism creates a perspective which changes the world from a neutral place to an Umwelt that always means something in relation to the organism" (Weber and Varela 2002, 188). Thus, it is the "restless" character of the metabolic process, and the continuous efforts of the living system to seek interactions with its surroundings to get the necessary energetic and material resources, which pave the way for a discerning perspective or point of view. This is the "existentialist" side of the Thompson's life-mind continuity thesis (Thompson 2011, 41). Colombetti (2014) has emphasised that the discriminative capacity that allows a living organism to monitor and regulate itself with respect to its conditions of viability has an integral affective-evaluative dimension insofar as it involves the living organism being "affected or struck by the suitability of an event for its own purposes" (19). Affectivity appears to be rooted at least in part in the appropriative activity of metabolism and the fact that a living organism's material self-maintenance matters to it in some basic sense. Because the primary condition of life is one of continuous self-renewal, an organism's forward trajectory is fuelled by desire: there is a constant need to supply itself with what it lacks to keep going, and "every contact with the world has, for the organisms, an existential meaning" (Weber and Varela 2002, 118). An entity that is concerned with getting the material resources it needs for its own survival and self-maintenance projects this concern onto its surroundings, which is at the core of sense-making. An animal that was incapable of attending selectively to its surroundings would be faced with a potentially endless array of possible stimuli, which would make effective engagement with its environment very difficult. Thus, even at a basic biological level, selective attunement and responsiveness to environmental perturbations centrally involves affectivity.
Whether particular environmental stimuli capture an organism's attention has much to do with whether those stimuli have "vital significance." At a more sophisticated level, sense-making encompasses the various forms of intentional directedness displayed by living animals. Intentionality is generally understood as feature of cognition, perception, and other mental states that are "about" something or "directed at" something. According to enactivism, living animals play an active role in the generation of meaning, and they are intentionally directed towards the world that surrounds them, in and through their bodies. In cases of "motor intentionality," for example, embodied agents make sense of objects in relation to themselves, identifying those objects pragmatically, in relation to their goals. Via the formation of bodily habits and associations, they can engage with their surroundings in a bodily and skilful way. Objects and events in their surroundings call for a certain mode of action insofar as agents have a sense that their situation deviates from some optimal body-environment relationship (and that it is contrary to their felt desires). The activity they undertake aims to move them closer to that optimum (thereby bringing the situation more in line with what they desire) (Thompson 2007, 312). Features of the environment that have little bearing on these goals are ignored, while other, more relevant, considerations become the focus of their attention.
Likewise, in perception, an agent interprets incoming stimuli selectively and in relation to pragmatic concerns. They are touched, affected, and stimulated, and what is experienced matters in some way or another.
What is disclosed is partly a matter of the features of that which exists in the world, and also partly a matter of what they bring to bear, given their specific bodily structure, capacities, and interests. Thus, both selective attention and context sensitivity involve the active participation of the agent in gauging the meanings of target stimuli. Insofar as intentionality is thoroughly bound up with affectivity and what an agent feels is important (Colombetti 2014), it is inherently evaluative. Following, but also extending, Heidegger, one might say that it is someone's capacity for affective and practical intentionality, i.e., "care," which allows them to apprehend the world "as a significant whole, an arena of possible projects, goals, and purposes" (Ratcliffe 2002, 289). Subjects do not passively receive information, but instead play an active role in enacting the meaning, significance, and import of things in their surroundings, in accordance with what they care about. Thus, enactivism emphasises that cognition (sense-making) and affectivity are not clearly distinguishable or separable, but rather integrated and interdependent (Colombetti 2014). Affectivity focuses attention and guides agents' enactments of meaning.
This enactivist notion of sense-making takes us beyond intentionality and intentional content as traditionally construed; its emphasis on active, embodied engagement allows us to switch focus from intentional content to a subject's embodied know-how and their capacity for intentional engagement and responsiveness to their surroundings. This understanding of intentionality, in turn, allows for a new understanding of mental disorders: such conditions do not principally involve disruptions to knowing-or perceiving-that, but rather difficulties with gauging-how to regulate one's coupling with the environment so as to engage effectively with relevant cognitive and practical options. That is, they centrally involve some sort of disruption to the relation between a living animal and its environment. Along these lines, de Haan (2017; 2020) maintains that mental disorders should be understood as disordered patterns of sense-making. When someone has a disorder, there is a recurring and more or less stable pattern in how someone's sense-making has "gone astray," so that "the way in which the person makes sense of [their] world is biased in a specific direction" (de Haan 2017), and their engagement and responsiveness to the world is distorted. Difficulties with adjusting or attuning their sensemaking can result in overly rigid patterns of interaction (de Haan 2020, 10) that undermine their capacity for adaptive engagement, and result in stress, fatigue, dysfunction, or disorder.
This account of mental disorder rests on an important distinction between biological sense-making and what de Haan terms "existential sense-making." Whereas biological sense-making involves making sense of environmental stimuli in terms of their impact on survival and self-maintenance, existential sense-making is underdetermined by biological meanings and values, and instead concerns the way in which people relate to themselves, their world, and other people. And while biological sense-making discloses a valenced environment for living organisms, existential sense-making discloses a much richer, value-imbued world for reflexive beings such as humans (de Haan 2017, 532). This is because existential sense-making involves taking up a stance whereby an agent relates to their self, their experiences, and their situation, and becomes aware of their own patterns of engagement with the world. While this more sophisticated sort of sense-making sometimes involves self-reflection, it also can be more unreflective and implicit in someone's actions. Even if they are not aware of their existential stance or orientation, it influences how they relate to and understand themselves and their experiences. According to de Haan, biological sense-making remains intact in cases of mental disorder; it is not that individuals have trouble satisfying norms of biological self-maintenance or survival. Instead, such conditions centrally involve disruptions to existential sense-making; that is, they are "disorders of the way in which people relate to themselves, their world, and/or other people" (2017, 533).
I have argued (2021a), in contrast, that mental disorders involve disruptions to both biological sense-making and existential sense-making. In my view, disruptions to what de Haan (2017) terms "existential sensemaking" are fully bound up with disruptions to living bodily dynamics, including those associated with skin conductance, the respiratory system, and the digestive system. Support for this claim comes from the fact that mental disorders such as depression and schizophrenia centrally involve altered bodily comportment and a loss of bodily attunement. For example, subjects with depression often exhibit diminished bodily activity, sluggishness, lethargy, slouched posture, and tension in the shoulders. Insofar as these disruptions to living bodily dynamics are fully bound up with disruptions to a subject's ability to make sense of themselves, their world, and other people, disruptions to existential sense-making cannot truly be distinguished from disruptions to biological sense-making.
Despite this disagreement, however, both de Haan and I are committed to the view that mental disorders involve disordered sense-making patterns. Thus, we agree that a mental disorder isn't simply the output or causal result of a neurological dysfunction, but rather a breakdown in the agent's ability to regulate their coupling with the world that surrounds them, including the social world. In a basic biological sense, sensemaking has to do with survival and adaptivity; among humans, sense-making also concerns "faring well" in a particular socio-cultural setting. And, as enactivist theorists have emphasised, sense-making is deeply affective: "The world takes on significance and value precisely in relation to what the organism is concerned about and striving for" (Colombetti 2014, 19). This seems especially striking in the case of existential sensemaking, whereby one makes sense of oneself, one's experiences, and one's situation. The meaning of events and experiences has much to do with what matters to a subject and what they care about; that is, this sort of sense-making necessarily takes place from the standpoint of a concerned perspective. Thus, if mental disorders are characterized by disordered patterns of sense-making, it becomes difficult to escape the conclusion that such disorders have an integral affective dimension. In cases of depression, for example, an agent may exhibit heightened attunement to negative considerations, may not attend to relevant positive considerations, and may find it difficult to adjust their sense-making in response to situational factors (Maiese 2021a). These disruptions to sense-making point to a breakdown in selective responsiveness: subjects continue to focus on the negative even when such considerations do not warrant so much attention, and they tend to ignore relevant features of themselves, their surroundings, and other people. Such biased patterns of sense-making are maladaptive insofar as they signify a disruption to selective attunement and responsiveness that makes it difficult for agents to fare well in their surroundings.

Affordance Disclosure and Disruptions to Skilled Intentionality
Some theorists have appealed to the theoretical notion of "affordances" to make sense of the disruptions to cognition and affectivity that occur in cases of mental disorder. The notion of affordance is a theoretical concept introduced by J.J. Gibson (1979) that emphasises the complementarity of the animal and the environment, and the link between perception and action. What the environment affords are "what it offers the animal, what it provides or furnishes, either for good or ill" (Gibson 1979, 237). The environment dynamically offers various possibilities for interaction and engagement, but only in relation to an organism with particular capacities. For example, an object is graspable by virtue of its physical properties together with an animal's bodily structure and ability to grasp that object. Thus, affordances can be understood as action possibilities that are specified relationally. However, it appears that animals do not engage with all the action possibilities that are available to them on the basis of their bodily structure and capacities; some affordances that the environment offers are unimportant to a subject because they have no bearing on that subject's goals (Rietveld and Kiverstein 2014).
This has led some theorists to distinguish between available action-possibilities and the smaller subset of affordances that become relevant from the standpoint of a particular agent. The landscape (or "total ensemble") of available affordances is comprised of "the entire set of affordances that are available, in a given environment at a given time" to particular sorts of living organisms (Ramstead, Veissière, and Kirmayer 2016). The field of affordances, in contrast, consists of the relevant possibilities for action that a particular individual is responsive to in a concrete situation (Rietveld and Kiverstein 2014). Whereas "the world is rich with affordances . . . only a subset of the possible actions the environment offers matter to a person enough to move them to action" (Kiverstein 2015, 536). Thus, an affordance field can be understood as the "situationspecific, individual "excerpt" of the general landscape of affordances" (de Haan et al. 2013, 7) offered by the environment that stand out as relevant for a particular agent in a specific situation. For an affordance to have relevance is for it to invite the subject to act and beckon certain forms of perceptual-emotional appraisal and bodily engagement (Ramstead, Veissière, and Kirmayer 2016, 4-5).
To make sense of these invitations to act, some theorists have introduced the notion of a "solicitation." Rietveld and Kiverstein (2014), for example, maintain that an affordance becomes a solicitation "when it is relevant to our dynamically changing concerns," takes on a "demand character" and becomes manifest at the bodily level in a state of "action readiness" (342). Along similar lines, Gallagher describes a solicitation as "an affordance that draws an agent to action due to its relevance, or the way that it stands out in the perceptual field" (2018, 722). Whether affordances solicit action is a thoroughly dynamic process, with objects becoming more or less soliciting over the course of a day. This is because "different objects offer possibilities to act, but some of them are more inviting than others" (Dings 2018, 683) at different times. Among the subjective factors that help to shape on agent's field of affordances are that agent's body scheme, capacities, habits, skills (Weichold 2018), and past experience (Rietveld 2012, 213). Which of the many affordances an agent is responsive to in a particular situation also depends significantly on their unique goals, concerns, needs, interests, and preferences (de Haan et al. 2013, 7), including their longer-term intentions, goals, projects, and commitments (Dings 2021).
Thus, it appears that affordances are not simply perceived via the senses, but rather disclosed; that is, they are gauged as relevant or selectively attended to, and this process of selective attention relies heavily on affectivity.
Those affordances which become relevant are those with affective significance, and the way in which things appear significant to a particular agent is bound up with their occurrent emotions, more diffuse mood, and general background affective orientation. Along these lines, Rietveld (2012) maintains that "the phenomenon of being attracted or drawn by a solicitation can be understood as an emotional perturbation" (213). A specific action-possibility "solicits action (i.e., calls me to act) only when I am responsive to act (i.e., concerned)" (Dings 2018, 687). A book sometimes affords reading, and at other times affords throwing; which of these affordances solicits me to act depends partly on my cares and concerns, and whether I am feeling angry. Some of these action-guiding cares and concerns are diachronic and pertain to ongoing projects, commitments, and longterm goals, whereas others pertain to shorter-term interests.
Depending on someone's overall mood, occurrent emotions, and enduring concerns, some action-possibilities have greater significance or matter more than others, or in different ways. Insofar as an agent's affective attunement to a particular situation helps to determine which available affordances solicit action, this attunement guides their selective responsiveness and enables them to engage effectively with a world that is overflowing with affordances. Along these lines, and building on the work of Merleau-Ponty, Kiverstein and Rietveld (2021) maintain that it "is through the caring engagement of their bodies that subjects experience a meaningful world" (82). It is an agent's concerns, and the way that they emotionally appraise their environment based on these concerns, that render some affordances "inviting and enticing, and others threatening and repelling" (Kiverstein 2015, 536).
It is worth noting that agents typically experience what an object affords or solicits unreflectively, as a result of who they are and what they care about. When a lifelong vegetarian, for example, sees a steak on the barbeque, they require no conscious reflection on their values to ensure they do not see the steak as "affording eating" (Dings 2020b). Instead, this capacity for selective responsiveness frequently operates pre-reflectively, prior to conceptualisation, and involves very fine-grained discriminations connected to what this agent feels in their gut, as it were. These affectively contoured discriminations are at work, for example, when someone has a funny feeling about a situation, or spontaneously develops a negative first impression of someone.
According to an affordance-based account of selective attention, we need not appeal to mental representations or propositional content to make sense of how this occurs. Instead, it appears that human agents possess some kind of pre-theoretical, non-intellectual understanding of where to direct their attention in a given context, which is built up through learning and mediated by past experience. As they navigate through the world, they do not sequentially process all the information that is potentially available to them, but instead focus on certain very specific things rather than others. Affect operates as the "allure" of consciousness and implies a "dynamic gestalt or figure-ground structure" whereby some objects emerge into affective prominence, while others become unnoticeable (Thompson 2007, 374). The agent's pre-reflective affective attunement to a particular situation, informed by their concerns and interests, thereby helps to determine which available affordances solicit action.
While the prefrontal lobe and other brain regions no doubt play a crucial role, the provision of affective and motivational colour or tone to events and situations is not simply a neural achievement. The affective dimension of selective attention also centrally involves bodily arousal and bodily feelings, which are best understood as distributed over a complex network of neurobiological processes, including metabolic systems, endocrine responses, musculoskeletal changes, and cardiovascular responses. Likewise, selective responsiveness depends significantly on bodily sensitivity, which consists in various changes in heart rate, blood pressure, hormones, skin temperature, and the orientation and positioning of body parts. Associated bodily feelings help to determine the focus of both perception and action by highlighting considerations with felt importance. As a result, the very way in which the world is disclosed to the agent is shaped and contoured by bodily feelings of caring. Thus, the process whereby affordances are disclosed as relevant goes beyond mere sensory perception, and involves an affectively laden appraisal process whereby some action possibilities are disclosed as salient and inviting (Dings 2020a).
One might wonder whether individuals can focus their attention on relevant features and considerations simply by relying on conceptual resources (i.e., without the help of affectivity). However, the Jastrow duckrabbit phenomenon shows that the mapping from attention to the natural stimulus can even be uniformly underdetermined across our species, including all cognisers who possess the concepts DUCK, RABBIT, and PICTURE. It is because agents attend to different aspects of a visual stimulus that they may see either the duck or the rabbit. What is more, some degree of selective attention takes place in all our interactions with our surroundings, though we tend not to notice it. Affordance-based accounts emphasise that selective attention often centres around fine-grained, action-oriented adjustments to behaviour, and that feelings of subjective import are central to this process. Note that this is fully consistent with phenomenological observations. In our everyday lives, the action possibilities that we experience as relevant, and which grab our attention, are those that reflect our concerns, emotions, moods, background affective orientations, and enduring commitments.
Many theorists have looked to these notions of affordance, solicitation, and affordance disclosure to make sense of the disruptions to functioning that occur in mental disorder. For example, de Haan et al. (2013) point to a breakdown in the structure of the field of relevant affordance, which involves at least three key dimensions: (1) the "width" of the field refers to the broadness of the scope of affordances that an individual perceives, which relates to their having a choice or options for action; (2) the "depth" of the field refers to the temporal aspect: the individual not only perceives affordances that are immediately present here and now, but is also pre-reflectively aware of future plans and action-possibilities; and (3) the "height" of the affordances in the field refers to the relevance or importance of the affordances that one is responsive to, i.e., "the experienced solicitation or affective allure" (de Haan et al. 2013, 7), and relates to salience and motivation. In cases of mental disorder, the width, depth, or height of an agent's affordance field become narrower, lack depth, or flatten out. And because engagement with relevant affordances is a function of the subject's cares and concerns and their sense of who they are, alterations to the affordance space typically also involve modifications to self-experience.
Similarly, Gallagher (2018) characterises different disorders in terms of distinctive changes in the affordance space. He says that this space is defined by evolution and bodily structure (e.g., the fact that an agent has hands), development (e.g., the agent's life-stage, and whether they are an infant or an adult), social and cultural practices (including normative constraints), and the subject's past experience, skill level, and education. Thus, if I lack the sensorimotor skills and capacities needed to climb the cliff in front of me, cliff-climbing is not part of my affordance space. In the case of depression, there are changes in a subject's affordance space: because drive, impulse, and appetite are reduced or lost, many action-possibilities are closed off. Likewise, in cases of schizophrenic delusion, affordances change: a chair might appear not as something to sit in, but rather as a "thing" that has lost its name, function, and meaning. And, in the case of OCD, "there is a serious constriction of the affordance space as the subject finds herself limited to one repetitive action, or one set of specific actions, and unable to move beyond that" (723). Presented with a hammer, the subject is unable to refrain from picking it up and using it. According to Gallagher, "particular types of psychiatric disorder reorient or reorganize concerns, interests, and abilities, and thereby change what counts as an agent's affordances or solicitations" (725). Similarly, in their description of changes in someone's physical-mental-affective health, Ramstead, Veissière, and Kirmayer (2016) suggest that adjustments across the affordance space can re-sculpt "a field of solicitations out of the total landscape of available affordances," dynamically moving the organism toward transformations in what counts as an optimal grip in a particular situation (13). While these different accounts differ in terms of their details, they all emphasise that disruptions to affordance engagement stem from an inability to gauge relevance or to gain an optimal grip on available action-possibilities.
This notion of "optimal grip" also plays a central role in the Skilled Intentionality Framework (Rietveld 2012;Rietveld et al. 2018;van Dijk and Rietveld 2017). Rietveld (2012) characterises the normative aspect of engagement with affordances in terms of embodied know-how and skill: "Acting appropriately requires that a complex and particular situational context is taken into account by the individual's motor intentional activity" (215).
Taking into account their particular situation, capabilities, and interests, the agent regulates themselves and coordinates their engagement with the environment so as to move toward "optimal grip on multiple relevant affordances simultaneously, that is, on a field of relevant affordances" (Rietveld et al. 2018, 45). This is a matter of being appropriately responsive to available affordances, being able to switch from one sort of activity to another as events unfold over time, being open to engagement with previously unexplored affordances, and being able to modify built-up patterns of engagement. What Dreyfus (2007), building on the work of Merleau-Ponty, describes as "skillful coping" requires that "embodied beings like us take as input energy from the physical universe and respond in such a way as to open them to a world organized in terms of their needs, interests, and bodily capacities" (251). Adaptive agency, then, "can be understood as an agent's having a grip on a rich, dynamic, and varied field of relevant affordances" (Ramírez-Vizcaya and Froese 2019, 8); it involves "a constant on-going sensorimotor loop of perceiving invitations for action, acting on them, perceiving new invitations, and so on" (Weichold 2018, 772). Even so-called "higher" forms of cognition, such as imagination, long-term planning, perspective-taking, and decision-making can be understood in terms of skilled activities of engaging with worldly situations and coordinating with multiple relevant affordances simultaneously.
In cases of mental disorder, agents are unable to achieve this "optimal grip" on available affordances. Whereas bodily affectivity ordinarily helps agents to engage selectively with specific features of their surroundings and thereby become attuned to relevant action-possibilities, mental disorder disrupts this capacity for selective attention. However, the difficulty is not simply that someone's sense organs are malfunctioning, rendering them unable to "perceive" objects as issuing demands. Rather, the agent faces challenges with respect to gauging the relevance of available affordances and being solicited appropriately. Disruptions to affordance disclosure take a variety of forms, depending on the disorder (Maiese 2021b). In some cases, the central difficulty is that subjects are solicited by irrelevant affordances. In other cases, relevant affordances go unnoticed. And, in others, the affordances that solicit action lack a sense of "mineness." In my view, all these disruptions can be understood as some sort of disruption to selective attention and responsiveness, rooted in an affective disturbance. But what about the language disturbances sometimes found in schizophrenia and the "context blindness" sometimes exhibited by autistic subjects?

Language Disturbances and "Context Blindness"
Perhaps few people will object to the claim that key symptoms of major depression or bipolar disorder result from disruptions to affectively grounded selective attention processes. However, it may seem less obvious that symptoms involving language and contextual integration can be accounted for in these terms. Whereas these symptoms are commonly understood to be the result of some sort of neurocognitive deficit, I argue that they are better understood in terms of disordered sense-making and a diminished ability to engage effectively with available affordances.
Language and affectivity often have been viewed as belonging to two distinct domains that must be studied separately. Whereas language belongs to structures of thought, is based on words and representations, and is communicatively deliberate, affectivity belongs to the body and is associated with unintentional sensations and reactions (Jensen 2014, 1). These sorts of assumptions may very well lead some theorists to balk at the suggestion that language difficulties are the result of an affective disturbance. But do disruptions to affectively guided selective attention processes contribute to such impairments? Such difficulties include repetition of phrases, frequent uncompleted sentences, neologisms, and "word salad." 2 Consider the following example from Saks (2007): "I'm just kidding around. . . . Kidding has to do with sheep. I'm sheepish. Have you ever killed anyone? I've killed lots of people with my thoughts" (215). In this example, single elements of language lose their function as carriers of intentional meaning (Fuchs and Röhricht 2017, 132) and stand out separately from the overall gist of the sentence. As a result, subjects are inadequately responsive to relevant linguistic affordances.
To explain why word intrusions disrupt the speech of some subjects with schizophrenia, Maher (2003) points to "defective employment of inhibitory activity necessary to exclude intrusions" (19). The ability to speak a sequence of words in a sentence is made possible by the ability to inhibit irrelevant associations for each separate word, as well as the ability to screen out external sources such as background conversation. That is, to focus their attention on a limited and significant aspect of language input, the subject must actively inhibit word associations that are not relevant given their concerns or the situation at hand. However, because subjects with schizophrenia are deficient in these inhibition mechanisms, and find it difficult to focus their attention on relevant contextual features, they are highly susceptible to word associations that are not relevant to the case at hand. For example, there is an association between the word "orange" and the word "Florida," but this association will be relevant only in particular contexts, in which specific interests, cares, or concerns are at play. When irrelevant word associations (ones that do not reflect what the subject cares about) intrude and solicit speech, they disrupt a subject's ability to complete meaningful sentences. A subject's overt utterance may not be in line with the thought that prompted it or the general background of their cares and concerns, making it difficult for them to communicate effectively with their interlocutors.
The notion that disruptions to affectivity and selective attention help to account for some of these key symptoms seems to resonate deeply with both enactivist and affordance-based approaches. First, some enactivist theorists have emphasized that language use closely reflects and expresses a subject's concerns. Cuffari (2014), for example, suggests that someone's particular use of language involves a particular way of caring and being careful in their speaking to others; that is, their linguistic sensitivities and habituated patterns of expressivity and response help to comprise their sources of caring and evaluating (Cuffari 2014). If so, then disruptions to affectivity would contribute to a kind of inability to be properly careful or attentive in one's employment of language. And in their discussion of skilful engagement with affordances, Kiverstein and Rietveld (2021) maintain that "the bodily activity of speaking is expressive of care -the ways of being involved with the world manifest in the regular patterns of doing in the speaker's form of life" (187). I hypothesise that affective disturbances make it difficult for some subjects with schizophrenia to inhibit irrelevant linguistic input, screen out unneeded or irrelevant words or phrases, and engage effectively with "linguistic affordances." In such cases, both relevant and irrelevant affordances have the same "height," and none of them stand out as especially salient. As a result, the subject is solicited to speak by language affordances that are not relevant given their cares and interests, and they find it difficult to determine which of the several meanings of a word is relevant for them in the situation at hand. What is more, due to their inability to gauge relevant speech affordances, a subject with schizophrenia may retreat into their own world; this further detracts from their ability to engage effectively with available action-possibilities.
It is also worth highlighting that language disturbances are not the only symptoms of schizophrenia that are indicative of a disruption to selective attention. Subjects also commonly exhibit deficits in perceptual grouping, so that objects do not stand together in an overall context and instead appear as meaningless details. They also have difficulty excluding distracting visual, auditory, and tactile input when trying to concentrate on selected parts of the environment (Maher 2003, 14). All these tasks require the inhibition of irrelevant information and the ability to focus one's attention on relevant considerations. However, among subjects with schizophrenia, there is a notable discrepancy between the amount of attention something deserves and the amount that it receives. What is more, in cases of so-called "unworlding," subjects experience a sense of strangeness about external objects that ordinarily would seem familiar, and subjects find themselves less capable of engaging with and "grasping" their surroundings (Sass 2004). Insignificant details of the surrounding environment become conspicuously salient, commonplace objects seem to lose their familiar meaning and recognizable significance, and the cognitive or perceptual world undergoes a kind of fragmentation. A chair, for example, might appear not as something that affords sitting, but rather as a "thing" that has lost its function and meaning.
Such considerations indicate that subjects with schizophrenia exhibit disordered sense-making and encounter difficulties with affordance engagement across a wide range of domains. This includes selective attention deficits that impact their ability to process linguistic stimuli, remember events, engage interpersonally with others, and exhibit executive control. These difficulties with selective attention are commonly viewed as sources of cognitive dysfunction in schizophrenia (Gold et al. 2018). However, the claim that these difficulties with selective attention result, in part, from an affective disturbance is supported by the fact that subjects with schizophrenia commonly experience diminished bodily attunement and strange bodily affective states.
The quasi-affective sensations and bodily states that subjects experience include "sensations of movement or pulling or pressure inside the body or on its surfaces; electric or migrating sensations; awareness of kinaesthetic, vestibular, or thermic sensations; and sensations of diminution or enlargement of the body or its parts" (Sass 2004, 135). Thus, disruptions to selective attention occur alongside disruptions to overall affective bodily attunement. But why think there is a link between the two? I propose that, because their framework of bodily attunement is diminished, subjects begin to experience sensations that are dissociated from their ongoing sense of self, lack a sense of personal relevance, and are experienced as free-floating rather than being meaningfully directed toward the world. In fact, there is evidence that subjects with schizophrenia commonly exhibit blunted affect and deficits in emotional expressiveness (Trémeau 2006). Kring and Moran's (2008) review of emotional response deficits in schizophrenia found that subjects are less expressive (both facially and vocally) than individuals without schizophrenia in response to a variety of evocative stimuli. For example, individuals with schizophrenia appear to display fewer positive and negative facial expressions in response to emotionally evocative film clips, foods, and social interactions (Kring and Moran 2008, 821). Yet, even though these individuals are markedly less expressiveness, they do not seem to differ as much with respect to their reports of emotional experience or their affective arousal (as measured by skin conductance reactivity, for example). Such data indicate that, although subjects with schizophrenia do experience emotion, it does not guide their behaviour in the usual way, leading to disruptions to agency and a decreased ability to gauge the relevance of available motor and social affordances.
Like subjects with schizophrenia, autistic subjects appear to encounter difficulties with selective attention. For example, they often say things that lack relevance to the situation at hand, are less able to deceive others, and often do not produce most aspects of pragmatics in their speech. They appear to have a limited understanding of the relationship between language and social context, and find it difficult to interpret a speaker's words in relation to their perspective and intentions. Because they do not make appropriate use of context to interpret the communicative intentions of their interlocutors (Vermeulen 2015, 186), they have difficulty understanding metaphor, sarcasm, and irony, and tend to adopt a literal interpretation of these figurative modes of speech.
They are less capable of homing in on social and contextually-based meanings that go beyond the semantic meaning of what is said. For example, autistic subjects have difficulty with using context to disambiguate the pronunciation or meaning of homographs (Lopez and Leekam, 2003). These are cases in which, in order to choose the correct (i.e., contextually appropriate) pronunciation of a word, one must understand that word in relation to the whole sentence's meaning. Because contextual disambiguation is difficult for autistic subjects, they tend to produce the word's more common pronunciation, regardless of the preceding sentence's meaning and overall context (Frith and Happé 1994, 124). They also exhibit deficits with respect to the completion of sentences with words that are congruent with the entire sentence (Booth and Happé 2010). For them, reading a sentence is more like reading a list of unconnected words. What is more, they tend to violate informal dialogical rules such as turn-taking, and often continue talking about a single topic regardless of whether it is relevant to the hearer. Such considerations lead Stanghellini (2001) to suggest that the autistic person's use of with that of others" (296). This points to a breakdown in the ability to engage with relevant linguistic and social affordances.
Autistic subjects also have difficulty integrating perceptual information, often show a preoccupation with details and parts, and fail to extract gist or configuration. Their difficulties with selectively attending to salient contextual features surfaces in their insusceptibility to certain perceptual illusions, their knack for finding embedded figures within a larger design, and their difficulties with "gestalt" perception (seeing whole figures or scenes as opposed to their parts). For example, children with autism excel at the Embedded Figures Test, which involves spotting a hidden figure among a larger design or meaningful drawing. In addition, they tend to have a knack for locating tiny objects (such as thread on a patterned carpet) and are good at detecting minute changes in familiar layouts, such as the arrangement of items on a bathroom shelf (Frith and Happé 1994, 122). And, when asked to make judgements about standard textbook visual illusions, they tend not to succumb to illusions as much as non-autistic subjects do. Because autistic subjects focus on the to-be-judged parts without integrating them with the surrounding illusion-inducing context, they are better able to make accurate judgements in such cases. However, subjects who have difficulty gauging the contextually appropriate meanings of perceptual scenes will be less capable of making sense of their surroundings and evaluating, disambiguating, and changing between several different possible interpretations in light of contextual considerations (Vermeulen 2015, 185). This is likely to result in rigid and absolute links between stimuli and meanings, and thus a lack of behavioural flexibility and insufficient attunement to relevant affordances.
Decreased contextual sensitivity likely plays a role in the difficulties autistic subjects sometimes have in distinguishing the important from the incidental and attending to the salient stimuli in a given situation (Loth, Gomez, and Happé 2011). Due to a lack of selective bias towards relevant aspects of perceptual input, autistic subjects often treat all perceptual details as equally important; as a result, cognitive processes can become "bogged down in minute details or irrelevancies" (Vermeulen 2015, 184). Subjects may pay attention to things that should be ignored, given the context, their immediate interests, and their longer-term goals.
To make sense of this sort of "context blindness," some theorists have suggested that autistic subjects exhibit "weak central coherence" (Frith 1989). The term "central coherence" refers to "the natural human tendency to draw together several pieces of information to construct higher-order meaning in context" (Frith and Happé 1994, 121). The notion that autistic subjects exhibit "context blindness" builds upon the notion of weak central coherence, and stresses that context use plays a central role in gauging relevance and guiding attention (Vermeulen 2015, 182). The notion of context blindness in autistic spectrum disorder refers primarily to difficulties with using context when making sense of one's surroundings and other people, i.e., in using context to interpret what is perceived (Vermeulen 2015, 183). Along these lines, Morsanyi, Handley, and Evans (2010) described the autistic mind as "decontextualized." After correctly naming the bed, mattress, and quilt, an autistic boy referred to the pillow on the bed as "a piece of ravioli" (Happé 1994, 118). The fact that he correctly named these other objects suggests that he "saw" the context of the pillow, but that contextual considerations did not appropriately feed into his interpretation of the meaning of this object. This reduced contextual sensitivity may contribute to the rigid or straightforward thinking often seen among autistic subjects. Indeed, since autistic subjects often rely on fixed meanings and rules, and find it difficult to alter their behaviour in response to contextual considerations, their sense-making is biased in a particular direction (de Haan 2020) and they find it difficult to obtain optimal grip on available affordances. Yet, despite this striking evidence of decreased contextual sensitivity, Vermeulen (2015) notes that "we still lack a clear understanding of the difficulties that people with [autism spectrum disorder] have in perceiving and using context" (Vermeulen 2015, 189). To make sense of this, I have proposed that the ability to utilise context in various forms of sense-making and perception depends significantly on affectivity and bodilyaffective attunement. Which contextual considerations are relevant depends significantly on an agent's immediate concerns and longer-term goals, including their concerns about satisfying existing social norms and expectations. Consider that most of the phenomena that we perceive and engage with in the environment can be construed in different ways and are open to multiple interpretations. Affectivity helps us to derive meaning from a world of objects, events, and other people whose appearance, workings, or behaviours are inherently ambiguous. Likewise, gauging global meaning requires interpreting details against a background of significance. Without the direction and focus of attention provided by bodily affectivity, autistic subjects find it difficult to ascertain the broader meaning of things and may focus instead on superficial or irrelevant details. As a result, they find it easier to screen out context (in the case of finding embedded figures within a larger design), but also struggle to see "the big picture" as opposed to its parts. Whereas subjects ordinarily interpret perceptual stimuli from the environment on the basis of their cares and concerns, the sense-making of autistic subjects is less affectively contoured. Without a stable framework of bodily affectivity to serve as a guide for sense-making and affordance perception, autistic subjects encounter difficulties navigating the material and social world.
What is more, subjects with autism often exhibit what Krueger (2021) terms "style blindness": they have a decreased ability to gauge the style (or the "how") of various forms of movement. Here Krueger appeals to Daniel Stern's (2010) notion of "forms of vitality," which encompass the manner or style in which an action is executed. For example, a particular movement sequence (e.g., chopping up vegetables for dinner) might be done in a confident way, an angry way, or a lethargic way. Whereas children with autism tend not to struggle with imitating the "what" of an action (nor carrying out complex, goal-directed movement that matches the movement of the person they are imitating), they do display deficits with respect to imitating the style (the "how") of this movement. Such evidence suggests that subjects with autism find it difficult to gauge the expressive qualities of various forms of movement; as a result, they may find it difficult to make sense of others' behaviour, gauge relevant social affordances, or respond appropriately to others' actions. In my view, this sort of "style blindness" is directly connected to their diminished affective bodily attunement, which renders them less capable of detecting the highly fine-grained expressive features of others' actions.
The claim that these difficulties stem, in part, from an affective disturbance is supported by evidence showing that the bodily arousal associated with affective states makes an essential contribution to selective attention. Pessoa (2008) explores how cognitive and affective processing are integrated in the brain and claims that the cognitive and emotional contributions to executive control conjointly and equally contribute to the control of thought and behaviour. Likewise, Panksepp (1998) describes emotion as a collection of meaning-generating and adaptive mechanisms that are rooted in specific neural and endocrine processes, and which allow the organism to adapt to life-challenging circumstances. And Lewis (2005) discusses how the sub-personal processes that underlie appraisal and emotion are a distributed network of self-organising and mutually influencing brain and bodily processes. Together with the amygdala, bodily arousal and endocrine activity help to maintain an organism's homeostatic equilibrium, enhance attention, and prepare the individual for action. Likewise, the work of Barrett and Bar (2009) suggests that bodily feelings and sensations signalling an object's salience or relevance assist in perception and object recognition from the very moment that visual stimulation begins. Even among very young humans, there is a link between emotional response, it is widely accepted among neuroscientists that "rapid and efficient selection of emotionally salient or goalrelevant environmental stimuli is crucial for flexible and adaptive behavior" (Yamaguchi and Onoda 2012, 1).
But, whereas some theorists might account for context insensitivity in reductive terms and point to brain dysfunction, the enactivist and affordance-based approaches I have discussed in this paper would predict disruptions to the whole living body and the way in which an agent as a whole relates to and actively engages with their world.
In fact, existing research supports the notion that autistic subjects exhibit disruptions to overall bodily attunement. A study by Leekam et al. (2007) found that over 90% of autistic children exhibit sensory abnormalities. First-person autobiographical accounts often reveal that subjects have unusual sensory experiences, including insensitivity to pain and atypical responses to auditory, visual, tactile, and olfactory stimuli. For example, subjects may become distressed or unusually fascinated by certain sounds, exhibit an unusual degree of interest in bright lights or shiny objects, or exhibit a negative reaction to gentle touch.
Research also indicates that autistic children have difficulty replicating facial expressions and fail to exhibit gestural emotion in peer interactions (Langdell 1981). Marcari et al. (2018) found that toddlers with ASD exhibited a muted affective response to novel, intrusive stimuli, and Yirmiya et al. (1989) found that Children with ASD displayed significantly less affect in their facial expressions compared to a control group of children with developmental delay. Macdonald et al. (1989) demonstrated that emotional expression deficits extend into adulthood, even for high functioning adults, and that subjects were relatively impaired with respect not just to the appreciation of the emotions of others, but also the production of emotional expressions. This points to a disruption to affectivity, which I have suggested contributes to the "context blindness" commonly found among autistic subjects.

Conclusion
I have argued that difficulties with selective attention and contextual sensitivity are commonly found in both schizophrenia and autism, and that these difficulties stem partly from disruptions to affective bodily attunement.
How, then, can we differentiate between the symptoms found in these conditions? Vermeulen (2015) speculates that perhaps not being able to activate contextually appropriate meanings is especially typical in autism, whereas not being able to repress contextually inappropriate meanings is more characteristic of schizophrenia (188).
Another possibility is that these deficits are quite similar in terms of their underlying causes and dynamics, and that what principally differentiates schizophrenia and autism is the presence or absence of yet other symptoms.
There remains work to be done to provide an enactivist or affordance-based account of these disorders, and to examine how disruptions to affectivity and selective attention contribute to key symptoms.
A lingering question concerns the intended scope of the argument presented here. Have I adequately defended the claim that all mental disorders are affective disorders? My central (relatively modest) aim has been to show that proponents of enactivist and affordance-based accounts should embrace this claim. But what about those who are not committed to such accounts? As noted earlier, if it is true that the capacity for selective attention depends significantly on affectivity, then any account of mental disorder that highlights the role of selective attention will need to acknowledge this. Of course, a full defence of the claim that all mental disorders are affective disorders might require that I discuss a much wider range of mental disorders and characteristic symptoms; there is not enough space to undertake such a defence here.
But what about delusions, such as thought insertion, which are sometimes found in schizophrenia? Since such delusions are commonly thought to be the result of impaired rationality or diminished epistemic capacities, why think that they result partly from some sort of affective disturbance? Consider that, in addition to experiencing possibilities to walk and kick, agents experience possibilities to attend, imagine, and deliberate (McClelland 2019, 170). Which of these mental affordances are appraised as relevant (and which possible acts of thinking are solicited) depends partly upon an agent's interests, concerns, and overall affective attunement.
This bodily attunement allows for the sort of "automatic proto-assessment" (McClelland 2019, 166) whereby agents select from a shortlist of the options for mental action that they feel, in-and-through their bodies, are more relevant or inviting. Only a fraction of possible thoughts will be solicited. Because trains of thoughts are ordinarily focused and guided by built-up patterns of affective bodily attunement, they do not seem to appear out of nowhere. Among some subjects with schizophrenia, however, the patterns of attention and bodily orientation that ordinarily serve as the backdrop for thought are attenuated. Because solicited thoughts do not arise against the structure-giving backdrop of an agent's desiderative feelings, their concerns about the future, or their current needs and desires, they seem alien and out of context. Without some framework in which particular mental affordances can take on relevance and significance, the thoughts that occur may seem object-like, and the experience of thinking may lose its desiderative tone and world-directedness. Some subjects then attempt to recontextualize them by attributing them to some other source (Martin and Pacherie 2013), thereby giving rise to reports of thoughts that are not theirs, but nonetheless in their minds. While this account is only a sketch, it begins to shed light on how symptoms such as delusions might be understood as resulting from a disruption to affectively driven processes of affordance engagement.
What implications does my proposed account have for treatment? Currently, medication is the most common mode of treatment for many mental disorders. Although I do not advocate the elimination of drug-based therapy, or deny that it ever can prove effective, it is evident that drugs often have negative side effects (in the case of schizophrenia), and also that we do not know of drugs that help to improve cognitive and affective functioning (in the case of autism). What is more, it is unlikely that the mere provision of social skills training will be enough to teach subjects to focus on relevant contextual features, switch course in response to changing circumstances, or navigate smoothly through complex social environments (Vermeulen 2015, 188). Instead, alongside efforts to create more hospitable environments (Krueger and Maiese 2018), we will need to cultivate subjects' overall bodily-affective attunement and capacities for selective attention. Indeed, the argument presented here supports the further development and utilisation of methods that target subjects' emotions and bodily-affective feelings in order to foster adaptive sense-making and affordance engagement. One way to do this is through the development of self-narratives that weave together different elements of a person's life experiences and diachronic concerns (Dings 2018). In addition, further research should be done to investigate the efficacy of expressive arts therapies that involve dance, movement, music, and visual art (Maiese 2015, chap. 6). The potential effectiveness of expressive arts therapies derives from the fact that they engage emotions and bodily-affective feelings to bring about shifts in higher-level cognitive and interpersonal functioning.
By tapping in to subjects' bodily affective orientations and attuning them to how their bodies are feeling, expressive arts interventions can strengthen subjects' capacities for selective attention and responsiveness, helping them to make sense of their surroundings and to gain an "optimal grip" on relevant affordances.