In this article, I side with those who argue that the debate about the definition of “disease” should be reoriented from the question “what is disease” to the question of what it should be. However, I ground my argument on the rejection of the naturalist approach to define disease and the adoption of a normativist approach, according to which the concept of disease is normative and value-laden. Based on this normativist approach, I defend two main theses: (1) that conceptual analysis (...) is not the right method to define disease and that conceptual engineering should be the preferred method and (2) that the method of conceptual engineering should be implemented following the principles of Alexandrova’s account of social objectivity in the context of the definition of disease. (shrink)

After describing the disorder of psychopathy, I examine the theories and the evidence concerning the psychopaths’ deficient moral capacities. I first examine whether or not psychopaths can pass tests of moral knowledge. Most of the evidence suggests that they can. If there is a lack of moral understanding, then it has to be due to an incapacity that affects not their declarative knowledge of moral norms, but their deeper understanding of them. I then examine two suggestions: it is their deficient (...) practical reason or their stunted emotions that are at fault. The evidence supports both explanations. I conclude with an overview of the debate concerning whether they are morally or legally responsible for their actions. (shrink)

In this article, I address two objections developed by Kingma against Boorse’s bio-statistical theory of health, the objections that choice of reference classes renders the theory both circular and problematically value-laden. These objections not only apply to the bio-statistical theory of health but also to other naturalistic theories, like the dispositional theory of health. I present three rejoinders. First, I argue that the circularity objection arises from excessive methodological demands. Second, I argue that naturalists can resist the normativist claim that (...) health and pathology are differentiated on the basis of personal or cultural values. Finally, I show that it is possible to justify choices between rival theories of health without the interference of evaluative commitments. With these rejoinders, I conclude that the bio-statistical theory, as well as other naturalistic theories of health utilizing reference classes, is not undermined by Kingma’s arguments. (shrink)

A satisfactory account of the nature of health is important for a wide range of theoretical and practical reasons. No theory offered in the literature thus far has been able to meet all the desiderata for an adequate theory of health. This article introduces a new theory of health, according to which health is best defined in terms of dispositions at the level of the organism as a whole. After outlining the main features of the account and providing formal definitions (...) of ‘health’, ‘healthy’, and ‘healthier than’, I present the main strengths of the proposed account. I argue that the proposed dispositional theory accounts for all paradigm cases of health and pathology, that it circumvents a number of problems faced by rival theories, and that it makes for a naturalistic theory of health with a rigorous metaphysical underpinning. 1Introduction 2The Dispositional Account 3Further Specification of the Dispositional Account 3.1Reference classes 3.2Comparison classes 3.3Which dispositions? 4Advantages of the Dispositional view 5Three Objections and Replies 5.1Objection 1: Counter-examples 5.2Objection 2: Issues with holism 5.3Objection 3: Expediting medicalization 6Final Remarks. (shrink)

In this paper, we examine recent critiques of the debate about defining disease, which claim that its use of conceptual analysis embeds the problematic assumption that the concept is classically structured. These critiques suggest, instead, developing plural stipulative definitions. Although we substantially agree with these critiques, we resist their implication that no general definition of “disease” is possible. We offer an alternative, inductive argument that disease cannot be classically defined and that the best explanation for this is that the concept (...) is structured as a cluster. We further argue that we do not need to reject the possibility of defining the general concept “disease” to legitimate developing stipulative definitions of disease that are relative to particular purposes. A cluster definition of disease is compatible with contextually motivated definitions, which may be considered précisifications of the more general cluster concept. (shrink)

While aging research and policy aim to promote ‘health’ at all ages, there remains no convincing explanation of what this ‘health’ is. In this paper, I investigate whether we can find, implicit within the sciences of aging, a way to know what health is and how to measure it, i.e. a theory of health. To answer this, I start from scientific descriptions of aging and its modulators and then try to develop some generalizations about ‘health’ implicit within this research. After (...) discussing some of the core aspects of aging and the ways in which certain models describe spatial and temporal features specific to both aging and healthy phenotypes, I then extract, explicate, and evaluate one potential construct of health in these models. This suggests a theory of health based on the landscape of optimized phenotypic trajectories. I conclude by considering why it matters for more candidate theories to be proposed and evaluated by philosophers and scientists alike. (shrink)

In this paper, I propose an existentialist-phenomenological model that conceives of mental illness through the terminology of Heidegger’s Being and Time. In particular, the concepts of existentiality, disturbance and the relation between ‘being-with’ and ‘the one’, will be implemented in order to reconstruct the experience of mental illness. The proposed model understands mental illness as a disturbance of a person’s existentiality. More precisely, mental illness is conceptualized as the disturbance of a person’s existential structure, the process of which leads to (...) a becoming explicit of the otherwise implicit dynamical structure that constitutes a person’s experience. In particular, the existential component of ‘being-with’ comes to play a central role in the disturbance of existentiality, thus, I will claim, that it enables a person’s structure of experience to be ‘open for normativity’. By adopting a pragmatist stance on Heideggerian phenomenology, the suggested model proves compatible with naturalist and normativist theories of mental illness while still offering a phenomenological description of the phenomenon. (shrink)

Social Constructivism about the disease concept has generally been taken to ignore the fundamental biological reality underlying diseases, as well as to fall foul of several apparently compelling objections. In this paper, I explain how the metaphysical relation of grounding can be used to tie a socially constructed account of diseases and their classification to their underlying biological and behavioural states. I then generalize the position by disambiguating several varieties of normativism, including a particularly strong ‘placeholder’ version of social constructivism, (...) and showing that the grounding approach is available to each. I go on to provide what I believe to be the first attempt at a full semantics for disease-talk and disagreement, before using the placeholder to demonstrate on that basis that the most troublesome objections to normativism can be avoided even by very strong versions of the position. (shrink)

This article presents a comparative analysis between Georges Canguilhem’sEssay on Some Problems Concerning the Normal and the Pathological, published in 1943 and the English language debate that started in the 1970s between the naturalists and the normativists. Seemingly, this comparison illustrates the opposition between the French historical epistemology and the Anglo-American philosophy of sciences. However, I put into perspective what is generally considered an opposition between the two traditions by analyzing certain conceptual similarities.

In this paper, I argue for a new way to understand the integration of facts and values in the concept of mental disorder that has the potential to avoid the flaws of previous hybrid approaches. I import conceptual tools from the account of procedural objectivity defended by Helen Longino to resolve the controversy over the definition of mental disorder. My argument is threefold: I first sketch the history of the debate opposing objectivists and constructivists and focus on the criticisms that (...) led to the emergence of the debate. Second, I offer a reconstruction of the “Natural Function Approach” argument to make explicit an unsound assumption underlying this approach. The reconstruction will allow me to show that the NFO’s argument depends on the ideal of value-free science that I will criticize. Then I propose an alternative ideal for psychiatry: social objectivity. I argue that the concept of mental health should be seen as “socially objective” rather than value-free, moving the debate towards the social procedures by which the definition is produced rather than the normative and factual content of its definition. (shrink)

In the debate over the definition of ‘mental health,’ three different approaches are generally distinguished: the normativist approach, the hybrid approach and the naturalistic approach. This paper qualifies this classification by clarifying the sense in which Christopher Boorse defends a naturalistic approachvis-à-visthe central concepts of psychiatry. This paper also clarifies in what way Boorse is opposed to the normativist approach advocated by some authors of the anti-psychiatric movement, such as Szasz.

This paper criticizes Jerome Wakefield’s harmful dysfunction analysis of disorder by arguing that the conceptual linkage it establishes between the medical concepts of health and disorder and the prudential notions of well-being and harm makes the account inapplicable to nonsentient organisms, such as plants, fungi, and many invertebrate animals. Drawing on a previous formulation of this criticism by Christopher Boorse, and noting that Wakefield could avoid it if he adopted a partly biofunction-based account of interests like that often advocated in (...) the field of environmental ethics, I argue that integrating such an account of interests into the HDA would generate serious concerns. Specifically, it would make dysfunction sufficient for disorder and so reestablish between dysfunction and disorder precisely the kind of sufficiency relation that harm-requiring accounts of disorder strive to avoid; blur the line between the HDA’s dysfunction and harm components and, in so doing, deprive the HDA of its alleged main advantage over monistic dysfunction-based accounts of disorders like Boorse’s; and tie the HDA to an understanding of harm that is in itself problematic. I argue that these three concerns, and the dilemmas they generate, rob the HDA of much of its prima facie appeal, ultimately indicating that a satisfactory account of disorder should most likely eschew all references to prudential notions of well-being and harm. (shrink)

Naturalistic theories of disease appeal to concepts of biological function, and use the notion of dysfunction as the basis of their definitions. Debates in the philosophy of biology demonstrate how attributing functions in organisms and establishing the function-dysfunction distinction is by no means straightforward. This problematization of functional ascription has undermined naturalistic theories and led some authors to abandon the concept of dysfunction, favoring instead definitions based in normative criteria or phenomenological approaches. Although this work has enhanced our understanding of (...) disease and illness, we need not necessarily abandon naturalistic concepts of function and dysfunction in the disease debate. This article attempts to move towards a new naturalistic theory of disease that overcomes the limitations of previous definitions and offers advantages in the clinical setting. Our approach involves a re-evaluation of concepts of biological function employed by naturalistic theories. Drawing on recent insights from the philosophy of biology, we develop a contextual and evaluative account of function that is better suited to clinical medicine and remains consistent with contemporary naturalism. We also show how an updated naturalistic view shares important affinities with normativist and phenomenological positions, suggesting a possibility for consilience in the disease debate. (shrink)

This thesis is about the notions of health and pathology in medical theory. I develop a theory, which defines ‘health’ and ‘pathology’ in a way that solves several problems with earlier suggestions of how to define these terms. I call the theory ‘the disposition profile efficiency theory’, abbreviated ‘the DPE-theory’. According to the DPE-theory, a trait token is healthy, roughly, if and only if all of its dispositions for performing physiological functions are efficient enough. A trait token is pathological, roughly, (...) if and only if at least one of its dispositions for performing a physiological function is not efficient enough. The notion of efficiency, I suggest, is reference class-relative: the efficiency of a trait token’s disposition for performing a physiological function expresses a relation between the trait token and a health standard for the trait token’s bearer’s reference class. The thesis also examines the most discussed theory of health and pathology, “the biostatistical theory” proposed by Boorse. Both the DPE-theory and the biostatistical theory are evaluated against a number of desiderata: the theory should be theoretically sound; only use empirical, statistical, and logical terms; not involve values; be clear; both account for health and pathology as reference class-relative properties, and account for the importance of integration of different physiological functions for health; and have reasonable implications. It is argued that the DPE-theory satisfies the desiderata, and that it does so better than the biostatistical theory. The main contributions of the thesis are the DPE-theory’s models of dispositions, its approach to defining reference classes, its efficiency measure, and its way of drawing the line between high enough efficiencies and too low efficiencies. Other important contributions concern the desideratum about reasonable implications. It is shown how the DPE-theory contributes to solving two much discussed objections directed towards the biostatistical theory, “the problem of common diseases” and “Kingma’s dilemma”. Further, the DPE-theory is used to illuminate discussions about certain types of conditions for which it is contested whether they should count as healthy or pathological. (shrink)