 An important development that is avowedly sceptical of the existing biomedical paradigm in psychiatry is the rise of approaches inspired by the 4E movement in philosophy of mind – the “embedded, embodied, extended and enactive” tradition. Many philosophers of psychology and cognitive scienctists dispute the viability of what they see as an unduly reductive and anti-environmental tradition of philosophical psychology. To this internalist tradition is attributed the view that the mind is confined to the ‘skin and skull’ of individual agents and that psychological processes and their pathologies are entirely explained by the brain and central nervous system. On this view, whatever is responsible for cognition is wholly within the agent, and thus can be studied while ‘bracketing off’ an agent’s social and material environment. Externalists have argued that this tradition has both driven and been reinforced by approaches to psychiatry that are too brain-centred (Sneddon 2002, Roberts et al 2019) and lobby for greater attention to environmental or other extra-cranial factors. (Internalists, or proponents of traditional views of  cognition, one should add, often disagree with this view of what they are committed to or find the commitments of 4E too vague to be helpful (Aizawa 2018, Rupert 2016)).  As well as externalists, the 4E movement includes ‘embedded’ theorists who stress the dependency of minds on environmental scaffolding (Hutchins 1995) and “embodied” theorists who believe that bodies or aspects of the wider environment are constitutive of mental states, and often that sensorimotor phenomena are constitutive parts of cognition, rather than just the input and output of cognition (or what Hurley (1998) calls the ‘sandwich model’). Enactivism tends to be the more radical view that mental life can be explained via the dynamic interaction of nervous system, body and environment without reference to mental representation (Hutto and Myin 2013).