While classifications of mental disorders have existed for over one hundred years, it still remains unspecified what terms such as 'mental disorder', 'disease' and 'illness' might actually denote. While ontologies have been called in aid to address this shortfall since the GALEN project of the early 1990s, most attempts thus far have sought to provide a formal description of the structure of some pre-existing terminology or classification, rather than of the corresponding structures and processes on the side of the (...) patient. We here present a view of mental disease that is based on ontological realism and which follows the principles embodied in Basic Formal Ontology and in the application of BFO in the Ontology of General Medical Science. We analyzed statements about what counts as a mental disease provided in the research agenda for the DSM-V, and in Pies' model. The results were used to assess whether the representational units of BFO and OGMS were adequate as foundations for a formal representation of the entities in reality that these statements attempt to describe. We then analyzed the representational units specific to mental disease and provided corresponding definitions. Our key contributions lie in the identification of confusions and conflations in the existing terminology of mental disease and in providing what we believe is a framework for the sort of clear and unambiguous reference to entities on the side of the patient that is needed in order to avoid these confusions in the future. (shrink)

In this paper, I examine the transition from zymotic views of disease to germ views in Britain in the mid-1800s. I argue that neither realist nor anti-realist accounts of theory-change can account for this case, because both rely on a well-defined notion of theory, which, as the paper will show, is inapplicable in this instance. After outlining the zymotic theory of disease, I show that, even though it hardly had anything in common with the germ theory, it was (...) highly successful. However, despite this success, it is not possible to identify stable elements that were carried over to the germ theory; thus, realists cannot account for the shift from one to the other. Anti-realists, however, don’t do much better: their focus tends to be on (radical) discontinuities across theories, yet the zymotic case does not exemplify this, either. Instead, there is a slow and complex evolution from zymotic to germ views, during which various zymotic elements are assimilated into the germ theory, until, eventually, none of the zymotic theory’s original elements are left. (shrink)

HARWOOD L and CLARK AM. Nursing Inquiry 2012; 19: 29–38 Understanding health decisions using critical realism: home‐dialysis decision‐making during chronic kidney diseaseThis paper examines home‐dialysis decision making in people with Chronic Kidney Disease (CKD) from the perspective of critical realism. CKD programmes focus on patient education for self‐management to delay the progression of kidney disease and the preparation and support for renal replacement therapy e.g.) dialysis and transplantation. Home‐dialysis has clear health, societal and economic benefits yet (...) service usage is low despite efforts to realign resources and educate individuals. Current research on the determinants of modality selection is superficial and insufficient to capture the complexities embedded in the process of dialysis modality selection. Predictors of home‐dialysis selection and the effect of chronic kidney disease educational programmes provide a limited explanation of this experience. A re‐conceptualization of the problem is required in order to fully understand this process. The epistemology and ontology of critical realism guides our knowledge and methodology particularly suited for examination of these complexities. This approach examines the deeper mechanisms and wider determinants associated with modality decision making, specifically who chooses home dialysis and under what circumstances. Until more is known regarding dialysis modality decision making service usage of home dialysis will remain low as interventions will be based on inadequate epistemology. (shrink)

The main purpose of this paper is to test structural realism against (one example from) the historical record. I begin by laying out an existing challenge to structural realism -- that of providing an example of a theory exhibiting successful structures that were abandoned -- and show that this challenge can be met by the miasma theory of disease. However, rather than concluding that this is an outright counterexample to structural realism, I use this case to (...) show why it is that structural realism, in its current form, has trouble dealing with theories outside physics. I end by making some concrete suggestions for structural realists to pursue if, indeed, they are serious about extending structural realism to other domains. (shrink)

Newborn screening for the genetic disease phenylketonuria (PKU) is generally considered the greatest success story of applied human genetics. Even those generally skeptical of the value of genetic testing often comment enthusiastically on this program. In fact, PKU screening has been plagued with serious problems since its inception in the early 1960s. This essay describes some of these difficulties and asks what lessons they hold for other screening programs. It also argues that realism in our assessment of such (...) programs requires that we pay greater attention to the concrete experience of families. How screening should work in theory is of less importance than how it does work in practice. (shrink)

The empirical evidence often justifies belief in scientific theories. For instance, the great wealth of chemical and other relevant data leaves us with no real alternative to believing that matter is made of atoms. Similarly, the natural history of past and present organisms makes it irrational to deny that life on earth has evolved from a common ancestry. Again, the character and epidemiology of infectious diseases effectively establishes that they are caused by microbes. Peter Lipton did much to illuminate the (...) logic of these and many similar inferences. Often the observed facts admit of only one good theoretical explanation. Rationality therefore dictates that we infer the truth of this explanation. (shrink)

The concept of disease has been the subject ofa vast, vivid and versatile debate. Categoriessuch as ``realist'', ``nominalist'', ``ontologist'',``physiologist'', ``normativist'' and``descriptivist'' have been applied to classifydisease concepts. These categories refer tounderlying theoretical frameworks of thedebate. The objective of this review is toanalyse these frameworks. It is argued that thecategories applied in the debate refer toprofound philosophical issues, and that thecomplexity of the debate reflects thecomplexity of the concept itself: disease is acomplex concept, and does not easily lenditself to (...) definition. (shrink)

Alzheimer's disease, a form of senile dementia, is characterised by two kinds of pathological deposits in the brain, called plaques and tangles. The molecular nature of the deposits has been identified but there is as yet little understanding of the underlying biochemistry and cell biology that lead to their formation. Progress in this area would be greatly aided by a realistic animal model. Two recent papers describe the production of transgenic mice that develop significant aspects of Alzheimer‐like pathology. The (...) mice produced by Games et al.(1) develop plaques while those produced by Götz et al.(2) display the early stages of tangle pathology. (shrink)

I argue that neither realist nor anti-realist accounts of theory-change can account for the transition from zymotic views of disease to germ views. The trouble with realism is its focus on stable and continuous elements that get retained in the transition from one theory to the next; the trouble with anti-realism is its focus on the radical discontinuity between theories and their successors. I show that neither of these approaches works for the transition from zymes to germs: (...) there is neither continuity nor discontinuity, but, instead, a gradual evolution from zyme to germ views, during which germ elements are slowly incorporated into zymotic views until, eventually, none of the original zymotic constituents are left. I argue that the problem with both realism and anti-realism is that they rest on the unwarranted assumption that there are clearly delineated zymotic and germ theories as well as arguments for and against these theories, an assumption that does not hold. (shrink)

"Partial realism" is a common position in the contemporary philosophy of science literature. It states that the "essential" elements of empirically successful scientific theories accurately represent corresponding features the world. This thesis makes several novel contributions related to this position. Firstly, it offers a new definition of the concept of “empirical success”, representing a principled merger between the use-novelty and unification accounts. Secondly, it provides a comparative critical analysis of various accounts of which elements are "essential" to the success (...) of a theory, including structural realism and the divide et impera strategy. A novel account of essentialness, entitled the “empirically successful sub-theory "account", is defended. Thirdly, it is argued that the realism/anti-realism debate should put to the side metaphysical questions and focus instead on partial realism's commitment to the continuity of science. Because this commitment lacks metaphysical implications, it is referred to as "deflationary realism". Anti-realists cannot reject deflationary realism as a matter of a priori principle; its overall viability can therefore only be assessed by a careful examination of the history of science. Finally, another consequence of partial realism, named "partial rationalism", is defended. Partial rationalism states that, in cases where several competing theories have been suggested, scientists are rational just in case they accept the essential elements of each of the scientific theories on offer. This novel position subverts the existing literature on scientific "revolutions", as it sometimes demands that scientists devise a synthesis between competing scientific theories, instead of "choosing" only one. The philosophical points defended in this thesis are illustrated and supported by case studies from the history of science, including Fresnel’s wave theory of light, the Copernican revolution, the "neo-Darwinian synthesis" in evolutionary biology, the "prion revolution" in molecular biology, the miasma theory of disease, and the chemical revolution. (shrink)

It has recently been suggested that realist responses to historical cases featured in pessimistic meta-inductions are not as successful as previously thought. In response, selective realists have updated the basic divide et impera strategy specifically to take such cases into account and to argue that more modern realist accounts are immune to the historical challenge. Using a case study—that of the nineteenth-century zymotic theory of disease—I argue that these updated proposals fail and that even the most sophisticated recent realist (...) accounts remain vulnerable to the challenge from history. (shrink)

In the traditional philosophical debate over different conceptual analyses of “disease,” it is often presupposed that “disease” is univocally definable and that there are clear boundaries which distinguish this univocal category “disease” from the category of “nondisease.” In this paper, I will argue for a shift in the discussion on the concept of “disease” and propose an alternative, pragmatic approach that is based on the conviction that “disease” is not a theoretical concept but a practical (...) term. I develop a view on which our use of the term “disease” is determined by two interacting factors, namely, value-laden considerations about the desirabilty of certain states and discoveries of cause which is/are explanatorily relevant. I show how these factors interact with regard to a taxonomy of kinds of diseases. This pragmatic approach will not lead me to a final definition of “disease,” but will result in a more realistic description of the way we build, use, apply, and change our concept of “disease.” Meanwhile, it is useful as a basis for critical reflection on disease-labeling in medicine. (shrink)

Mental and behavioral disorders represent a significant portion of the public health burden in all countries. The human cost of these disorders is immense, yet treatment options for sufferers are currently limited, with many patients failing to respond sufficiently to available interventions and drugs. High quality ontologies facilitate data aggregation and comparison across different disciplines, and may therefore speed up the translation of primary research into novel therapeutics. Realism-based ontologies describe entities in reality and the relationships between them in (...) such a way that – once formulated in a suitable formal language – the ontologies can be used for sophisticated automated reasoning applications. Reference ontologies can be applied across different contexts in which different, and often mutually incompatible, domain-specific vocabularies have traditionally been used. In this contribution we describe the Mental Functioning Ontology (MF) and Mental Disease Ontology (MD), two realism-based ontologies currently under development for the description of humanmental functioning and disease. We describe the structure and upper levels of the ontologies and preliminary application scenarios, and identify some open questions. (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)

Learning and development are often linked in the organization studies literature. To understand the dynamics of organizational moral development, this paper utilizes the notion of organizational moral learning (OML). It is explored using three perspectives: organizational learning, Islamic and critical realist perspectives. The perspectives are then synthesized together to form a single framework, called the OML by ‘spiritual hearts’ framework. At the centre of the framework is the spiritual heart, the seat of profound understanding and moral consciousness. The heart plays (...) a central role in organizational moral development, especially with regard to its potential to be ‘purified’ and corrupted. Two extreme parameters then are created: on one side is the ‘purified hearts’ with high moral consciousness contributing towards OML, and on the other is the ‘corrupted hearts’ with high immoral consciousness contributing towards organizational immoral learning. Between the two extremes are the ‘diseased hearts’, possessing a mixture of moral and immoral consciousness to various degrees, and have the potentials to contribute to both moral and immoral developments. The paper further suggests strategies to facilitate OML and simultaneously inhibits organizational immoral learning. (shrink)

Disease-specific stem cell therapies, created from induced pluripotent stem cell lines containing the genetic defects responsible for a particular disease, have the potential to revolutionize the treatment of refractory chronic diseases. Given their capacity to differentiate into any human cell type, these cell lines might be reprogrammed to correct a disease-causing genetic defect in any tissue or organ, in addition to offering a more clinically realistic model for testing new drugs and studying disease mechanisms. Clinical translation (...) of these therapies provides an opportunity to design a more systematic, accessible and patient-influenced model for the delivery of medically innovative treatments to chronically ill patients. (shrink)

Since the September 11 attacks, a new security agenda has swept aside much of the old sensitivity and apathy about intervening in “failing” states. The war on terror has redefined “governance” from concentrating on issues of economic viability and popular rights to a focus on the capacity of states to generate sufficient “order” to deter or capture the agents of the new transnational security threats: terrorists, smugglers, money launderers, the carriers of zoonotic disease. As part of this process, the (...) governance standards of other states became part of Western states' own security agendas, generating new, self-interested incentives for aid and intervention. In this article, I explore the possibilities for developing a realist-informed normative framework for humanitarian intervention in the context of the post–September 11international concern with transnational threats. (shrink)

The biopsychosocial (BPS) model has been of considerable utility to those researching health and illness. This has been particularly the case for critical realists and those with a systemic orientation to their work. Whilst the strengths of the model are conceded in this article, its limitations are also examined. These relate to its ontological sophistication being compromised by its proneness to epistemological naivety. It is a model to explain the emergence of disease and disability, not a reflexive theory applicable (...) to the whole field of health research. This tension is linked to the emergence of a re-orientation of medical knowledge away from bio-medical reductionism. From the outset the model was not about a general critique, or a grand theory, of health and illness. Instead it was a useful intervention, on the part of medical practitioners, like George Engel and Adolf Meyer, to create a reformed medical model on behalf of their profession. Case studies of the problematics of diagnosis and medicalization are offered to illuminate the limitations of the BPS model for health researchers. (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)

Our philosophical understanding of mental illness is being shaped by neuroscience. However, it has the paradoxical effect of igniting two radically opposed groups of philosophical views. On one side, skepticism and denialism assume that, lacking clear biological mechanisms and etiologies for most mental illnesses, we should infer they are constructions best explained by means of social factors. This is strongly associated with medical nihilism: it considers psychiatry more harmful than benign. On the other side of the divide, naturalism and reductionism (...) are on the look for failures in the biological functioning of the organism whenever a genuine mental illness occurs. Psychiatry as currently practiced, accordingly, exhibits the gaps of an ongoing research programme; a yet to be completed neuroscience would link mental illnesses with identifiable biological mechanisms. Both sides of this divide claim to be fostered by scientific discoveries and advances in neuroscience, when taken at face value. Against this background, we argue instead for a modest view. To that end, we draw attention to some nuances in the scientific realism debate. While contending that neuroscientific theories and models aim to provide true representations of their target systems, and can justifiably claim to have attained some, we argue that our confidence should not be placed beforehand in specific features of these scientific representations. Hence, it would be unwarranted to extract morals for psychiatry from posits (or their absence) in neuroscientific explanations of mental illnesses. To illustrate our position, we examine some recent discoveries in neuroscience concerning bipolar disorder. We conclude by linking our topic to a broader issue in the philosophy of medicine: insofar as psychiatry is a biomedical specialty, its classifications of health and disease are guided by pragmatic concerns, as well as by scientific discoveries. (shrink)

The classification of ageing as a disease is fundamental to developing new pharmacological strategies that can target said phenomenon. The European Medicines Agency does not do this and maintains a questionable perspective based on the traditional naturalistic argument and the value-free ideal. An alternative is proposed which, inspired by consequentialism, is committed to considering ageing as a disease in European regulatory contexts as long as the ethical consequences are desirable. Within a realistic framework, I show that making this (...) decision would have moderate positive effects such as increased knowledge about antiageing pharmacology or potential greater chances of completing vital projects. Furthermore, we will see that the main arguments used by critics to show that the negative effects outweigh the positive ones are not sound. Therefore, I conclude that it would be beneficial for the European Medicines Agency to change its position on ageing. (shrink)

Ecosystem health, as James Nelson argues, must be understood as having both descriptive and normative content; it is in this sense a 'morally thick' concept. The health analogy refers (a) at the similarities between conservation ecology and medicine or plant pathology as normative sciences, and (b) to the ability of ecosystems to 'heal' themselves in the face of disturbances. Nelson, however, goes beyond these two aspects and argues that judgements of illness in ecosystems only support moral obligations to protect them (...) if they are attributed a 'good of their own'. But this latter extension of the analogy flies in the face of ecological science, which has been forced to abandon organicism. If one separates the question of the warranted assertibility of environmentalists' goals from the question of where values in nature are located, the search for an objective realm of value realism can be seen to be unnecessary. (shrink)

In recent years, philosophers have identified a number of moral and psychological harms associated with the attention economy (Alysworth & Castro, 2021; Castro & Pham, 2020; Williams, 2018). Missing from many of these accounts of the attention economy, however, is what exactly attention is. As a result of this neglect of the cognitive science of attention, many of these accounts are not empirically credible. They rely on oversimplified and unsophisticated accounts of not only attention, but self- control, and addiction as (...) well. Of note are accounts of the attention economy that rely on the ‘brain disease’ rhetoric of addiction and subsequent control failures (Aylsworth & Castro, 2021; Bhargava & Velasquez, 2021), accounts that rely on a strict dichotomy of top-down vs. bottom-up attention (Williams, 2018; Aylsworth & Castro, 2021), and accounts that construe attention as a limited resource (Williams, 2018). -/- Drawing on recent work from the neuroscience and psychology of attention, I demonstrate the shortcomings of these accounts and sketch a way forward for an empirically grounded account of the attention economy. These accounts tend to uphold strict dichotomies of voluntary control (e.g., compulsion versus choice, dual-process models of self-control, and top-down versus bottom-up) that cannot account for the complexities of attentional control, mental agency, and decision-making. As such, these empirically and conceptually impoverished accounts cannot adequately address the current so-called crisis of attention. To better understand the harms associated with the attention economy, we need an empirically responsible account of the nature and function of attention and mental agency. (shrink)

Ludwik Fleck’s Genesis and Development of a Scientific Fact is an extended argument for the inclusion of social factors in the history and philosophy of science. Fleck uses the history of syphilis as his case study, which falls into two parts. In the first two chapters of his book, Fleck presents a history of the change of the concept of syphilis as a “carnal scourge with strong moralistic connotations” in the middle ages to the modern concept of syphilis as an (...) infectious disease (1979, 77). In the second part of the book, he presents a detailed account of the development of a serum test for syphilis, the Wasserman reaction. Fleck also argues that perception is theory-laden, for example, in his comparative study of anatomical drawings, and for the importance of social pressures on the development of science, for example, in his discussion of the rivalry between nations to first develop a cure for syphilis, as demanded by politicians (1979, 133 ff. and 68). (shrink)

Rationale One's understanding of medical progress – what it is, how it is pursued and how it is assessed – may be deeply dependent on one's understanding of the metaphysics of medicine, and of diseases in particular. -/- Aims and Objectives In this paper I present a new account of the nature of diseases, neither realist nor constructivist, and describe what progress in medicine looks like if we understand diseases in this way. -/- Conclusions This new account, Constructive Realism, (...) may provide a better account of medicine than either realism or constructivism. (shrink)

The ontology of medicine—the question of whether disease entities are real or not—is an underdeveloped area of philosophical inquiry. This essay explains the primary question at issue in medical ontology, discusses why answering this question is important from both a philosophical and a practical perspective, and argues that the problem of medical ontology is unique, i.e., distinct, from the ontological problems raised by other sciences and therefore requires its own analysis.

We investigate the nature of the sense of presence that usually accompanies perceptual experience. We show that the notion of a sense of presence can be interpreted in two ways, corresponding to the sense that we are acquainted with an object, and the sense that the object is real. In this essay, we focus on the sense of reality. Drawing on several case studies such as derealization disorder, Parkinson’s disease and virtual reality, we argue that the sense of reality (...) is two-way independent from the spatial and sensory contents of experience. We suggest that the sense of reality is an affective experience akin to a metacognitive feeling. Finally, we present a potentially important implication of our account for the current debate between Intentionalism and Naïve Realism. Since perception is “opaque” with respect to the reality of what is perceived, Intentionalism cannot refer to the sense of reality as what differentiates perception from sensory-like experiences such as imaginings. In contrast, Naïve Realism has an independent explanation of the specificity of perception. (shrink)

Definition of the problem: In 1997, Percutaneous Transluminal Coronary Angioplasty (PTCA) was performed in 138.001 cases in Germany. The standard indications, single vessel disease and badly controlled angina, are more and more extended to multivessel disease with and without severe angina, unstable or preinfarction angina, and acute myocardial infarction (AMI) itself. Dilating asymptomatic stenoses of more than 70–80% is a widely used indication, intending prophylaxis of complete occlusion and AMI. Actually there is no generally accepted guideline for the (...) different new indications, conservative versus invasive treatment schedule. It is difficult for the patient to get appropriate information before his decision between mechanical procedures and conservative methods; authentic informed consent actually seems to be in a very bad position. In 1992 the working group called ”Arbeitsgemeinschaft leitender kardiologischer Krankenhausärzte (ALKK)” decided to start a registry of all PTCA procedures, in order to gain knowledge about the present status of PTCA in Germany. Up to March 1999, 198.608 PTCA are logged.Arguments: Each PTCA was included on an intention-to-treat basis. The registry succeeded in a nearly complete recording with 98,6% of all PTCA procedures complete on March 17th, 1999. 93,5% of stenosed and 72,2% of the total occluded vessels were successfully dilated. In 4.729 cases (2,63%) the PTCA caused severe complications. The overall in-hospital mortality was only 0,5%, if the procedures done for AMI were excluded (including AMI it was 1,1%). The calculation of complications should be an essential part of the patients informed consent.Conclusion: Complete recording of all PTCA procedures is feasible even on a nationwide basis. Some results of the registry, as the indication control and the complication rate may help to realize a better doctor-patient-conversation on risks and benefits of either concept. The trend of many CHD patients is ”modern”: It should be done what can be done (mechanically), with results at once. Although said somehow paternalistic, this point of view cannot be tolerated: Proper informed consent today includes the realistic alternative of modern medicaments, especially those with an aggressive cholesterol lowering potency. (shrink)

Within philosophy of medicine it has been a widespread view that there are important theoretical and practical reasons for clarifying the nature of basic health concepts like disease, illness and sickness. Many theorists have attempted to give definitions that can function as general standards, but as more and more definitions have been rejected as inadequate, pessimism about the possibility of formulating plausible definitions has become increasingly widespread. However, the belief that no definitions will succeed since no definitions have succeeded (...) is an inductive objection, open to realist responses. The article argues that an influential argument from philosophy of language constitutes a more fundamental objection. I use disease as an example and show that this argument implies that if a common understanding of disease can be analysed into a definition, then this is a non-trivial definition. But any non-trivial analysis must be viciously circular: the analysis must presuppose that disease can be defined, but this is what the analysis is supposed to yield as a result. This means, the article concludes, that disease and other controversial health concepts do not have analyses grounded in a common language. Stipulative and contextual definitions can have local significance, but the normative roles of such definitions are at the same time limited. (shrink)

Stem cell research has entered the public consciousness through the media. Proponents and opponents of all such research, or of human embryonic stem cell research specifically, engage in heated exchanges in the modern public forum where stakeholders negotiate, the agora. One common claim that emerges from the fray is that a particular type of stem cell research should be pursued as the most promising path toward the reduction of suffering and untimely death for all of humanity. Upon evaluation, experimental data (...) regarding the potential role of stem cells in regenerative therapies for three conditions—spinal cord injury, type 1 diabetes, and cardiovascular disease—tell distinct, complex, and inconclusive stories. Further analyses in this article incorporate realistic considerations of a broad range of relevant factors--limited funding for biomedical research, media motives, the discordance hypothesis of evolutionary medicine, the relationship between religion and science, medical care in developing nations, and culture wars over abortion. Holistic investigation inspired by the current agora conversation supports the need to drastically change interactions regarding stem cell research so that its potential to benefit humanity may be more fully realized. (shrink)

Jonathan Y. Tsou examines and defends positions on central issues in philosophy of psychiatry. The positions defended assume a naturalistic and realist perspective and are framed against skeptical perspectives on biological psychiatry. Issues addressed include the reality of mental disorders; mechanistic and disease explanations of abnormal behavior; definitions of mental disorder; natural and artificial kinds in psychiatry; biological essentialism and the projectability of psychiatric categories; looping effects and the stability of mental disorders; psychiatric classification; and the validity of the (...) DSM's diagnostic categories. The main argument defended by Tsou is that genuine mental disorders are biological kinds with harmful effects. This argument opposes the dogma that mental disorders are necessarily diseases that result from biological dysfunction. Tsou contends that the broader ideal of biological kinds offers a more promising and empirically ascertainable naturalistic standard for assessing the reality of mental disorders and the validity of psychiatric categories. (shrink)

The authors discuss concepts of health and disease in Chinese medicine, new interpretative techniques in psychotherapy, concepts of culture and the notion of risk, Brecht's and Wallner's Verfremdung and Wallner's Constructive Realism compared to Glasersfeld's Radical Constructivism. The book shows the rare situation of philosophy becoming concrete.

Definitive diagnosis of malaria requires the demonstration through laboratory tests of the presence within the patient of malaria parasites or their components. Since malaria parasites can be present even in the absence of malaria manifestations, and since symptoms of malaria can be manifested even in the absence of malaria parasites, malaria diagnosis raises important issues for the adequate understanding of disease, etiology and diagnosis. One approach to the resolution of these issues adopts a realist view, according to which the (...) needed clarifications will be derived from a careful representation of the entities on the side of the patient which form the ultimate truthmakers for clinical statements. We here address a challenge to this realist approach relating to the diagnosis of malaria, and show how this challenge can be resolved by appeal to Basic Formal Ontology (BFO) and to the Ontology for General Medical Science (OGMS) constructed in its terms. (shrink)

This paper addresses a family of issues surrounding the biological phenomenon of resistance and its representation in realist ontologies. The treatments of resistance terms in various existing ontologies are examined and found to be either overly narrow, internally inconsistent, or otherwise problematic. We propose a more coherent characterization of resistance in terms of what we shall call blocking dispositions, which are collections of mutually coordinated dispositions which are of such a sort that they cannot undergo simultaneous realization within a single (...) bearer. A definition of ‘protective resistance’ is proposed for use in the Infectious Disease Ontology (IDO) and we show how this definition can be used to characterize the antibiotic resistance in Methicillin-Resistant Staphylococcus aureus (MRSA). The ontological relations between entities in our MRSA case study are used alongside a series of logical inference rules to illustrate logical reasoning about resistance. A description logic representation of blocking dispositions is also provided. We demonstrate that our characterization of resistance is sufficiently general to cover two other cases of resistance in the infectious disease domain involving HIV and malaria. (shrink)

The neurologist Oliver Sacks has become very famous for his writings. His popularity has scattered all mass medias. In his books, he eloquently tells stories about patients suffering from extraordinary neurological diseases. Since the conceptual framework of Sacks' narratives has been widely unconsidered, this article pursues a more general and systematic approach to his work. Sacks terms his idiographic and phenomenological access to the world of science Romantical Science. With its features, he develops a concept of a Neurology of Identity, (...) that is basically concerned with the patient's personality and subjectivity. Sacks' personal approach to medicine implies another understanding of diseases: For him, diseases cannot be reduced to pathological facts, they constitute other worlds. He characteristically uses philosophical, psychological and mythical terms for interpretation and narration. But conversely to its sympathetic appearance, Sacks' approach entails some deficits: His presentation is not always realistic, his interpretations are often one-sided. The theoretical reflections on his method and attitude remain poor. Nevertheless, he puts medicine back into lifeworld to open it for many discourse universes beyond science in practice and theoretical reflection. (shrink)

SummaryTake the following version of scientific realism: we have good reason to believe that (some of the) current scientific theories tell us something specific about the underlying, i.e. unobservable, structures of the world, for instance that there are electrons with a certain electric charge, or that there are viruses that cause certain diseases. Popper, the rationalist, would not have adhered to the proposed formulation of scientific realism in terms of the rationality of existential beliefs concerning unobservables. Popper did (...) not believe in belief. According to Van Fraassen, the empiricist, one may yet have a rational existential belief concerning unobservables, given a liberal notion of rationality of belief. In this paper I will investigate to what extent a reassessment of both Popper’s rejection of the rationality of belief and Van Fraassen’s reformulation of the rationality of belief, points towards a new and pragmatist dissolution of the ‘problem of scientific realism’. (shrink)

Involving patients in decisions on primary prevention can be questioned from an ethical perspective, due to a tension between health promotion activities and patient autonomy. A nurse-led intervention for prevention of cardiovascular diseases, including counselling (risk communication, and elements of shared decision-making and motivational interviewing) and supportive tools such as a decision aid, was implemented in primary care. The aim of this study was to evaluate the nurse-led intervention from an ethical perspective by exploring in detail the experiences of patients (...) with the intervention, and their views on the role of both the nurse and patient. The study had a qualitative design. 18 patients who had received the intervention participated. Data were gathered by in-depth interviews. The interviews were analysed using directed content analysis. The findings revealed that patients perceived the consultations not as an infringement on their autonomy, but as supportive to risk reduction efforts they tried but found hard to realise. They specifically emphasised the role of the nurse, and appreciated the nurse's realistic advice, encouragement, and help in understanding. Patients' views on and experiences with risk management are in line with notions of relational autonomy, caring cooperation and communicative action found in the literature. We conclude that patients define the relationship with the nurse as shared work in the process of developing a healthier lifestyle. (shrink)

The unchanging realities of race relations in the United States, recently highlighted by the catastrophe of Hurricane Katrina, demonstrate that Black Americans are still not viewed, treated or protected as citizens in this country. The rates of poverty, disease and incarceration in Black communities have been recognized by some Critical Race Theorists as genocidal acts. Despite the appeal to the international community’s interpretation of human rights, Blacks are still the most impoverished and lethally targeted group in America. Given the (...) “white racial framing” that stems from “white habitus,” and enforced systemically, the situation of Black Americans is best described through a racial realist perspective, in which racial equality is merely an illusion. Under such dire colonial circumstances, I argue that there should be a renewed discussion on the role that violence and decolonization can play in the American context. (shrink)

In recent years, genetically engineered (GE) mosquitoes have been proposed as a public health measure against the high incidence of mosquito-borne diseases among the poor in regions of the global South. While uncertainties as well as risks for humans and ecosystems are entailed by the open-release of GE mosquitoes, a powerful global health governance non-state organization is funding the development of and advocating the use of those bio-technologies as public health tools. In August 2016, the US Food and Drug Agency (...) (FDA) approved the uncaged field trial of a GE Aedes aegypti mosquito in Key Haven, Florida. The FDA’s decision was based on its assessment of the risks of the proposed experimental public health research project. The FDA is considered a global regulatory standard setter. So, its approval of the uncaged field trial could be used by proponents of GE mosquitoes to urge countries in the global South to permit the use of those bio-technologies. -/- From a public health ethics perspective, this paper evaluates the FDA’s 2016 risk assessment of the proposed uncaged field trial of the GE mosquito to determine whether it qualified as a realistic risk evaluation. -/- The FDA’s risk assessment of the proposed uncaged field trial did not proximate the conditions under which the GE mosquitoes would be used in regions of the global South where there is a high prevalence of mosquito-borne diseases. -/- Given that health and disease have political-economic determinants, whether a risk assessment of a product is realistic or not particularly matters with respect to interventions meant for public health problems that disproportionately impact socio-economically marginalized populations. If ineffective public health interventions are adopted based on risk evaluations that do not closely mirror the conditions under which those products would actually be used, there could be public health and ethical costs for those populations. (shrink)

Kidney transplantation is the most efficacious and cost-effective treatment for end-stage renal disease. However, the treatment’s accessibility is limited by a chronic shortage of transplantable kidneys, resulting in the death of numerous patients worldwide as they wait for a kidney to become available. Despite the implementation of various measures the disparity between supply and needs continues to grow. This paper begins with a look at the current treatment options, including various sources of transplantable kidneys, for end-stage renal disease. (...) We propose, in accordance with others, the introduction of compensated kidney donation as a means of addressing the current shortage. We briefly outline some of the advantages of this proposal, and then turn to examine several of the ethical arguments usually marshaled against it in a bid to demonstrate that this proposal indeed passes the ethics test. Using available data of public opinions on compensated donation, we illustrate that public support for such a program would be adequate enough that we can realistically eliminate the transplant waiting list if compensation is introduced. We urge a pragmatic approach going forward; altruism in living kidney donation is important, but altruism only is an unsuccessful doctrine. (shrink)

Periodic attacks of uncertain origin, where the clinical presentationresembles epilepsy but there is no evidence of a somatic disease, arecalled Pseudo-Epilepsy or Pseudo-Epileptic Attack Disorder (PEAD). PEADmay be called a `non-disease', i.e. a disorder on the fringes ofestablished disease patterns, because it lacks a rationalpathophysiological explanation. The first aim of this article is tocriticize the idea, common in medical science, that diseases are realentities which exist separately from the patient, waiting to bediscovered by the doctor. We argue (...) that doctor and patient construct adisease, and that the construction of the disease PEAD includes manynormative evaluations. The second aim is to provide insight into thesuffering of patients with PEAD. We focus on three aspects of thepatient, identity, autonomy and responsibility. We present somecharacteristic descriptions of (pseudo-)epileptic attacks by FjodorDostoevsky, Gustave Flaubert and Thomas Mann. We argue that diagnosingPEAD reduces a meaningful life event into an insignificant, thoughintriguing, medical phenomenon, and that the patient will not benefitfrom being diagnosed as having PEAD. (shrink)

This paper offers four arguments against a moral human right to health, two denying that the right exists and two denying that it would be very useful (even if it did exist). One of my sceptical arguments is familiar, while the other is not.The unfamiliar argument is an argument from the nature of health. Given a realistic view of health production, a dilemma arises for the human right to health. Either a state's moral duty to preserve the health of its (...) citizens is not justifiably aligned in relation to the causes of health or it does not correlate with the human right to health. It follows that no one holds a justified moral human right to health against the state.Education and herd immunity against infectious disease both illustrate this dilemma. In the former case, the state's moral duty correlates with the human right to health only if it demands too much from a cause of health; and in the latter, only if it demands nothing from a cause of health (that is, too little). (shrink)

The rapid developments in technologies -- especially computing and the advent of many 'smart' devices, as well as rapid and perpetual communication via the Internet -- has led to a frequently voiced view which Nicholas Agar describes as 'radical optimism'. Radical optimists claim that accelerating technical progress will soon end poverty, disease, and ignorance, and improve our happiness and well-being. Agar disputes the claim that technological progress will automatically produce great improvements in subjective well-being. He argues that radical optimism (...) 'assigns to technological progress an undeserved pre-eminence among all the goals pursued by our civilization'. Instead, Agar uses the most recent psychological studies about human perceptions of well-being to create a realistic model of the impact technology will have. Although he accepts that technological advance does produce benefits, he insists that these are significantly less than those proposed by the radical optimists, and aspects of such progress can also pose a threat to values such as social justice and our relationship with nature, while problems such as poverty cannot be understood in technological terms. He concludes by arguing that a more realistic assessment of the benefits that technological advance can bring will allow us to better manage its risks in future. (shrink)

Through their transcript products genes regulate the rates at which an immense variety of transcripts and subsequent proteins occur. Understanding the mechanisms that determine which genes are expressed, and when they are expressed, is one of the keys to genetic manipulation for many purposes, including the development of new treatments for disease. Viewing each gene in a genome as a distinct variable that is either on or off, or more realistically as a continuous variable, the values of some of (...) these variables influence the values of others through the regulatory proteins they express, including, of course, the possibility that the rate of expression of a gene at one time may, in various circumstances, influence the rate of expression of that same gene at a later time. If we imagine an arrow drawn from each gene expression variable at a given time to a gene variable whose expression it influences a short while after, the result is a network, technically a directed acyclic graph. For example, the DAG in Figure 1 is a representation of a system in which the expression level of gene G1 at time 1 ) causes the expression level of G2, which in turn causes the expression level of G3. The arrows in Figure 1 which do not have a variable at their tails are “error terms” which represent all of the causes of a variable other than the ones explicitly represented in the DAG. The DAG describes more than associations—it describes causal connections among gene expression rates. A shock to a cell—by mutation, heating, chemical treatment, etc. may alter the DAG describing the relations among gene expressions, for example by activating a gene that was otherwise not expressed, producing a cascade of new expression effects. Although “knockout” experiments can reveal some of the underlying causal network of gene expression levels, unless guided by information from other sources, such experiments are limited in how much of the network structure they can reveal, due to the sheer number of possible combinations of experimental manipulations of genes necessary to reveal the complete causal network. Recent developments have made it possible to compare quantitatively the expression of tens of thousands of genes in cells from different sources in a single experiment, and to trace gene expression over time in thousands of genes simultaneously. cDNA microarrays are already producing extensive data, much of it available on the web. Thus there are calls for analytic software that can be applied to microarray and other data to help infer regulatory networks. In this paper we will review current techniques that are available for searching for the causal relations between variables, describe algorithmic and data gathering obstacles to applying these techniques to gene expression levels, and describe the prospects for overcoming these obstacles. (shrink)

Defining and identifying causal intervention effects for transmissible infectious disease outcomes is challenging because a treatment – such as a vaccine – given to one individual may affect the infection outcomes of others. Epidemiologists have proposed causal estimands to quantify effects of interventions under contagion using a two-person partnership model. These simple conceptual models have helped researchers develop causal estimands relevant to clinical evaluation of vaccine effects. However, many of these partnership models are formulated under structural assumptions that preclude (...) realistic infectious disease transmission dynamics, limiting their conceptual usefulness in defining and identifying causal treatment effects in empirical intervention trials. In this paper, we propose causal intervention effects in two-person partnerships under arbitrary infectious disease transmission dynamics, and give nonparametric identification results showing how effects can be estimated in empirical trials using time-to-infection or binary outcome data. The key insight is that contagion is a causal phenomenon that induces conditional independencies on infection outcomes that can be exploited for the identification of clinically meaningful causal estimands. These new estimands are compared to existing quantities, and results are illustrated using a realistic simulation of an HIV vaccine trial. (shrink)

BackgroundGene drive technologies (GDTs) promote the rapid spread of a particular genetic element within a population of non-human organisms. Potential applications of GDTs include the control of insect vectors, invasive species and agricultural pests. Whether, and if so, under what conditions, GDTs should be deployed is hotly debated. Although broad stances in this debate have been described, the convictions that inform the moral views of the experts shaping these technologies and related policies have not been examined in depth in the (...) academic literature.MethodsIn this qualitative study, we interviewed GDT experts (n = 33) from different disciplines to identify and better understand their moral views regarding these technologies. The pseudonymized transcripts were analyzed thematically.ResultsThe respondents’ moral views were principally influenced by their attitudes towards (1) the uncertainty related to GDTs; (2) the alternatives to which they should be compared; and (3) the role humans should have in nature. Respondents agreed there is epistemic uncertainty related to GDTs, identified similar knowledge gaps, and stressed the importance of realistic expectations in discussions on GDTs. They disagreed about whether uncertainty provides a rationale to refrain from field trials (‘risks of intervention’ stance) or to proceed with phased testing to obtain more knowledge given the harms of the status quo (‘risks of non-intervention’ stance). With regards to alternatives to tackle vector-borne diseases, invasive species and agricultural pests, respondents disagreed about which alternatives should be considered (un)feasible and (in)sufficiently explored: conventional strategies (‘downstream solutions’ stance) or systematic changes to health care, political and agricultural systems (‘upstream solutions’ stance). Finally, respondents held different views on nature and whether the use of GDTs is compatible with humans’ role in nature (‘interference’ stance) or not (‘non-interference stance’).ConclusionsThis interview study helps to disentangle the debate on GDTs by providing a better understanding of the moral views of GDT experts. The obtained insights provide valuable stepping-stones for a constructive debate about underlying value conflicts and call attention to topics that deserve further (normative) reflection. Further evaluation of these issues can facilitate the debate on and responsible development of GDTs. (shrink)

As a modern academic Ulysses, the historical scientist is enticed by numerous plausible scientific theories that can explain the historical data in search of the truth. However, the predicament of her work is to inevitably crash onto the rocks and cliffs of uncertainty. The problem discussed in this paper is that several scientific models can be suitable to account for the same empirical observations. The risk of falling into speculation is looming, and exceedingly dangerous in science. This is also the (...) case in archaeological sciences, such as bioarchaeology. A bioarchaeologist frequently encounters traces of disease in ancient skeletons, and pertinent patterns may often result from equally probable different causes. This is a methodological issue commonly encountered in the interpretation of pathological patterns in human remains, and constitutes part of the problem known in bioarchaeology as the osteological paradox. During an informal trilogue, three characters discuss the osteological paradox, and attempt to define it in philosophical terms. The aim of this work is to present the problems of scientists with the philosophical approach to the debate between scientific realism and antirealism, focusing in particular on the so-called problem of underdetermination. Our original approach is to apply the distinction between ‘how-possibly’ models and ‘how-actually’ models by Alisa Bokulich to archaeological issues, integrating various fields of science with a multidisciplinary and omnivorous approach. The trilogue ends providing the historical scientist with reasons and means to believe in her ability to conceive of true and reliable scientific models to interpret the historical past. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Philosophy, Psychiatry, & Psychology 3.2 (1996) 139-142 Concurrent Contents: Recent and Classic References at the Interface of Philosophy, Psychiatry, & Psychology Articles Abramowitz, S., C. Abramowitz, C. Jackson et al. 1973. The politics of clinical judgment. Journal of Consulting and Clinical Psychology 41: 385-391.Audi, R. N. 1972. Psychoanalytic explanation and the concept of rational action. The Monist 56: 444- 464.Barondess, J. A. 1979. Disease and illness--a crucial distinction. (...) American Journal of Medicine 66: 375-376.Barrett, R. J. 1988. Interpretations of schizophrenia. Culture, Medicine and Psychiatry 12: 357-388.Bechtel, W. 1993. The case for connectionism. Philosophical Studies 7: 119-154.Belzen, J. A. 1995. The impact of phenomenology on classical psychiatry: Rümke's position between Jaspers and Kraepelin. History of Psychiatry 6: 349-385.Benda, C. E. 1967. Neuroses of conscience. Journal of Existentialism 7: 425-442.Binns, P. 1995. Commentary on "Contentless consciousness." Philosophy, Psychiatry, & Psychology 2: 61-63.Blankenburg, W. 1980. Phenomenology and psychopathology. Journal of Phenomenological Psychology 11: 50-78.Bloomfield, T. M. 1979. Psychoanalysis: A human science? Journal for the Theory of Social Behavior 9: 271-287.Blumenfeld, D. 1972. Free action and unconscious motivation. The Monist 56: 426-443.Boudreaux, G. 1977. Freud on the nature of unconscious mental processes. Philosophy of the Social Sciences 7: 1-32.Bracken, P. J. 1995. Beyond liberation: Michael Foucault and the notion of a critical psychiatry. Philosophy, Psychiatry, & Psychology 2, no. 1: 1-13.Brazier, M. 1995. Commentary on "Who should be committable?." Philosophy, Psychiatry, & Psychology 2, no. 1: 49-50.Bursztajn, J., and A. Brodsky. 1995. Authenticity and autonomy in the managed-care era: Forensic psychiatric perspectives. Journal of Clinical Ethics 5, no. 3: 237-242.Byrnes, J. F. 1979. Suggestions on writing the history of psychological data. History and Theory 16: 297-305.Campbell, E. J., J. G. Scadding, and R. J. Roberts. 1979. The concept of disease. British Medical Journal 2: 757-762.Carveth, D. 1988. In reply to Eagle's reply on "The epistemological foundations of psychoanalysis." Philosophy of the Social Sciences 18: 377-378.Chadwick, R. F. 1995. Commentary on "Karl Jaspers and Edmund Husserl." Philosophy, Psychiatry, & Psychology 2, no. 1: 83-84.Christiansen, B. 1964. The scientific status of psychoanalytic clinical evidence (III). Inquiry 7: 47-79.Davis, M. 1987. Realistic utilitarianism and the social conditions of cognitive psychotherapy. Social Theory & Practice 13: 237-259.Dega, W., et al. 1978. Ethics and mental health: Discussion. Dialectics and Humanism 5: 219-235.Dingle, H. 1949. The logical status of psycho-analysis. Analysis 9: 63-66.Dupeau, J. 1977. Freud and degeneracy. Diogenes Spring: 43-64.Eagle, M. 1988. A reply to Carveth's "The epistemological foundations of psychoanalysis. Philosophy of the Social Sciences 18: 371-375.Elevitch, B. 1974-75. Reasons, motives and psychoanalysis. Philosophical Forum (Boston) 6: 143- 162.Elliot, P. 1995. Policies, identity, and social change: Contested grounds in psychoanalytic feminism. Hypatia 10: 41-55.Fabrega Jr, H. 1980. The position of psychiatric illness in biomedical theory: A cultural analysis. Journal of Medicine and Philosophy 5: 145-168.Fisk, G. 1993. Accreditation of psychotherapists. British Journal of Hospital Medicine 50: 437-438.Flynn, B. G. 1985. Reading Habermas reading Freud. Human Studies 8: 57-76.Forrow, L., R. M. Arnold, and J. Frader. 1991. Teaching clinical ethics in the residency years--preparing competent professionals. Journal of Medicine and Philosophy 16: 93-112.Friedman, M. 1982. Philosophical anthropology and psychotherapy. Philosophical Context 12: 9-19.Galdston, I. 1969. The ontologic foundations of morality. Existential Psychiatry 7: 69-75.Gardner, S. 1995a. Commentary on "Irrationality and the dynamic unconscious." Philosophy, Psychiatry, & Psychology 2, no. 2: 175-176.Gardner, S. 1995b. Psychoanalysis, science, and commonsense. Philosophy, Psychiatry, & Psychology 2, no. 2: 93-113.Handelsman, M. M. et al. 1995. Does legally mandated consent to psychotherapy ensure ethical appropriateness? The Colorado experience. Ethics and Behavior 5, no. 2: 119-129.Hanlon, M. D. 1977. Commentary on Dunham's "Psychiatry, Sociology and Civil Liberties." Values and Ethics in Health Care 2: 275-278.Heaton, J. M. 1972. Insight in... (shrink)