In 1998, the US Supreme Court first held that asymptomatic HIV infection constituted a disability when it ruled on the case of Bragdon v. Abbott. The use of yet another label to identify women living with HIV has been rarely questioned. While we do value the use of this label as an anti-discriminatory strategy, we believe that there is a need to examine how language and more specifically, the use of words such as disability, limitation, and impairment may create new (...) forms of identities for women living with HIV. Using this legal case as a starting point, the goal of this paper is to critically examine the 'fabrication' of asymptomatic HIV infection as a disability. Grounded in a feminist poststructuralist perspective, this paper exposes the relationship between language, social institutions, subjectivity, and power in the construction of difference. By doing so, it addresses the identification of women living with HIV/AIDS as disabled and the self-differentiation process that they must go through in order to live as normally as possible. (shrink)

The year 2013 marked the 50th anniversary of the publication of a classic of the historiography of sciences, Michel Foucault’s The birth of the clinic: An archaeology of medical gaze. In different parts of the world, events were organized to reflect on this important work. The article argues that if one cannot draw a direct line linking the work of the leading historians-philosophers of the twentieth-century sciences in France to Michel Foucault’s archaeological study of the clinic, we must recognize that (...) the author of The Birth of the Clinic has taken up from these historians-philosophers the methodological and conceptual tools that made it possible to study the history of science and knowledge in a new way. (shrink)

In this introductory paper, I try to give an overview of the concept of normativity in its philosophical history and its contemporary interpretations and uses in different fields. From philosophy of logic and mathematics to philosophy of language and mind, and to philosophy of medicine and care, normativity is found as a key concept pointing at the possibility of scientific and technical progress and improvement of human life in the interaction between the individual and his environment.

In this paper I will briefly discuss flourishing and freedom, relating them to health and disease; discuss the tensions between flourishing and freedom; and exemplify how those discussions are relevant to chronic disease suffering. The concept of freedom has significant connections with the concepts of health, disability and disease. Understanding disease and disability in terms of the loss of aspects of freedom may help our understanding of the suffering that arises from chronic disease. On the other hand, flourishing may require (...) a degree of adversity. Therefore disability and disease may be conducive to flourishing. Flourishing may be understood as subordinated to freedom, as a path to freedom, or as transcending freedom. It is suggested that freedom and flourishing are expressed as mutually enhancing cycles, actualized according to the personal circumstances that will ground their expression. In a distant horizon of innocent spontaneous self-expression, flourishing and freedom may become coincident. Regarding chronic disease as a constraint on ‘species-typical’ abilities to fulfill one’s significant life interests, as well as an unwanted intrusion into the patient’s life, presents chronic disease suffering as a loss of both positive and negative freedom. The conceptual relation between flourishing and freedom will thus organise the possibilities the sufferer sees as open to their self. (shrink)

In this article I assess Georges Canguilhem's historical epistemology with both theoretical and historical questions in mind. From a theoretical point of view, I am concerned with the relation between history and philosophy, and in particular with the philosophical assumptions and external norms that are involved in history writing. Moreover, I am concerned with the role that history can play in the understanding and evaluation of philosophical concepts. From a historical point of view, I regard historical epistemology, as developed by (...) Gaston Bachelard and Georges Canguilhem, as a conception and practice which came out of the project, elaborated in France from the 1920s to the 1940s, of combining history of science and philosophy. I analyse in particular Canguilhem's epistemology in his theory and practice of history of science. What he called 'normative history' is the focus of my analysis. I evaluate the question of the nature and provenience of the norm employed in normative history, and I compare it with the norm as discussed by Canguilhem in Le normal et le pathologique. While I am critical of Canguilhem's treatment of history, I conclude that his philosophical suggestion to analyse the formation of scientific concepts 'from below' represents a useful model for history and philosophy of science, and that it can be very profitably extended to philosophical concepts. (shrink)

This article presents a conceptual discussion on the phenomenon of incorporation of tools and other objects in the light of Maine de Biran’s philosophy of the relation between the body and the motor will. Drawing on Maine de Biran’s view of the body as that portion of the material world which directly obeys one’s motor will, as well as on his view (supported by studies in contemporary cognitive science) of active touch as the perceptual modality that is sensitive to objects (...) as fields of forces resisting the perceiver’s movements, we discuss the phenomena of motor incorporation and haptic incorporation, as well as the relation between them. Motor incorporation occurs when something is integrated into the motor system, i.e. when practice enables one to animate an object as directly, effortlessly and fluently as one is able to animate one’s own body. The subject then has the experience of acting there, where the object is located, not at the body–object interface. In order to better understand the phenomenon of motor incorporation, we highlight the phenomenological difference between directly and indirectly moving something. Haptic incorporation occurs when something is integrated into the haptic system, i.e. when an object is used as an instrument for the haptic perception of other objects. Finally, we seek to shed light on the phenomenon of transparency, understanding the transparency acquired by the incorporated object as both a relational property and a matter of degrees. (shrink)

This article presents a conceptual discussion on the phenomenon of incorporation of tools and other objects in the light of Maine de Biran’s philosophy of the relation between the body and the motor will. Drawing on Maine de Biran’s view of the body as that portion of the material world which directly obeys one’s motor will, as well as on his view (supported by studies in contemporary cognitive science) of active touch as the perceptual modality that is sensitive to objects (...) as fields of forces resisting the perceiver’s movements, we discuss the phenomena of motor incorporation and haptic incorporation, as well as the relation between them. Motor incorporation occurs when something is integrated into the motor system, i.e. when practice enables one to animate an object as directly, effortlessly and fluently as one is able to animate one’s own body. The subject then has the experience of acting there, where the object is located, not at the body–object interface. In order to better understand the phenomenon of motor incorporation, we highlight the phenomenological difference between directly and indirectly moving something. Haptic incorporation occurs when something is integrated into the haptic system, i.e. when an object is used as an instrument for the haptic perception of other objects. Finally, we seek to shed light on the phenomenon of transparency, understanding the transparency acquired by the incorporated object as both a relational property and a matter of degrees. (shrink)

The state subvention and distribution of health care not only jeopardize the financial sustainability of the state, but also restrict without a conclusive rational basis the freedom of patients to decide how much health care and of what quality is worth what price. The dominant biopolitics of European health care supports a healthcare monopoly in the hands of the state and the medical profession, which health care should be opened to the patient’s authority to deal directly for better basic health (...) care. In a world where it is impossible for all to receive equal access to the best of basic health care, one must critically examine the plausible scope of the authority of the state to limit access to better basic health care. Classical distributive justice affords a basis for re-examining the current European ideology of equality, human dignity, and solidarity that supports healthcare systems with unsustainable egalitarian concerns. (shrink)

This paper focuses on one of the original moments of the development of the “phenomenological” current of psychiatry, namely, the psychopathological research of Ludwig Binswanger. By means of the clinical and conceptual problem of schizophrenia as it was conceived and developed at the beginning of the twentieth century, I will try to outline and analyze Binswanger’s perspective from a both historical and epistemological point of view. Binswanger’s own way means of approaching and conceiving schizophrenia within the scientific, medical, and psychiatric (...) context of that time will lead us to grasp the epistemological stakes at the origins of his project of reforming psychiatry by means of phenomenology. I will finally attempt to upgrade and update Binswanger’s project in light of the current reappraisal of phenomenology within the ongoing debate on psychopathology engaged by studies in the field of science and philosophy of mind. (shrink)

In this paper, my aim is to understand the origin of experimental and scientific models of pathogeny of the diseases of the nervous system in the Salpêtrière (Paris). I will analyse the role of the contexts of cell theory, microscopy and the advances in histological techniques in the creation of various pathogenic models, based on the concept of the cell, the Wallerian degeneration and the neurone concept. I argue that, as medicine and pathology remain autonomous in their methods and goals, (...) because of the evident degree of complexity of diseases, close and reciprocal interactions with sciences, their practices and theories, make it possible to establish convergences between clinical observations, pathological data and those from the experimental models of pathologies. The search for pathogenic models behaves like an engine, which is efficient in assembling facts, in testing pathogeneses and reforming nosologies, combined with the breakthroughs in biology. This paper is a case study showing the emergence of such interactions in the last decades of the nineteenth-century in Paris. (shrink)

Recently, there has been a growing interest, both within theoretical biology and the philosophy of biology, in the possibility and desirability of a theory of development. Among the many issues raised within this debate, the questions of the spatial and temporal boundaries of development have received particular attention. In this article, noting that so far the discussion has mostly centered on the processes of morphogenesis and organogenesis, we argue that an important missing element in the equation, namely the development of (...) language and cognition in general, may play an important role in settling the issue of temporal boundaries. After examining the idea that the development of language, cognition, and action are bona fide biological processes, we explore the consequences for a general theory of development of taking them into consideration. (shrink)

The aim of this article is (1) to investigate the ‘neurosciences’ as an object of study for historical and genealogical approaches and (2) to characterize what we identify as a particular ‘style of thought’ that consolidated with the birth of this new thought community and that we term the ‘neuromolecular gaze’. This article argues that while there is a long history of research on the brain, the neurosciences formed in the 1960s, in a socio-historical context characterized by political change, faith (...) in scientific and technological progress, and the rise of a molecular gaze in the life sciences. They flourished in part because these epistemological and technological developments were accompanied by multiple projects of institution-building. An array of stakeholders was mobilized around the belief that breakthroughs in understanding the brain were not only crucial, they were possible by means of collaborative efforts, cross-disciplinary approaches and the use of a predominantly reductionist neuromolecular method. The first part of the article considers some of the different approaches that have been adopted to writing the history of the brain sciences. After a brief outline of our own approach, the second part of the article uses this in a preliminary exploration of the birth of the neurosciences in three contexts. We conclude by arguing that the 1960s constitute an important ‘break’ in the long path of the history of the brain sciences that needs further analysis. We believe this epistemological shift we term the ‘neuromolecular gaze’ will shape the future intellectual development and social role of the neurosciences. (shrink)

The movements and protests of 1968 worldwide criticized the traditional idea of normality. From the 1970s onwards, psychiatry and antipsychiatry became an ideological battleground centered on the boundaries between normality and madness. In this scenario, characterized by a deep cultural and political transformation within the Left, the traditional concept of rationality and its very connection with irrationality was called into question. As a consequence, the very ideal of reason was questioned. This paper will explore the debate on rationality, irrationality and (...) irrationalism within the so-called anti-institutional psychiatry and its reception in the Italian New Left during the second half of the 1970s. (shrink)

Este artículo explora el problema de la síntesis entre vitalismo y racionalismo, dentro de la filosofía contemporánea. Para ello comparamos las trayectorias intelectuales de Georges Canguilhem (1904-1995) y José Ortega y Gasset (1883-1955). Se contrastan sus concepciones de la filosofía como saber “híbrido”, vinculado a la ciencia, así como sus puntos de vista sobre el vitalismo, la antropología, la técnica y el perspectivismo. Para evitar que la comparación sea puramente abstracta y ahistórica, se recurre al método de la sociología de (...) la filosofía. Esto obliga a situar ambas trayectorias en sus respectivos campos filosóficos y unidades generacionales, atendiendo también a su procedencia social y a su carrera profesional. (shrink)

This paper aims at giving an account of the philosophy of norms of Georges Canguilhem in the framework of his philosophical vitalism. According to Canguilhem, vitalism is not a metaphysical or ontological theory, but rather a general attitude or a perspective about life and living beings, both understood employing the axiological concept of ‘normativity’. This notion allows Canguilhem to enlarge the concept of life beyond the field of biological phenomena, encompassing also phenomena of the social world, included technique and scientific (...) knowledge and rationality. Canguilhem’s perspective relocates human activities within a vitalistic conception of life, which redefines the meaning of human reason by putting it in relation to values and norms. (shrink)

Parsons’ sick role concept has become problematic in the face of the increased significance of chronic illnesses and the growing emphasis on lifestylecentred health promotion. Both developments de-limit the medical system so that it extends into the world of health, fundamentally changing the doctor-patient relationship. But as the sick role is firmly based on the reciprocities of a resiliently capitalist achievement society it still informs normative expectations in the field of health and illness. The precarious social position of chronic patients (...) between being governed by and being consumers of medicine, I will argue, can only be adequately understood if one involves, as Parsons did, the moral economy surrounding health and illness. (shrink)

In the 1940s, Georges Canguilhem has established the concept of biological normativity on the level of the organism in his key work on “ The Normal and the Pathological ”. We would like to present a contemporary analysis of Canguilhem’s work, set it in context with more recent results from the field of complexity and immunology, and evaluate the problematic whether normativity is a genuine capacity of the organism. Based on Canguilhem’s conditions of the definition of biological normativity, we show (...) that the immune system as one of the complex systems of the living equally shares the capacity to be normative. We will then conclude that normativity can also be conceptually independently displayed on the level of complex systems of the living. (shrink)

BackgroundThe evaluation of pain remains one of the most difficult challenges that healthcare practitioners face. Chronic pain appears to affect more than 35% of the population in the West, and indeed, pain is the most common reason patients seek medical care. Despite its ubiquity, studies in the last decades reveal that many patients feel their pain is dismissed by healthcare practitioners and that, as a result, they are denied proper medical care. Buchman, Ho, and Goldberg (J Bioethic Inq 14:31-42, 2017) (...) point to this phenomenon as a form of “epistemic injustice”: an unfair and harmful downgrading of credibility affecting some individuals and groups, which prevents them from receiving appropriate and beneficial medical care.MethodsBy exploring the existing literature on this downgrading of patients’ credibility written by healthcare professionals and scholars in medical humanities, I identify and examine the reasons patients are often not believed about their pain and why healthcare is too-often unhelpful or hurtful to people presenting with chronic pain. I also explore to what extent it is possible to forge an alternative epistemological model.ResultsI suggest that most of the causes of this downgrading of patient’s credibility result from either the difficulty in communicating pain or the widespread belief that pathology is always the result of objective tissue damage. I examine whether pain has to be effectively communicated and have an objective cause in order for it to be deemed credible. In the end, I argue that in the case of pain, both communication and objectivity are highly problematic.ConclusionsI conclude by suggesting that, although alternative epistemological models might be impossible to build, believing patients has both moral and clinical benefits, and this warrants further research. (shrink)

Bruno Latour, as part of his advocacy of science studies urges us to move beyond what he calls ‘the Modernist Settlement’ that, among other things, separated science from politics and subject from object. As part of this project he has frequently called for the abolition of epistemology, including quite specifically the historical epistemology/epistemological history of Gaston Bachelard and Georges Canguilhem. Pierre Bourdieu, on the other hand, deploys the resources of historical epistemology, to dismiss Latour’s science studies. After examining the charges (...) against historical epistemology and their rebuttal, I rule in favor of the defense. However, I also suggest that Latour raises genuine concerns about how to equip ourselves to tackle problems such as those associated with climate change; these are problems that require engagement with the politics of nature, with the politics of the sciences of nature and with the epistemological challenges associated with the need to deploy multiple disciplines in the service of complex, practical, policy-relevant problem solving. (shrink)

The theory of dynamical systems allows one to describe the change in a system' 's macroscopic behavior as a bifurcation in the underlying dynamics. We show here, from the example of depressive syndrome, the existence of a correspondence between clinical and electro-physiological dimensions and the association between clinical remission and brain dynamics reorganization. On the basis of this experimental study, we discuss the interest of such results concerning the question of normality versus pathology in psychiatry and the relationship between mind (...) and brain. (shrink)

Este artigo aborda o tratamento que Canguilhem e Foucault oferecem da medicina. Passando pelas distintas análises da clínica, da medicina em sua história e de seu aspecto social e político, observaremos desdobramentos irredutíveis em torno de uma problemática compartilhada.

This paper considers the theoretical circumstances that urged Michel Foucault to analyse modern societies in terms of biopower. Georges Canguilhem’s account of the relations between science and the living forms an essential starting point for Foucault’s own later explorations, though the challenges posed by the molecular revolution in biology and François Jacob’s history of it allowed Foucault to extend and transform Canguilhem’s philosophy of error. Using archival research into his 1955–1956 course on “Science and Error,” I show that, for Canguilhem, (...) it is inauthentic to treat a living being as an error, even if living things are capable of making errors in the domain of knowledge. The emergent molecular biology in the 1960s posed a grave challenge, however, since it suggested that individuals could indeed be errors of genetic reproduction. The paper discusses how Canguilhem and Foucault each responded to this by examining, among other texts, their respective reviews of Jacob’s The Logic of the Living. For Canguilhem this was an opportunity to reaffirm the creativity of life in the living individual, which is not a thing to be evaluated, but the source of values. For Foucault, drawing on Jacob’s work, this was the opportunity to develop a transformed account of valuation by posing biopower as the DNA of society. Despite their disagreements, the paper examines these three authors as different iterations of a historical epistemology attuned to errancy, error, and experimentation. (shrink)

Biology seems to present local and transitory regularities rather than immutable laws. To account for these historically constituted regularities and to distinguish them from mathematical invariants, Montévil and Mossio (Journal of Theoretical Biology 372:179–191, 2015) have proposed to speak of constraints. In this article we analyse the causal power of these constraints in the evolution of biodiversity, i.e., their positivity, but also the modality of their action on the directions taken by evolution. We argue that to fully account for the (...) causal power of these constraints on evolution, they must be thought of in terms of normativity. In this way, we want to highlight two characteristics of the evolutionary constraints. The first, already emphasised as reported by Gould (The structure of evolutionary theory, Harvard University Press, 2002), is that these constraints are both produced by and producing biological evolution and that this circular causation creates true novelties. The second is that this specific causality, which generates unpredictability in evolution, stems not only from the historicity of biological constraints, but also from their internalisation through the practices of living beings. (shrink)

How does one testify and, moreover, testify philosophically to the experience of receiving an organ transplant? What kinds of survival or forms of living are being fostered by newly emerging conjunctions between philosophy and biomedicine? Focusing on transplantation and immunology, we are going to reflect on some of the ways and styles in which motifs drawn from these biomedical fields have come to occupy an increasingly prominent place in recent philosophy expressing and formulating different concerns and paradigms. Spurred on by (...) Francisco J. Varela and Jean-Luc Nancy's autobiographical reflections on transplantation, we are going to consider distinct moments and preoccupations at work in the motifs of immunity, autoimmunity, the pharmakon and the graft in the thought of Jacques Derrida, Roberto Esposito and Bernard Stiegler. (shrink)

The aim of this paper is to discuss a key question in the history and philosophy of medicine, namely how scholars should treat the practices and experimental hypotheses of modern life science laboratories. The paper seeks to introduce some prominent historiographical methods and theoretical approaches associated with biomedical research. Although medical scientists need no convincing that experimentation has a significant function in their laboratory work, historians, philosophers, and sociologists long neglected its importance when examining changes in medical theories or progress (...) in scientific knowledge. The reason appears to have been the academic influence of the then dominant tradition in the history of ideas, but was also due to a misconception of what could usefully be termed the view on “historical ontology.” During the last two decades, there have been many books and research articles that have turned towards the subject, so that the study of experimental practice has become a major trend in the contemporary history and philosophy of medicine. A closer look at the issue of laboratory research shows that concepts in medicine and the life sciences cannot be understood as historically constant, free-standing ideas, but have to be regarded as dependent on local research settings. They often carry particular “social memories” with them and thus acquire important ethical implications. (shrink)

The term “genetic load” first emerged in a paper written in 1950 by the geneticist H. Muller. It is a mathematical model based on biological, social, political and ethical arguments describing the dramatic accumulation of disadvantageous mutations in human populations that will occur in modern societies if eugenic measures are not taken. The model describes how the combined actions of medical and social progress will supposedly impede natural selection and make genes of inferior quality likely to spread across populations – (...) a process which in fine loads their progress. Genetic load is based on optimal fitness and emerges from a “typological view” of evolution. This model of evolution had previously, however, been invalidated by Robert Wright and Theodosius Dobzhansky who, as early as 1946, showed that polymorphism was the rule in natural populations. The blooming and persistence of the concept of genetic load, after its theoretical basis had already expired, are a historical puzzle. This persistence reveals the intricacy of science and policy-making in eugenic matters. The Canguilhemian concept of ‘scientific ideology’ is used along with the concept of ‘immutable mobile’ and compared with the concept of ‘co-production’, to provide complementary perspectives on this complex phenomenon. (shrink)

Two essential periods may be identified in the early stages of the history of vitamin D-resistant rickets. The first was the period during which a very well known deficiency disease, rickets, acquired a scientific status: this required the development of unifying principles to confer upon the newly developing science of pathology a doctrine without which it would have been condemned to remain a collection of unrelated facts with very little practical application. One first such unifying principle was provided by the (...) notion of hygiene; while the blanket explanations provided by this notion alone were much too general to enable rickets to achieve scientific status, it did point out the need to look for specific external causes for the disease and to examine the life-style and dietary habits of the patients. The second phase of the conceptualization of the disease was the assumption of a specific cause — that is, using concepts developed in the area of infectious diseases. This was made possible by fundamental similarities between deficiency and infectious diseases, in spite of their apparent differences. Both types of illness have some of the characteristics of what Georges Canguilhem calls the ontological representation of disease as opposed to dysharmonic representations, which primarily concern the endocrine diseases. It is precisely this shift from one to the other manner of perceiving ill health that enabled the identification of the vitamin D-resistant rickets. Conceptualization of the notion of vitamin D resistancy required that the conditions causing the disease be looked for within the organism rather than outside it; this was thus the first time that endocrine concepts were applied to studying the physiology of vitamin D.The history of resistant rickets therefore represents an interesting model for understanding the growth of biomedical knowledge. It allows the development of a number of more general ideas on the question of the relationship between biology and medicine and on the thorny problem of specificity in medical thinking. As far as this topic is concerned it can be seen that there was an ongoing exchange between medical and biological thinking during the initial period up until 1937, and that one could deny any such specificity in medical thinking during this same period. Albright, for example, used human diseases as spontaneously produced models for experimental biology. It was also more feasible for an experimental biologist to administer toxic doses than for a clinician to do so.What, then, if any, is the place of the specificity of medical thinking in this history? The fact that medicine is characterized not only by it ccognitive content78 but also by its final aim, which is to restore health, makes it necessary to take factors other than objective knowledge into consideration. This is particularly evident in two aspects of medicine, therapeutics and nosology, and in approaching the notion of pathological individuality.Therapeutic activity has a largely empirical approach. Many drugs, such as cod-liver oil, were discovered empirically. Treatment often in the past, and still now, has proceeded by trial and error, upon no established theoretical basis. At this level the relationship between biology and medicine is roughly comparable to that between science and technology79 \3- that is, it is impossible to reduce either therapeutics or technical activities to the simple application of basic science. In this sense, the application of vitamin D to vitamin-resistant rickets is quite typical. Further-more, in the case studied here, the therapeutic activity heralds a definite breaking away from the medicatrix naturae of conventional medicine dating back to ancient times, and it embodies a new concept of the organism and of disease: no longer can the diseased organism be thought of as merely having a perturbed equilibrium requiring restoration by means of a natural style of medicine. On the contrary, vitamin D resistance is an obstacle that indicates profound biological dysfunction, to be rectified only by means of an extremely aggressive and therefore dangerous therapy. The therapy thus serves to reveal the severity of the dysfunction, thereby leading inevitably to conceptual innovation. This sheds light on the theoretical innovations of which the therapeutic activity is capable.Therapeutic activity is also influenced by notions of health and illness, normal and pathological states, none of which may be determined entirely objectively. For example, the term healing as used by Albright in the case of resistant rickets that he described may be discussed in this light.Nosology, or the classification of diseases, depends largely on the description of clinical syndromes, which are themselves mainly based on subjective elements (discomfort, disability, or the extent of a patient's suffering). The advent of pathological anatomy at the beginning of the nineteenth century disrupted classification by introducing the concept of localized anatomical lesions81-and, hence, an element of material objectivity \3- into nosology. Radiological examination further complicated matters by enabling the equivalent of an autopsy on living matter. Lastly, biological examination complicated nosology by showing that biological anomalies may exist in human beings without necessarily leading to a pathological condition. Medical thinking can choose to combine all these elements to describe a disease, but can also separate them and retain only a few, or a single one, according to requirements - as did Albright.The notion of biological and pathological individuality is fundamental to the development of medical thinking. Whatever its theoretical origin, medical thinking has since ancient times incorporated the idea that each individual reacts differently to the same treatment and his own specific pathological tendencies. I mentioned earlier that in the history of vitamin D-resistant rickets the notion of rachitic tendency reflected this type of thinking. After 1937, this history progressed by successively separating new individual entities, affecting smaller and smaller groups of individuals in each case. In other words, the need to understand and to define individual illness more closely required the development of new concepts and the construction of new individual categories of disease linking these concepts to older clinical, radiological, and biochemical elements. (shrink)

Psychiatry is becoming a cognitive neuroscience. This new paradigm not only aims to give new ways for explaining mental diseases by naturalizing them, but also to have an influence on different levels of psychiatric norms. We tried here to verify whether a biological paradigm is able to fulfill this normative goal. We analyzed three main normative assumptions that is to say the will of giving psychiatry a valid nosology, a rigorous definition of what is a mental disease, and new tools (...) for destigmatizing mentally ill patients. Although these different kinds of normativity are very heterogeneous, we must conclude that, in all these cases, biological psychiatry is a failure, in part because of a lack of epistemological conceptualization. (shrink)

There is a conceptual crisis in the biomedical sciences that is particularly salient in psychopathology research. Underlying the crisis is a controversy that pertains to the current medical model of disease that largely draws from causal-mechanistic explanations. The bedrock of this model is the analysis of biological part-dysfunctions that aims at unequivocally defining a pathological condition and demarcating it from its neighboring entities. This endeavor has led to a quest for physiological, biochemical, and genetic signatures. Yet, so far there is (...) little evidence for reliable biomarkers for any mental disorder. The contemporary biomedical paradigm largely ignores historical, dynamic, and system-level aspects—a view that has contributed much to the conceptual disjunction of the patient as a person from his/her disease. Notwithstanding the impressive progress in the biomedical sciences, increasingly more critics question whether the constituting framework is sufficient to convey a comprehensive understanding of illnesses, especially mental illnesses. Thus, the medical model urgently requires an update. But rather than revamping it by methodological advancements, it will be necessary to critically review its philosophical roots. The most problematic issues that require reworking are: the preponderance of the biostatistical theory; the undue decoupling of physiological from evolutionary explanations of function; the clinging to the Modern Synthesis ; and the neglect of dynamic and system-level properties. The proposed overhaul requires the heeding of historical explanations that draw from the Extended Evolutionary Synthesis as well as systems biology approaches for tackling multilevel and dynamic phenomena of complex systems. (shrink)

A biological function is supposed to be performed adequately, and hence may fail to do so: this is dysfunction. This raises two questions. One is how to make explicit the way in which function can be discriminated from dysfunction without confusing dysfunction with non-function. The second question is how what is “right” and “wrong” can be legitimated by natural regulatory norms. A function can be viewed as a quality to which at least one variable with a definite set of values (...) is associated. Accordingly, function and dysfunction are the same quality of the same trait, but differ in the values associated to this variable. Dysfunction occurs when the associated set of values does not match this normal state. Biological systems have the epistemic singularity that their existence is the consequence of two distinct causal regimes, the so-called “proximate” and “ultimate” causes, whose convergence defines a system’s prescriptive normality. Each cause imposes restrictive rules that limit the possible ways these systems can putatively exist. When a system is insensitive to ultimate cause, it is determined by proximate causation alone, and hence escapes its own prescriptive norms. In conclusion: The normality of a biological system is defined by the convergence of proximate and ultimate causes. A function is a variable-associated quality whose values are defined relative to the norms of the system. Dysfunction occurs when the set of values of the same variable does not match the normality of the system, which can occur when the system is insensitive to ultimate causation. (shrink)

The new generation of psychopharmacological products have proved their efficacy. Some neuro-degenerative diseases, such as Parkinson's and Alzheimer's diseases, could be treated by means of the gene therapy. Although the aetiology of such diseases is still not completely known, it has been proven that the patients lack some substances that could be produced by means of the transfer of in vivo or ex vivo genes that codify them in the proper places of the brain. Furthermore, it is announced that the (...) implantation in laboratory grown stem cells of diverse origins is very hopeful. Cerebral (micro)electronic implants could be effective to fight some motor diseases as well as sensory functions. All of these kinds of new treatments need to be tested through clinical research. Most national legislation includes provisions on the clinical trials of drugs and a series of guarantees, procedures and conditions which are designed to ensure protection for individuals used in experiments and to assure that the trial is indeed of scientific relevance. However, few lay down similar regulations or provide for specific controls for the research of other treatments. Finally, enhancement of psychic capacities pose new problems for society as well as do the need for new legal decisions. (shrink)

During the last decades, medical historiography has undergone considerable changes. This review attempts an outline of the developments since 1945. The first section sketches the institutional background of the discipline focusing on the characteristic features which emerged in different national traditions. The following sections—essentially restricted to the German speaking context—describe the development of the fields in research and teaching, ranging from the history of ideas to the social history of medicine, from philogical and editorial work to the philosophy and sociology (...) of medical knowledge. (shrink)

“Deleuze and the Inversion of Kantism”. In this paper we aim to look into French philosopher Gilles Deleuze’s work in order to see whether there is such a thing as a ‘reversal of Kantianism’, parallel to his more well-known reversal of Platonism. To this end, we will propose, firstly, to read in the key of reversal the movements made by Deleuze regarding intensity and extension, on the one hand, and the paradox of inner sense, on the other. Then, we will (...) analyze why Kant had already accomplished two great reversals, regarding the classical conception of both time and law, and consequently, we will develop the Deleuzean conception of Nietzschean eternal return as a simultaneous reversal of both aspects. Finally, we will inquire about the tropos of the aforementioned reversal, calling on the concepts of humor and irony. (shrink)

In this paper Foucault’s thought on monstrosity is explored. Monsters appear whenever and wherever knowledge/power assemblages emerge. That which eludes the latter, and which threatens to subvert them, is the monstrous. Foucault distinguished the production, throughout history, of juridical-natural monsters, moral monsters, and political monsters. In this paper it is argued that Foucault must have sensed that monstrosity eludes all notions of identity and difference, and therefore also the notion that places it ‘outside’. It is the space of emergence itself, (...) i.e. the location where sheer potentiality becomes the possible of and in the event. All monstrosity is therefore deeply, and inevitably, political. It is the promise of unsettling subversion. (shrink)

Mechanisms are a way of explaining how biological phenomena work rather than why single elements of biological systems are there. However, mechanisms are usually described as physiological entities, and little or no attention is paid to malfunction as an independent theoretical concept. On the other hand, malfunction is the main focus of interest of applied sciences such as medicine. In this paper I argue that malfunctions are parts of pathological mechanisms, which should be considered separate theoretical entities, conceptually having a (...) priority over physiological sequences. While pathological mechanisms can be described in terms of a Cummins-like mechanistic explanation, they show some unnoticed peculiarities when compared to physiological ones. Some features of pathological mechanisms are considered, such as outcome variability, ambivalence and dependence on a range. (shrink)

In 2003, the Food and Drug Administration approved the use of growth hormone treatment for idiopathic short stature children, i.e. children shorter than average due to an unknown medical cause. Given the absence of any pathological conditions, this decision has been contested as a case of medicalisation. The aim of this paper is to broaden the debate over the reasons for and against the treatment, to include considerations of the sociocultural phenomenon of the medicalisation of short stature, by means of (...) a critical understanding of the concept of medicalisation. After defining my understanding of medicalisation and describing both the treatment and the condition of idiopathic short stature, I will problematise two fundamental issues: the medical/non-medical distinction and the debate about the goals of medicine. I will analyse them, combining perspectives of bioethics, medical sociology, philosophy of medicine and medical literature, and I will suggest that there are different levels of normativity of medicalisation. Ultimately, this study shows that: the definition of idiopathic short stature, focusing only on actual height measurement, does not provide enough information to assess the need for treatment or not; the analysis of the goals of medicine should be broadened to include justifications for the treatment; the use of growth hormone for idiopathic short stature involves strong interests from different stakeholders. While the treatment might be beneficial for some children, it is necessary to be vigilant about possible misconduct at different levels of medicalisation. (shrink)

This paper argues that in daycare centres in France, where children are cared for from four months to age three, the competence of female staff members is usually denied and unvalued vis à vis the expert opinions. The paper highlights empirical research on early childhood and gender, providing pragmatic access to children's languages of desire, a language mostly ignored. Incorporating the ideas of Foucault, Deleuze and Guattari, the paper draws upon the conceptualization of Fernand Deligny who took care of autistic (...) children in mapping what he called ‘lines of wandering’, an idea that shows how desire can become accessible. In the present ‘society of control’ which Deleuze analyses and which coexists with Foucault's discipline and biopower, such lines of flight enable the emergence of a new narrative for young children's desire, and for the competence of the female staff members in their departure from the highway of normalization. (shrink)