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.

Examining the naturalist and normativist concepts of health and disease this article starts with analysing the view of C. Boorse. It rejects Boorse's account of health as species-typical functioning, giving a critique of his view based on evolutionary theory of contemporary biology. Then it gives a short overview of the normativist theories of health, which can be objectivist and subjectivist theories. Rejecting the objectivist theories as philosophically untenable, it turns to the subjectivist theories of Gert (...) and Culver, and to the view of Nordenfelt. These theories give quite a good subjectivist account of health and disease, but they do not pay enough attention to the notion of the environment, without which it is impossible to define health and disease. Starting with their definitions but introducing the notion of “reasonable social norms”, the article arrives at the following definition of health: The healthier a physical or mental characteristic, process, reaction is, the more it makes it possible for the individual to adapt to reasonable social norms without pain and suffering, and the longer, and happier a life it will be able to ensure him in that society. (shrink)

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. (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?

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 (...) class='Hi'>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)

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 (...) class='Hi'>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)

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)

It is now widely accepted that the concepts of “health” and “disease” in psychiatric and psychological contexts are value laden. In this article I argue that even in the realm of physical illness and disease (appendicitis, phenylketonuria, etc.), the concepts of “health”, “illness” and "disease” are value laden. I explore the four most common bases used to objectively ground the key concept “normal functioning”, namely, genetic structure, evolutionary fitness, non-premature death and absence of (...) pain. I argue that they all fail to adequately provide an objective grounding for the. concept “normal functioning” (health) and, hence, for “abnormal functioning” (illness, disease). The reason an objective grounding cannot be given is that physical “health”, “illness” and “disease” rest on widely shared values in addition to the condition of the organism. (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)

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)

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)

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)

Contemporary philosophy of health has been quite focused on the problem of determining the nature of the concepts of health, illness and disease from a scientific point of view. Some theorists claim and argue that these concepts are value-free and descriptive in the same sense as the concepts of atom, metal and rain are value-free and descriptive. To say that a person has a certain disease or that he or she is unhealthy is (...) thus to objectively describe this person. On the other hand it certainly does not preclude an additional evaluation of the state of affairs as undesirable or bad. The basic scientific description and the evaluation are, however, two independent matters, according to this kind of theory. Other philosophers claim that the concept of health, together with the other medical concepts, is essentially value-laden. To establish that a person is healthy does not just entail some objective inspection and measurement. It presupposes also an evaluation of the general state of the person. A statement that he or she is healthy does not merely imply certain scientific facts regarding the person’s body or mind but implies also a (positive) evaluation of the person’s bodily and mental state. My task in this paper will be, first, to present the two principal rival types of theories and present what I take to be the main kind of reasoning by which we could assess these theories, and second, to present a deeper characterization of the principal rival theories of health and illness. (shrink)

A multifactorial and growing crisis of health care systems in the developed world has affected medicine. In order to provide rational responses, some central concepts of the past, such as the definitions of health and disease, need to be updated. For this purpose physicians should initiate a new debate. As a point of departure the following definitions are proposed: Health is a dynamic state of wellbeing characterized by a physical, mental and social potential, which satisfies (...) the demands of a life commensurate with age, culture, and personal responsibility. If the potential is insufficient to satisfy these demands the state is disease. This term includes sickness, illness, ill health, and malady. The described potential is divided into a biologically given and a personally acquired partial potential. Their proportions vary throughout the life cycle. The proposed definitions render it empirically possible to diagnose persons as healthy or diseased and to apportion some of the responsibility for their state of health to individuals themselves. Treatment strategies should always consider three therapeutic routes: improvements of the biologically given and of the personally acquired partial potentials and adaptations of the demands of life. These consequences favourably contrast with those resulting from the WHO-definition of health. (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)

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)

Philosophical discussions of health and disease have traditionally been dominated by a debate between normativists, who hold that health is an inescapably value-laded concept and naturalists, such as Christopher Boorse, who believe that it is possible to derive a purely descriptive or theoretical definition of health based upon biological function. In this paper I defend a distinctive view which traces its origins in Aristotle's naturalistic ethics. An Arisotelian would agree with Boorse that health and (...) class='Hi'>disease are ubiquitous features of the natural world and thus not mere projections of human interests and values. She would differ from him in rejecting the idea that value is a non-natural quality. I conclude my discussion with some comments of the normative character of living systems. (shrink)

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)

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)

Analyses of biological concepts of disease and social conceptions of health indicate that they are structurally interdependent. This in turn suggests the need for a bridge theory of illness. The main features of such a theory are an emphasis on the logical properties of value terms, close attention to the features of the experience of illness, and an analysis of this experience as action failure, drawing directly on the internal structure of action. The practical applications of this (...) theory are outlined for a number of problems in each of the three main practical areas, clinical work, teaching and research. In each case the resources of the theory suggest new models and generate new results. The full practical significance of the theory, however, is shown to consist in the way in which it ties together biological and social theories into an integrated picture of the conceptual structure of medicine as a whole. It is argued, finally, that practical efficiency of this kind is a test of theory not only in the philosophy of medicine but also in general philosophy. (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)

This article isolates ten prepositions, which constitute the undercurrent paradigm of contemporary discourse of health disease and medicine. Discussion of the interrelationship between those prepositions leads to a systematic refutation of this paradigm. An alternative set is being forwarded. The key notions of the existing paradigm are that health is the natural condition of humankind and that disease is a deviance from that nature. Natural things are harmonious and healthy while human made artifacts are coercive interference (...) with natural balance. It is suggested that the current paradigm is influenced by the world of finances and by instrumental reason. The alternative model suggests that human nature cannot be delineated. Humans fashion their own selves and nature by artificial means, medicine among them. The article discusses the implications of the paradigm adapted in various scholarly and popular debates such as the use of sex hormones for contraception, the care of the elderly, holistic medicine and distributive justice in health care. Medicine is not an isolated or a privileged realm. There is no unique entitlement to health care. It is always part of a broader agenda of social values and institutions. A open view of human societies, values and practices as they are situated within concrete material conditions is the platform required for an integrative and creative discourse of health care. (shrink)

Assessing the normative status of concepts of health and disease involves one in questions regarding the relationship between fact and value. Some have argued that Christopher Boorse's conception of health and disease lacks such a valuational element because it cannot account for types of harms which, while disvalued, do not have evolutionarily dysfunctional consequences. I take Boorse's account and incorporate some Humean-like sociobiological assumptions in order to respond to this challenge. The possession of moral sentiments, (...) I argue, offers an evolutionary advantage (thus falling within Boorse's definition of normal functional abilities). However, this does not amount to emotivism: on the contrary, these sentiments can be the basis of a value system. This value structure introduces the concept of sympathizing with a fellow being's suffering as the basis of a normative dimension to disease. For example, it holds the disvalue of disease to lie in the fact that disease involves suffering and functional limitations.The naturalistic Humean type of account presented here thus jumps the normative-descriptive divide. When Boorse's account is extended to include social sentiments and behaviors, a conception of health emerges which is broader than Boorse's or Kass's, but narrower than the WHO's. (shrink)

What are the effects of our environment on human development and the next generation? Numerous studies have provided ample evidence that a healthy environment and lifestyle of the mother is important for her offspring. Biological mechanisms underlying these environmental influences have been proposed to involve alterations in the epigenome. Is there enough evidence to suggest a similar contribution from the part of the father? Animal models provide proof of a transgenerational epigenetic effect through the paternal germ line, but can this (...) be translated to humans? To date, literature on fathers is scarce. Human studies do not always incorporate appropriate tools to evaluate paternal influences or epigenetic effects. In reviewing the literature, I stress the need to explore and recognize paternal contributions to offspring's health within the Developmental Origins of Health and Disease hypothesis, and coin this new concept the Paternal Origins of Health and Disease paradigm. A better understanding of preconceptional origins of disease through the totality of paternal exposures, or the paternal exposome, will provide evidence-based public health recommendations for future fathers. A father's hereditary contribution exceeds that of his DNA sequence. The environment can regulate systems such as the sperm epigenome, which is inheritable as well and may steer the genome and health status of his offspring. We here suggest a new concept, the Paternal Origins of Health and Disease, as part of the DOHaD theory. (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)

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)

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 concepts of health and disease are crucial in defining the aim and the limits of modern medicine. Accordingly it is important to understand them and their relationship. However, there appears to be a discrepancy between scholars in philosophy of medicine and health care professionals with regard to these concepts. This article investigates health care professionals’ concepts of health and disease and the relationship between them. In order to do so, four (...) different models are described and analyzed: the ideal model, the holistic model, the medical model and the disjunctive model. The analysis reveals that each model has its pros and cons, and that health care professionals appear to apply more than one models. Furthermore, the models and the way health care professionals’ use them may be helpful for scholars in philosophy of medicine with regard to developing theories and communicating them to health care professionals. (shrink)

Norman Daniels argues that health is important for justice because it affects the distribution of opportunities. He claims that a just society should guarantee fair opportunities by promoting and restoring the “normal functioning” of its citizens, that is, their health. The scope of citizens' mutual obligations with respect to health is defined by a reasonable agreement that, according to Daniels, should be based on the distinction between normal functioning and pathology drawn by the biomedical sciences. This paper (...) deals with the question whether it is legitimate to ascribe the responsibility of defining this important moral boundary to the biomedical sciences, which Daniels regards as value neutral. Daniels appeals to Christopher Boorse's sophisticated bio-statistical theory (BST) to show the plausibility of a value-neutral distinction between normal functioning and pathology. Here I argue that a careful analysis of the concept of normal functioning, such as the one offered by the recent critique by Elselijn Kingma, shows that it depends from evaluative assumptions. This, I argue, implies that Daniels's theory must give up its naturalistic commitments. In the conclusion, the paper offers a detailed discussion and an objection to one of Daniels's arguments in favor of a moderate form of normativism that remains too close to Boorse's naturalism. (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)

As human beings we sometimes in one way or another become sick, and therefore go for treatment depending on our choice of treatment (religious perspective or Western medical treatment). Although African traditional religion is not against a Western medical way of treatment or healing process, its followers believe that there are some diseases that Western medicine cannot treat, and therefore need spiritual attention, as it is sometimes practiced in churches. This article discusses the African traditional view regarding disease, causes (...) of disease, how disease is diagnosed and treated, with a special focus on Ghana. The article also describes the role of the diviner or the African traditional priest or what others may term as ‘herbalists’. The advantages and disadvantages of the African traditional healing process are considered. The article concludes by discussing African traditional healing in the context of a contemporary health care discourse, as well as a proposal for dialogue between traditional healers, Western medical practitioners, the government of Ghana, and the governments of various countries where this issue may be applicable, to build a consensus in addressing health issues. (shrink)

This article investigates health care professionals' concepts of health and disease and the relationship between them. In order to do so, four different models are described and analyzed: the ideal model, the holistic model, the medical model and the disjunctive model. The analysis reveals that each model has its pros and cons, and that health care professionals appear to apply more than one models. Furthermore, the models and the way health care professionals' use them (...) may be helpful for scholars in philosophy of medicine with regard to developing theories and communicating them to health care professionals. (shrink)

In recent years, an increasing number of medical books and papers attempting to analyse the concepts of health and disease from the perspective of evolutionary biology have been published.This paper introduces the evolutionary approach to health and disease in an attempt to illuminate the premisses and the framework of Darwinian medicine. My primary aim is to analyse to what extent evolutionary theory provides for a biological definition of the concept of disease. This analysis reveals (...) some important differences between functional explanations in the field of evolutionary biology and functional explanations in the field of medicine. Moreover, I shall argue that the biological functions relevant to the health of an organism cannot be determined on the basis of evolutionary theory. Accordingly, it seems that Darwinian medicine does not provide for the definition of a biological concept of disease. Still,Darwinian medicine may suggest why we are susceptible to certain diseases; it might also prove a suggestive heuristic on the basis of which new hypotheses concerning relevant treatments of various diseases might be advanced. (shrink)