How should we define ‘health’ and ‘disease’? There are three main positions in the literature. Naturalists desire value-free definitions based on scientific theories. Normativists believe that our uses of ‘health’ and ‘disease’ reflect value judgments. Hybrid theorists offer definitions containing both normativist and naturalist elements. This paper discusses the problems with these views and offers an alternative approach to the debate over ‘health’ and ‘disease’. Instead of trying to find the correct definitions of ‘ (...) class='Hi'>health’ and ‘disease’ we should explicitly talk about the considerations that are central in medical discussions, namely state descriptions and normative claims . This distinction avoids the problems facing the major approaches to defining ‘health’ and ‘disease’, and it more clearly captures what matters in medical discussions. (shrink)

Despite the longstanding debate on definitions of health and disease concepts, and the multitude of accounts that have been developed, no consensus has been reached. This is problematic, as the way we define health and disease has far-reaching practical consequences. In recent contributions it is proposed to view health and disease as practical- and plural concepts. Instead of searching for a general definition, it is proposed to stipulate context-specific definitions. However, it is not clear (...) how this should be realized. In this paper, we review recent contributions to the debate, and examine the importance of context-specific definitions. In particular, we explore the usefulness of analyzing the relation between the practical function of a definition and the context it is deployed in. We demonstrate that the variety of functions that health and disease concepts need to serve makes the formulation of monistic definitions not only problematic but also undesirable. We conclude that the analysis of the practical function in relation to the context is key when formulating context-specific definitions for health and disease. At last, we discuss challenges for the pluralist stance and make recommendations for future research. (shrink)

The literature on health and diseases is usually presented as an opposition between naturalism and normativism. This article argues that such a picture is too simplistic: there is not one opposition between naturalism and normativism, but many. I distinguish four different domains where naturalist and normativist claims can be contrasted: (1) ordinary usage, (2) conceptually clean versions of “health” and “disease,” (3) the operationalization of dysfunction, and (4) the justification for that operationalization. In the process I present (...) new arguments in response to Schwartz (2007) and Hausman (2012) and expose a link between the arguments made by Schwartz (2007) and Kingma (2010). Distinguishing naturalist claims at these four domains will allow us to make progress by (1) providing more nuanced, intermediate positions about a possible role for values in health and disease; and (2) assisting in the addressing of relativistic worries about the value-ladenness of health and disease. (shrink)

This open access book is a systematic update of the philosophical and scientific foundations of the biopsychosocial model of health, disease and healthcare. First proposed by George Engel 40 years ago, the Biopsychosocial Model is much cited in healthcare settings worldwide, but has been increasingly criticised for being vague, lacking in content, and in need of reworking in the light of recent developments. The book confronts the rapid changes to psychological science, neuroscience, healthcare, and philosophy that have occurred (...) since the model was first proposed and addresses key issues such as the model’s scientific basis, clinical utility, and philosophical coherence. The authors conceptualise biology and the psychosocial as in the same ontological space, interlinked by systems of communication-based regulatory control which constitute a new kind of causation. These are distinguished from physical and chemical laws, most clearly because they can break down, thus providing the basis for difference between health and disease. This work offers an urgent update to the model’s scientific and philosophical foundations, providing a new and coherent account of causal interactions between the biological, the psychological and social. (shrink)

If one had to identify the biggest change within the philosophical tradition in the twenty-first century, it would certainly be the rapid rise of experimental philosophy to address differences in intuitions about concepts. It is, therefore, surprising that the philosophy of medicine has so far not drawn on the tools of experimental philosophy in the context of a particular conceptual debate that has overshadowed all others in the field: the long-standing dispute between so-called naturalists and normativists about the concepts of (...) health and disease. In this paper, I defend and advocate the use of empirical methods to inform and advance this and other debates within the philosophy of medicine. (shrink)

Philosophical discussions about health and disease often refer to a 'medical model' of bodily disease, in which diseases are regarded as causes of illness; diagnosis consists in identifying the disease affecting the patient, and this determines the appropriate treatment. This view is plausible only for diseases whose cause is known, though even in such instances the disease is the effect on the affected person, and must not be confused with its own cause. But in fact (...) the medical diagnostic process which progresses from recognition of patterns of symptoms and signs, through search for abnormalities of structure and/or function, towards knowledge of causation often stops short of this desirable end-point; and at whatever point it comes to a halt, its result is expressed in terms of 'diseases'. Thus in medical discourse the names of diseases are a convenient device by which the current conclusion of the diagnostic process can be stated briefly; and they have widely varying factual implications. This nominalist analysis of the medical usages of the names of diseases has consequences for definitions of health and disease, and for some problems in medical ethics. (shrink)

The paper differentiates between three levels of the notion of health – biological health, medical health, and social health – and underlines the cultural concept of health and disease, its dependence on religion, ideology, and the general view of life. Keywords: biological health, medical health, normality, social health, well-being CiteULike Connotea Del.icio.us What's this?

The categories of health and disease/illness are conceptualized from the perspective of the philosophy of medicine. Philosophical contradictions are revealed, which, fueling the debate between naturalism and normativism, prevent biomedicine from developing a single satisfactory understanding of these categories. The theoretical and practical consequences of such biomedicine features as pathocentrism, identification of health with complete well-being, dichotomy of health and disease in the absence of a clear criterion for their differentiation are analyzed. The role of (...) humanistic approaches to the medicine rehumanization is investigated with a focus on their balanced view of health and disease/illness, attentive to the fundamental vulnerability of human nature. (shrink)

In this paper, I consider what kind of normative work might be done by speaking of ecosystems utilising a 'medical' vocabulary – drawing, that is, on such notions as 'health', 'disease', and 'illness'. Some writers attracted to this mode of expression have been rather modest about what they think it might purchase. I wish to be bolder. Drawing on the idea of 'thick' evaluative concepts as discussed by McDowell, Williams and Taylor, and resorting to a phenomenological argument for (...) a kind of moral realism, I argue that the project of developing a robust understanding of the moral significance of recognising the health or illness of ecosystems is definitely a starter. (shrink)

In line with recent proposals for experimental philosophy and philosophy of science in practice, we propose that the philosophy of medicine could benefit from incorporating empirical research, just as bioethics has. In this paper, we therefore take first steps towards the development of an empirical philosophy of medicine, that includes investigating practical and moral dimensions. This qualitative study gives insight into the views and experiences of a group of various medical professionals and patient representatives regarding the conceptualization of health (...) and disease concepts in practice and the possible problems that surround them. This includes clinical, epistemological, and ethical issues. We have conducted qualitative interviews with a broad range of participants (n = 17), working in various health-related disciplines, fields and organizations. From the interviews, we highlight several different practical functions of definitions of health and disease. Furthermore, we discuss 5 types of problematic situations that emerged from the interviews and analyze the underlying conceptual issues. By providing theoretical frameworks and conceptual tools, and by suggesting conceptual changes or adaptations, philosophers might be able to help solve some of these problems. This empirical-philosophical study contributes to a more pragmatic way of understanding the relevance of conceptualizing health and disease by connecting the participants’ views and experiences to the theoretical debate. Going back and forth between theory and practice will likely result in a more complex but hopefully also better and more fruitful understanding of health and disease concepts. (shrink)

A number of philosophers of medicine have attempted to provide analyses of health and disease in which the role that values play in those concepts is restricted. There are three ways in which values can be restricted in the concepts of health and disease. They can be: (i) eliminated, (ii) tamed or (iii) corralled. These three approaches correspond, respectively, to the work of Boorse, Lennox, and Wakefield. The concern of each of these authors is that if (...) unrestricted values are allowed to infect our concepts of health and disease, then anything could be construed as healthy or diseased. They believe that, if at all possible, such a result should be avoided. Unfortunately, as I argue, this result is unavoidable and such attempts to limit values in these concepts are destined to fail. I argue for this position by showing how each of these three attempts to provide value-restricted analyses of health and disease fail as analyses of the concepts of health and disease and that they fail because of their attempts to restrict the role of values in their accounts. I also show how, despite their best efforts, each of these analyses are, themselves, value-driven and value-laden. This leads to the conclusion that values infect our concepts of health and disease at all levels. (shrink)

The concepts of health and disease play pivotal roles in medicine and the health professions This volume brings together the requisite literature for understanding current discussions and debates these concepts. The selections in the volume attempt to present a wide range of views concerning the nature of the concepts of health and issues using both historical and contemporary sources -- Back cover.

Competing contemporary theories of health, the reductionist and the relativist of an objective goal, can be classified as objectivist theories. The ultimate goal of all living things is life, the standard by which states or functions can be measured, and thereby defined as healthy or disease states. While disease can be classified in a taxonomy of biological dysfunctions without remainder, health is a richer concept that includes not only biological values, but also moral values, both leading (...) to the ultimate goal of human flourishing. (shrink)

On ‘Mismatch’ and ‘Metabolic Ghettos:’ The Conceptualization of Global Health Differences in Research on the Developmental Origins of Health and Disease. Epigenetic approaches to human health have received growing attention in the past two decades. They allow to view the development of human organisms as plastic, i.e. as open to influences from the social and material environment such as nutrition, stress, and trauma. This has lent new credence to approaches in biomedicine that aim to draw attention (...) to the importance of development for later life health. Some scholars in the social sciences and humanities have welcomed such approaches as a departure from gene‐centric perspectives and as an opportunity for highlighting the social and political determinants of health and illness. Others have warned that they might lead to new forms of biological reductionisms and determinisms. In this article, we explore how research on developmental plasticity addresses and articulates global health disparities, specifically in the context of postcolonial India. We discuss two prominent approaches from the field of Developmental Origins of Health and Disease (DOHaD) that build on epigenetic perspectives on health and illness and view different global rates of disease susceptibility as the result of developmental processes: first, the ‘mismatch paradigm’ by Peter Gluckman and Mark Hanson and second, the ‘metabolic ghetto’ concept by Jonathan Wells. We highlight how both approaches render historical and social factors meaningful for the development of global health disparities, but emphasize how they at the same time remain prone to determinisms and reductionisms reminiscent of a gene‐centric perspective. DOHaD actors themselves are critical of these tendencies, and in conclusion we explore novel opportunities for interdisciplinary collaborations enabled by this critical potential. (shrink)

Near the end of his speech, Timaeus outlines a theory of bodily health and disease which has seemed to many commentators loosely unified or even inconsistent . But this section is better unified than it has appeared, and gives us at least one important insight into the workings of physical causality in the Timaeus. I argue first that the apparent disorder in Timaeus’s theory of disease is likely a deliberate effect planned by the author. Second, the taxonomy (...) of disease in the passage consists of one genus subsuming two species. Third, in Timaeus’s theory, health lies between perfect stability and a chaos of all possible motions; this indicates a conception of health as the activation of the body's powers in the right way. A power is a property directed towards bringing about some change. Fourth, the activation of these powers can change depending on the location of their possessors. This last point shows that causation among the physical items in the Timaeus involves structures as well as pushes. (shrink)

The concepts of health and disease are foundational to biomedical ethics. This essay critiques two widely used approaches to understanding health and disease: the World Health Organization definition of health as "complete physical, mental and social well-being," and the attempts by Thomas Szasz and Christopher Boorse to define health and disease in objective, value-free terms. Drawing particularly on the thought of Karl Barth, I argue that in Christian perspective, health must be (...) understood in terms of the goods and goals toward which human life is directed, which must themselves be understood in terms of God's good purposes made known in Christ. We are called to "will to be healthy" and resist disease, but understanding what this entails in particular concrete situations requires skills and habits of attentiveness to God's command, cultivated in the context of the Christian community and its practices. (shrink)

This chapter contains section titled: Introduction Objectivism and Constructivism Problems for Constructivism Objectivism Troubles with Objectivism References.

This book is aimed at providing the reader with a systematic overview of the concepts of health and disease as utilized in various areas of the health sciences. It attempts to provide some historical background to modern models of health and disease. Special attention is given to controversial topics such as the notion of "mental health." the volume contains a number of new papers on health and disease by physicians, philosophers and others.

The main feature of the signs of health in the animal habitus and behaviour can be characterised as the readiness to adequately (for a species) serve the need for impression (in animalistic elements of the Umwelt). The signs of disease, however multifarious and diverse, generally display certain lack of Umwelt-oriented attentiveness, alertness. Attention of deeply afflicted animals is strongly Innenwelt-oriented; and in some species a set of such signs, suggesting sickness or mortal disease is used as a (...) set of traits in the mimicry of dying. The semiotic factors in health-disease relationships are apparently connected with intuition — like responses creating in the semiosphere a structure of Umwelt-Innenwelt polarized tensions, important in ecological and evolutional developments. (shrink)

I respond to the 4 commentaries by Awais Aftab & Kristopher Nielsen, Hane Htut Maung, Diane O’Leary and Kathryn Tabb under 3 main headings: “What is the BPSM really?” & Why update it?; “Is our approach foundationally compromised?”, and finally, “Antagonists or fellow travellers?”.

Germund Hesslow has argued that concepts of health and disease serve no important scientific, clinical, or ethical function. However, this conclusion depends upon the particular concept of disease he espouses; namely, on Boorse's functional notion. The fact/value split embodied in the functional notion of disease leads to a sharp split between the science of medicine and bioethics, making the philosophy of medicine irrelevant for both. By placing this disease concept in the broader context of medical (...) history, I shall show that it does capture an essential part of modern medical ideology. However, it is also a self-contradictory notion. By making explicit the value desiderata of medical nosologies, a reconfiguration of the relation between medicine, bioethics, and the philosophy of medicine is initiated. This, in turn, will involve a recovery of the caring dimensions of medicine, and thus a more humane practice. (shrink)

Philippa Lang - Medicine and Philosophy in Classical Antiquity: Doctors and Philosophers on Nature, Soul, Health and Disease - Journal of the History of Philosophy 45:1 Journal of the History of Philosophy 45.1 151-152 Muse Search Journals This Journal Contents Reviewed by Philippa Lang Emory University Philip van der Eijk. Medicine and Philosophy in Classical Antiquity: Doctors and Philosophers on Nature, Soul, Health and Disease. Cambridge-New York: Cambridge University Press, 2005. Pp. xiv + 404. Cloth, $95.00. (...) This immaculately edited volume usefully collects ten significant articles by van der Eijk, together with one chapter based on other previously published material. They appear here slightly revised,.. (shrink)

Review on Philip J. van der Eijk, Medicine and Philosophy in Classical Antiquity: Doctors and Philosophers on Nature, Soul, Health and Disease, Cambridge University Press, Cambridge, 2005.

Christopher Boorse's Bio Statistical Theory (BST) defines health as the absence of disease, and disease as the adverse departure from normal species functioning. This paper presents a two-pronged problem for this account. First I demonstrate that, in order to accurately account for dynamic physiological functions, Boorse's account of normal function needs to be modified to index functions against situations. I then demonstrate that if functions are indexed against situations, the BST can no longer account for diseases that (...) result from specific environmental factors. The BST is impaled on either horn of this dilemma and therefore must be dismissed. (shrink)

The fundamental standard of health care is health. Theories of health affect how we conceive of good health, ill health, Good patients, and Good providers. They also profoundly affect how we go about attempting to solve health problems once we’ve identified them. In this chapter, I argue that the way health care providers, bioethicists, and public health experts approach health relies on ideal theory despite the heavy knowledge that this world will (...) never be ideal. We need a conception of health that accounts for this. I outline the weakness of ideal theory in general and with respect to theories of health, and argue in favor of a nonideal approach to health that is rooted in intersubjectivity, empiricism, inclusivity, contextual specificity, and reflexivity which are not entrusted to any one set of knowers. Throughout, I use the example of how we approach fatness, and medicalize obesity, to illustrate where we’ve gone wrong and to chart a path toward how we can go right. (shrink)

In the late 1720s and early 1730s, Christian Wolff writes a series of short treatises on general medical concepts such as health, disease, cause of disease, symptom, etc. The paper makes the claim that these texts should be considered as a pioneering attempt at developing a systematic philosophy of medicine based on metaphysical and epistemological investigations on medical concepts, doctrines, and practices. The main focus is on Wolff’s analysis of the concepts of health and disease (...) in functional terms and its connection to his teleological characterization of both natural and artificial machines. This also explains Wolff’s use of the normatively loaded concepts of fitness and nature to clarify the distinction between health as good functioning and disease as dysfunction. The conclusion is that Wolff’s mechanist view of living bodies and his realism about biological functions are just one side of the coin; the other is his commitment to a normative view of the human body’s nature and purposes. (shrink)

Vision is the main entrance for environmental input to the human brain. Even if vision is our most used sensory modality, its importance is not limited to environmental exploration. Rather it has strong links to motor competences, further extending to cognitive and social aspects of human life. These multifaceted relationships are particularly important in developmental age and become dramatically evident in presence of complex deficits originating from visual aberrancies. The present review summarizes the available neuropsychological evidence on the development of (...) visual competences, with a particular focus on the associated visuo-motor integration skills in health and disease. With the aim of supporting future research and interventional settings, the goal of the present review is to constitute a solid base to help the translation of neuropsychological hypotheses into straightforward empirical investigations and rehabilitation/training protocols. This approach will further increase the impact, ameliorate the acceptance, and ease the use and implementation of lab-derived intervention protocols in real-life situations. (shrink)

The phenomenon of self-healing forces has again and again challenged doctors in the different historical periods of medical science. They relied on effects of self-healing forces in diagnosis and therapy. They also tried to explain these effects based on the current model of organism. The understanding of this phenomenon has always influenced the understanding of therapy and played a role in defining the concept of health and disease. In the 17th and 18th century the idea of self-healing force (...) was interpreted as a phenomenon related to the organic forces, whereas in the 19th century the explanation was reduced to a materialistic mechanism. Nowadays the knowledge of heath-shock-proteins open the way of a new understanding of the organic defense mechanisms. (shrink)

Health and illness are key concepts of medicine but they also have essential significance for each and every one of our lives. For this reason, social value systems are inevitably integrated into medicine through the concept of health and illness. In turn, medical knowledge and medico-scientific notions are perpetually incorporated into societal perceptions of health and illness. Generally, such integration usually occurs via an extended concept of health and illness, which is to be discussed in the (...) following. To a certain extent, medical and societal notions of health are mutually co-determined. The underlying dynamics deserve a closer look because if health and illness are societal and medical concepts alike this fundamentally impacts on the epistemological and the practical dimension of diagnosis and prognosis as discussed in this volume of Medicine Studies. (shrink)

Introduction to the book symposium “THE BIOPSYCHOSOCIAL MODEL OF HEALTH AND DISEASE: NEW PHILOSOPHICAL AND SCIENTIFIC DEVELOPMENTS BY DEREK BOLTON AND GRANT GILLETT”.

Sense of agency is a compelling but fragile experience that is augmented or attenuated by internal signals and by external cues. A disruption in SoA may characterise individual symptoms of mental illness such as delusions of control. Indeed, it has been argued that generic SoA disturbances may lie at the heart of delusions and hallucinations that characterise schizophrenia. A clearer understanding of how sensorimotor, perceptual and environmental cues complement, or compete with, each other in engendering SoA may prove valuable in (...) deepening our understanding the agency disruptions that characterise certain focal neurological disorders and mental illnesses. Here we examine the integration of SoA cues in health and illness, describing a simple framework of this integration based on Bayesian principles. We extend this to consider how alterations in cue integration may lead to aberrant experiences of agency. (shrink)

The traditional contrast between naturalist and normativist disease concepts fails to capture the most salient features of the health concepts debate. By using health concepts as a window on background notions of medical science and ethics, I show how Christopher Boorse (an influential naturalist) and Lennart Nordenfelt (an influential normativist) actually share deep assumptions about the character of medicine. Their disease concepts attempt, in different ways, to shore up the same medical model. For both, health (...) concepts function like demarcation criteria in the philosophy of science: they mark off the jurisdiction of medical science, and protect it from an inappropriate intrusion of socioeconomic factors, which threaten the integrity of modern medicine. These views are challenged by new developments in healthcare such as managed care and total quality review. To frame the health concepts debate in a way that better captures the issues integral to these new developments, I advance a new way of reading the distinction between weak and strong normativists. Strong normativists are skeptical of the demarcation project, think facts and values cannot be disentangled, and hold that socioeconomic conditions unavoidably influence how pathology is understood. The new health concepts debate should be framed as one between weak and strong normativists, and it concerns how we should respond to the current developments in health care. (shrink)