The goal of this programmatic paper is to highlight a close connection between the core problem in the philosophy of medicine, i.e. the concept of health, and the core problem of the philosophy of mind, i.e. the concept of consciousness. I show when we look at these phenomena together, taking the evolutionary perspective of modern state-based behavioural and life-history theory used as the teleonomic tool to Darwinize the agent- and subject-side of organisms, we will be in a better position to (...) make sense of them both as natural phenomena. (shrink)

A proposal for the biological grounding of intrinsic teleology and sense-making through the theory of autopoiesis is critically evaluated. Autopoiesis provides a systemic language for speaking about intrinsic teleology but its original formulation needs to be elaborated further in order to explain sense-making. This is done by introducing adaptivity, a many-layered property that allows organisms to regulate themselves with respect to their conditions of viability. Adaptivity leads to more articulated concepts of behaviour, agency, sense-construction, health, and temporality than those given (...) so far by autopoiesis and enaction. These and other implications for understanding the organismic generation of values are explored. (shrink)

This article explores contemporary biopolitics in the light of Michel Foucault's oft quoted suggestion that contemporary politics calls `life itself' into question. It suggests that recent developments in the life sciences, biomedicine and biotechnology can usefully be analysed along three dimensions. The first concerns logics of control - for contemporary biopolitics is risk politics. The second concerns the regime of truth in the life sciences - for contemporary biopolitics is molecular politics. The third concerns technologies of the self - for (...) contemporary biopolitics is ethopolitics. The article suggests that, in these events, human beings have become `somatic individuals': personhood is increasingly being defined in terms of corporeality, and new and direct relations are established between our biology and our conduct. At the same time, this somatic and corporeal individuality has become opened up to choice, prudence and responsibility, to experimentation, to contestation and so to a politics of `life itself'. (shrink)

What is it to be mentally healthy? In the ongoing movement to promote mental health, to reduce stigma, and to establish parity between mental and physical health, there is a clear enthusiasm about this concept and a recognition of its value in human life. However, it is often unclear what mental health means in all these efforts and whether there is a single concept underlying them. Sometimes, the initiatives for the sake of mental health are aimed just at reducing mental (...) illness, thus implicitly identifying mental health with the absence of diagnosable psychiatric disease. More ambitiously, there are high-profile proposals to adopt a positive definition, identifying mental health with psychic or even overall well-being. We argue against both: a definition of mental health as mere absence of mental illness is too thin, too undemanding, and too closely linked to psychiatric value judgments, while the definition in terms of well-being is too demanding and potentially oppressive. As a compromise, we sketch out a middle position. On this view, mental health is a primary good, that is, the psychological preconditions of pursuing any conception of the good life, including well-being, without being identical to well-being. (shrink)

Metaphors abound in both the arts and in science. Due to the traditional division between these enterprises as one concerned with aesthetic values and the other with epistemic values there has unfortunately been very little work on the relation between metaphors in the arts and sciences. In this paper, we aim to remedy this omission by defending a continuity thesis regarding the function of metaphor across both domains, that is, metaphors fulfill any of the same functions in science as they (...) do in the arts. Importantly, this involves the claim that metaphors in arts as well as science have both epistemic and aesthetic functions. (shrink)

Biological individuality is a notoriously thorny topic for biologists and philosophers of biology. In this paper we argue that biological individuality presents multiple, interconnected questions for biologists and philosophers that together form a problem agenda. Using a case study of an interdisciplinary research group in ecology, behavioral and evolutionary biology, we claim that a debate on biological individuality that seeks to account for diverse practices in the biological sciences should be broadened to include and give prominence to questions about uniqueness (...) and temporality. We show that broadening the problem agenda of biological individuality draws attention to underrecognized philosophical issues and discussions and thereby organizes and enriches the existing debate. (shrink)

We defend a view of the distinction between the normal and the pathological according to which that distinction has an objective, biological component. We accept that there is a normative component to the concept of disease, especially as applied to human beings. Nevertheless, an organism cannot be in a pathological state unless something has gone wrong for that organism from a purely biological point of view. Biology, we argue, recognises two sources of biological normativity, which jointly generate four “ways of (...) going wrong” from a biological perspective. These findings show why previous attempts to provide objective criteria for pathology have fallen short: Biological science recognizes a broader range of ways in which living things can do better or worse than has previously been recognized in the philosophy of medicine. (shrink)

This article offers the critical concept misfit in an effort to further think through the lived identity and experience of disability as it is situated in place and time. The idea of a misfit and the situation of misfitting that I offer here elaborate a materialist feminist understanding of disability by extending a consideration of how the particularities of embodiment interact with the environment in its broadest sense, to include both its spatial and temporal aspects. The interrelated dynamics of fitting (...) and misfitting constitute a particular aspect of world-making involved in material-discursive becoming. The essay makes three arguments: the concept of misfit emphasizes the particularity of varying lived embodiments and avoids a theoretical generic disabled body; the concept of misfit clarifies the current feminist critical conversation about universal vulnerability and dependence; the concept of misfitting as a shifting spatial and perpetually temporal relationship confers agency and value on disabled subjects. (shrink)

As a result of the world-wide COVID-19 epidemic, an internal tension in the goals of medicine has come to the forefront of public debate. Medical professionals are continuously faced with a tug of...

Conceptual analysis of health and disease is portrayed as consisting in the confrontation of a set of criteria—a “definition”—with a set of cases, called instances of either “health” or “ disease.” Apart from logical counter-arguments, there is no other way to refute an opponent’s definition than by providing counter-cases. As resorting to intensional stipulation is not forbidden, several contenders can therefore be deemed to have succeeded. This implies that conceptual analysis alone is not likely to decide between naturalism and normativism. (...) An alternative to this approach would be to examine whether the concept of disease can be naturalized. (shrink)

Enactive cognitive science combines questions in epistemology, ontology, and ethics by conceiving of bodies as open-ended and mutually transforming through activity. While enaction is not a theory of ethics, it can contribute to its foundations. We present a schematization of enactive ideas that underlie traditional distinctions between Being, Knowing, and Doing. Ethics in this scheme begins in the relation between knowing and becoming. Critical of dichotomous thinking, we approach the questions of alterity and ethical reality. Alterity is relevant to the (...) enactive approach, but not in the radical sense of transcendental arguments. We propose difference, instead, as a more generative concept. Following Simondon, we see norms and values manifest in webs of past and future acts together with their potentialities for becoming. We propose a transindividual concept of moral attunement that includes ethical know-how and consciousness raising. Through generative difference and attunement to configurations of becoming, enaction underpins an ethics of participation linking virtue ethics and ethics of care. (shrink)

I develop an interpretation of Maurice Merleau-Ponty's concept of motor intentionality, one that emerges out of a reading of his presentation of a now classic case study in neuropathology—patient Johann Schneider—in Phenomenology of Perception. I begin with Merleau-Ponty's prescriptions for how we should use the pathological as a guide to the normal, a method I call triangulation. I then turn to his presentation of Schneider's unusual case. I argue that we should treat all of Schneider's behaviors as pathological, not only (...) his abstract movements, as is commonly acknowledged in the secondary literature, but also crucially his concrete movements. Using these facts of Schneider's illness, I reconstruct a ‘fundamental function’ of consciousness, as Merleau-Ponty called it, in which there are two kinds of bodily agency: the power of the body to be solicited by a situation and the power of the body to project a situation. I propose that these powers became dissociated in Schneider's case, as evidenced by his abstract and concrete movements, while in the normal case, these powers comprise a dynamic unity, enacted as motor intentionality. I also discuss how my interpretation complements Merleau-Ponty's assertion that motor intentions exist between mind and matter. (shrink)

A large slice of contemporary phenomenology of medicine has been devoted to developing an account of health and illness that proceeds from the first-person perspective when attempting to understand the ill person in contrast and connection to the third-person perspective on his/her diseased body. A proof that this phenomenological account of health and illness, represented by philosophers, such as Drew Leder, Kay Toombs, Havi Carel, Hans-Georg Gadamer, Kevin Aho, and Fredrik Svenaeus, is becoming increasingly influential in philosophy of medicine and (...) medical ethics is the criticism of it that has been voiced in some recent studies. In this article, two such critical contributions, proceeding from radically different premises and backgrounds, are discussed: Jonathan Sholl’s naturalistic critique and Talia Welsh’s Nietzschean critique. The aim is to defend the phenomenological account and clear up misunderstandings about what it amounts to and what we should be able to expect from it. (shrink)

In the last 50 years, discussions of how to understand disability have been dominated by the medical and social models. Paradoxically, both models overlook the disabled person’s experience of the lived body, thus reducing the body of the disabled person to a physiological body. In this article we introduce what we call the Ecological-Enactive (EE) model of disability. The EE-model combines ideas from enactive cognitive science and ecological psychology with the aim of doing justice simultaneously to the lived experience of (...) being disabled, and the physiological dimensions of disability. More specifically, we put the EE model to work to disentangle the concepts of disability and pathology. We locate the difference between pathological and normal forms of embodiment in the person’s capacity to adapt to changes in the environment. To ensure that our discussion remains in contact with lived experience, we draw upon phenomenological interviews we have carried out with people with Cerebral Palsy. (shrink)

In this paper I explore health and illness through the lens of enactivism, which is understood and developed as a bodily-based worldly-engaged phenomenology. Various health theories – biomedical, ability-based, biopsychosocial – are introduced and scrutinized from the point of view of enactivism and phenomenology. Health is ultimately argued to consist in a central world-disclosing aspect of what is called existential feelings, experienced by way of transparency and ease in carrying out important life projects. Health, in such a phenomenologically enacted understanding, (...) is an important and in many cases necessary part of leading a good life. Illness, on the other hand, by such a phenomenological view, consist in finding oneself at mercy of unhomelike existential feelings, such as bodily pains, nausea, extreme unmotivated tiredness, depression, chronic anxiety and delusion, which make it harder and, in some cases, impossible to flourish. In illness suffering the lived body hurts, resists, or, in other ways, alienates the activities of the ill person. (shrink)

This study clarifies the need for a renewed account of the body in physiotherapy to fill sizable gaps between physiotherapeutical theory and practice. Physiotherapists are trained to approach bodily functioning from an objectivist perspective; however, their therapeutic interactions with patients are not limited to the provision of natural-scientific explanations. Physiotherapists’ practice corresponds well to theorisation of the body as the bearer of original bodily intentionality, as outlined by Merleau-Ponty and elaborated upon by enactivists. We clarify how physiotherapeutical practice corroborates Merleau-Ponty’s (...) critical arguments against objectivist interpretations of the body; particularly, his analyses demonstrate that norms of optimal corporeal functioning are highly individual and variable in time and thus do not directly depend on generic physiological structures. In practice, objectively measurable physical deviations rarely correspond to specific subjective difficulties and, similarly, patients’ reflective insights into their own motor deficiencies do not necessarily produce meaningful motor improvements. Physiotherapeutical procedures can be understood neither as mechanical manipulations of patients’ machine-like bodies by experts nor as a process of such manipulation by way of instructing patients’ explicit conscious awareness. Rather, physiotherapeutical practice and theory can benefit from the philosophical interpretation of motor disorders as modifications of bodily intentionality. Consequently, motor performances addressed in physiotherapy are interpreted as relational features of a living organism coupled with its environment, and motor disorders are approached as failures to optimally manage the motor requirements of a given situation owing to a relative loss of the capacity to structure one’s relation with their environment through motor action. Building on this, we argue that the process of physiotherapy is most effective when understood as a bodily interaction to guide patients towards discovering better ways of grasping a situation as meaningful through bodily postures and movements. (shrink)

Prevention of age-related disorders is increasingly in focus of health policies, and it is hoped that early intervention on processes of deterioration can promote healthier and longer lives. New opportunities to slow down the aging process are emerging with new fields such as personalized nutrition. Data-intensive research has the potential to improve the precision of existing risk factors, e.g., to replace coarse-grained markers such as blood cholesterol with more detailed multivariate biomarkers. In this paper, we follow an attempt to develop (...) a new aging biomarker. The vision among the project consortium, comprising both research and industrial partners, is that the new biomarker will be predictive of a range of age-related conditions, which may be preventable through personalized nutrition. We combine philosophical analysis and ethnographic fieldwork to explore the possibilities and challenges of managing aging through bodily signs that are not straightforwardly linked to symptomatic disease. We document how the improvement of measurement brings about new conceptual challenges of demarcating healthy and unhealthy states. Moreover, we highlight that the reframing of aging as risk has social and ethical implications, as it is generative of normative notions of what constitutes successful aging and good citizenship. (shrink)

Psychedelic-assisted Psychotherapy combines the use of psychedelic compounds, such as psilocybin, with psychotherapy. PAP has shown some promise as a novel treatment for Major Depressive Disorder, and empirical research suggests that its efficacy turns on the altered states induced by psychedelic compounds. In this paper we draw on the literature of phenomenology to explain the therapeutic potential of psychedelic experiences. Svenaeus characterises mental illness as a form of suffering that entails three distinct but related experiences of alienation or “unhomelike being-in-the-world”: (...) illness suffering, which relates to embodiment; existential suffering, which relates to self-narratives, and political suffering, which relates to social relationships. Ratcliffe further characterises the experience of MDD in phenomenological terms as a loss of pre-intentional possibility that manifests as excessive noematic feeling in the experience of embodiment, restrictive narratives in the construction of self, and disconnectedness in experience of the social world. We contend that PAP ameliorates the suffering associated with MDD by inducing and consolidating a state of broadened pre-intentional possibility—one that entails sudden, profound and enduring changes in embodiment, self-narratives, and social experience. We argue further that this phenomenological account is consistent with a bio-psycho-social model of mental health and illness, and we frame it as an argument supporting the plausibility of recent claims about treatment success. This helps to justify ongoing future empirical research in this setting. (shrink)

This goal of this thesis in the philosophy of nature is to move us closer towards a true biological science of consciousness in which the evolutionary origin, function, and phylogenetic diversity of consciousness are moved from the field’s periphery of investigations to its very centre. Rather than applying theories of consciousness built top-down on the human case to other animals, I argue that we require an evolutionary bottomup approach that begins with the very origins of subjective experience in order to (...) make sense of the place of mind in nature. To achieve this goal, I introduce and defend the pathological complexity thesis as both a framework for the scientific investigation of consciousness and as a lifemind continuity thesis about the origins and function of consciousness. (shrink)

The phenomenological method has been fruitfully used to study the experience of illness in recent years. However, the role of illness is not merely that of a passive object for phenomenological scrutiny. I propose that illness, and pathology more generally, can be developed into a phenomenological method in their own right. I claim that studying cases of pathology, breakdown, and illness offer illumination not only of these experiences, but also of normal function and the tacit background that underpins it. In (...) particular, I claim that the study of embodiment can be greatly enhanced, and indeed would be incomplete, without attending to bodily breakdown and what I term bodily doubt. I offer an analogy between illness and Husserl’s epoché, suggesting that both are a source of distancing, and therefore motivate a reflective stance. (shrink)

This paper presents a new interpretation of Michel Foucault’s critical project. It is well known that Foucault’s genealogical critique does not focus on issues of justification, but instead tackles “aspectival captivity,” that is, apparently inevitable limits of thought that constrain the agent’s freedom but that, in fact, can be transformed. However, it has not been recognized that, according to Foucault, critique can proceed along two distinct paths. In a key passage of “What Is Critique?,” Foucault states that critique is tasked (...) with questioning truth about its effects of power and with questioning power about its discourses of truth. We show that this “double movement” organizes Foucault’s critical project as a whole, giving it a significantly wider scope and a more complex structure than has been previously acknowledged. At the heart of the above-mentioned bifurcation lies an apparent tension between two contrastive roles Foucault assigns to truth-telling in the context of critique: on the one hand, truth-telling (as avowal) is a target of critique; on the other, truth-telling (as parrhesia) is one of critique’s methods. We argue that combining these two dimensions in a unified account is crucial for understanding and re-evaluating Foucault’s critical project as a whole. By showing that truth-telling remains an essential element of Foucauldian critique, this paper also rectifies some influential misinterpretations according to which Foucault’s critical project seeks to eliminate truth from the picture. (shrink)

Several philosophers have recently argued that phenomenology is well-suited to help understand the concepts of health, disease, and illness. The general claim is that by better analysing how illness appears to or is experienced by ill individuals—incorporating the first-person perspective—some limitations of what is seen as the currently dominant third-person or ‘naturalistic’ approaches to understand health and disease can be overcome. In this article, after discussing some of the main insights and benefits of the phenomenological approach, I develop three general (...) critiques of it. First, I show that what is often referred to as naturalism tends to be misunderstood and/or misrepresented, resulting in straw-man arguments. Second, the concept of normality is often problematically employed such that some aspects of naturalism are actually presupposed by many phenomenologists of medicine. Third, several of the key phenomenological insights and concepts, e.g. having vs. being a body, the alienation of illness, the epistemic role of the first-person perspective, and the idea of health within illness, each bring with them new problems that limit their utility. While acknowledging the possible contributions of phenomenology, these criticisms point to some severe limitations of bringing phenomenological insights to bear on the problems facing philosophy of medicine that should be addressed if phenomenology is to add anything substantially new to its debates. (shrink)

Today’s question concerning technology involves asking about both the post-pandemic world and the post-data-economy world, in a situation where resentments and scapegoats are easily generated. We c...

In the science and values literature, scholars have shown how science is influenced and shaped by values, often in opposition to the ‘value free’ ideal of science. In this paper, we aim to contribute to the science and values literature by showing that the relation between science and values flows not only from values into scientific practice, but also from (allegedly neutral) science to values themselves. The extant literature in the ‘science and values’ field focuses by and large on reconstructing, (...) post hoc, how values have influenced science; our reconstruction of the case studies, instead, aims to show that scientific concepts and methods _too, because of specific identifiable characteristics,_ can promote some values rather than (or at the expense of) others. We explain this bidirectional relation in analogy to debates on the normativity of technical artifacts and on feminist approaches in science, and we illustrate our claims with cases from the health sciences and machine learning. While our arguments in this paper also draw on post hoc reconstructions, we intend to show where, in the science in the making, we should engage not only with the question whether a practice is value-laden, but also how specific conceptual and methodological choices can influence values down the road. All in all, these considerations expand the ways in which philosophers can contribute to more value-aware scientific practices. (shrink)

This article offers a novel reconstruction of Foucault’s methodology that emphasises his respect for the natural sciences. Foucault’s work has long been suspected of reducing knowledge to power, and thus collapsing into unconstrained relativism and methodological incoherence. These concerns are predicated on a misunderstanding of Foucault’s overall approach, which takes the form of a historico-critical project rather than a normative epistemology. However, Foucault does sometimes make normative epistemological judgements, especially about the human sciences. Furthermore, there are outstanding questions about what (...) secures the descriptive rigour of the genealogical method. To address these issues, I develop two claims that will significantly enrich our understanding of Foucault’s methodology. The first is that Foucault’s respect for the natural sciences is crucial in making sense of his normative epistemological judgements. The second is that the descriptive rigour of his genealogical method derives from the fact it is modelled on empirical inquiry. (shrink)

Are the small and indolent cancers found in abundance in cancer screening normal variations, risk factors, or disease? Naturalists in philosophy of medicine turn to pathophysiological findings to decide such questions objectively. To understand the role of pathophysiological findings in disease definition, we must understand how they mislead in diagnostic reasoning. Participants on all sides of the definition of disease debate attempt to secure objectivity via reductionism. These reductivist routes to objectivity are inconsistent with the Bayesian nature of clinical reasoning; (...) when they appeal to the sciences, they are inconsistent with what philosophy of biology tells us about its natural kinds. Proposals that we narrow the scope of our claims in the disease definition debates are useful, but paradigms can still distort our reasoning in particular cases, even when we are self-conscious about their status. (shrink)

Whereas theories on health generally argue in favor of one specific concept, we argue that, given the variety of health practices, we need different concepts of health. We thus approach health concepts as a Wittgensteinian family of thick concepts. By discussing five concepts of health offered by theory, we argue that all capture something that seems relevant when we talk and think about health. Classifying these concepts reveals their family resemblances: each of these concepts differs from the others in at (...) least one respect and resembles the others in several respects. Moreover, our classification shows that “health” always both describes a condition and evaluates that condition at the same time. Having both descriptive and evaluative dimensions, we can see health concepts as “thick concepts.” It is because of this evaluative dimension that it is important to reflect on the question of what understanding of health guides specific practices. We show that the distinctions revealed by our classification can serve as a conceptual toolbox for reflection on the assumptions and purposes of particular health practices. Finally, we illustrate how such reflection could work out by briefly exploring three specific health practices. (shrink)

This article argues that the limited influence of Ludwik Fleck's ideas on philosophy of science is due not only to their indirect dissemination by way of Thomas Kuhn, but also to an incommensurability between the standard conceptual framework of history and philosophy of science and Fleck's own more integratedly historico-social and praxis-oriented approach to understanding the evolution of scientific discovery. What Kuhn named "paradigm" offers a periphrastic rendering or oblique translation of Fleck's Denkstil/Denkkollektiv , a derivation that may also account (...) for the lability of the term "paradigm". This was due not to Kuhn's unwillingness to credit Fleck but rather to the cold war political circumstances surrounding the writing of The Structure of Scientific Revolutions . Following a discussion of Fleck's anatomical allusions, I include a brief discussion of Aristotle (on menstruation and darkened mirrors) and conclude with a reference to the productivity of error in Mach and Nietzsche. (shrink)

In the two volumes which make up Capitalism and Schizophrenia, Deleuze and Guattari propose new concepts of “machine” and “organism.” The problem of the relationship between machines and organisms has a long philosophical history, and this essay treats their work as a contribution to this debate. It is argued that their solution to this problem is found in their difficult concept of the “body without organs,” a concept that is given some much-needed clarification in the essay. The first section details (...) Deleuze and Guattari’s concept of the machine, examining the ways in which it differs from the traditional concept as described by Canguilhem: their machines do not have predictable movements, but instead produce events; they do not have a purpose; they are able to reproduce themselves. The second section details their conception of the organism through their account of Geoffroy Saint-Hilaire: organisms are bodies which normalize and which create hierarchies; they also do not have a purpose; they have a “unity of composition.” The final section argues that their concept of the “body without organs” shows us how to understand the relation between the two transformed concepts, and defines the body without organs as the becoming-machine of the organism. (shrink)

Human enhancement is ontologically, epistemologically, and ethically challenging and has stirred a wide range of scholarly and public debates. This article focuses on some conceptual issues with HE that have important ethical implications. In particular it scrutinizes how the concept of human enhancement relates to and challenges the concept of health. In order to do so, it addresses three specific questions: Q1. What do conceptions of HE say about health? Q2. Does HE challenge traditional conceptions of health? Q3. Do concepts (...) of health set limits to or direct HE? Addressing Q1 reveals that HE tends to frame and form our conception of health. Thereby it challenges traditional conceptions of health. Accordingly, health does not provide strong sources for setting limits to HE. On the contrary HE seems to define and expand the concept of health. Common to the concepts of HE and health is that both depend on vague value concepts, such as happiness, well-being, or goodness. There seems to be a tendency in the HE literature to define the goal of human life in terms of what is bigger, stronger, faster, more intelligent, and more resilient. However, this is confusing “goodness” with “more” and quality with quantity. Until HE more appropriately defines happiness, HE will fail to provide a relevant compass for improving the life of human beings. On the contrary, if we let simplified conceptions of “enhancement” come to define goodness or health, we may do more harm than good. Until doing so, we may well learn from Tithonus, listen to Douglas Adams’ Wowbagger, and pay attention to Virginia Woolf’s Orlando. Enhanced life may not be better. The same goes for health. (shrink)

This article examines the philosophical role of illness. It briefly surveys the philosophical role accorded to illness in the history of philosophy and explains why illness merits such a role. It suggests that illness modifies, and thus sheds light on, normal experience, revealing its ordinary and therefore overlooked structure. Illness also provides an opportunity for reflection by performing a kind of suspension (epoché) of previously held beliefs, including tacit beliefs. The article argues that these characteristics warrant a philosophical role for (...) illness. While the performance of most philosophical procedures is volitional and theoretical, however, illness is uninvited and threatening, throwing the ill person into anxiety and uncertainty. As such it can be viewed as a radical philosophical motivation that can profoundly alter our outlook. The article suggests that illness can change the ways in which we philosophise: it may shape philosophical methods and concerns and change one's sense of salience and conception of philosophy. (shrink)

Since antiquity well into the beginnings of the 20th century geometry was a central topic for philosophy. Since then, however, most philosophers of science, if they took notice of topology at all, considered it as an abstruse subdiscipline of mathematics lacking philosophical interest. Here it is argued that this neglect of topology by philosophy may be conceived of as the sign of a conceptual sea-change in philosophy of science that expelled geometry, and, more generally, mathematics, from the central position it (...) used to have in philosophy of science and placed logic at center stage in the 20th century philosophy of science. Only in recent decades logic has begun to loose its monopoly and geometry and topology received a new chance to find a place in philosophy of science. (shrink)

In contrast to the “normativist” view, “naturalist” theorists claim that the concept of health refers to natural or normal states and propose different characterizations of healthy and diseased conditions that are meant to be objectivist and biologically grounded. In this article, we examine the core concept of these naturalist accounts of disease, i.e., the concept of biological malfunction, and develop a new formulation of the notion of malfunction following the recent organizational approach to functions in the philosophy of biology. We (...) focus on the notions of adaptive regulation and functional presupposition to develop a new conceptual framework that justifies the ascription of malfunctional behaviors to biological systems according to the embodied normativity of biological organizations. (shrink)

Although the term integration is central to the definition of brain death, there is little agreement on what it means. Through a genealogical analysis, this essay argues that there have been two primary ways of understanding integration in regard to organismal wholeness. One stems from neuroscience, focusing on the role of the brain in responding to external stimuli, which was taken up in phenomenological accounts of life. A second, arising out of cybernetics, focuses on the brain’s role in homeostasis. Recent (...) debates over brain death are largely over this cybernetic understanding of integration. However, the phenomenological understanding of organismal wholeness can be seen in arguments by the President’s Council on Bioethics in favor of brain death. This essay argues that the cybernetic understanding of life is problematic and should be discarded. A phenomenological understanding of life can provide a better basis for arguments over definitions of life and death. (shrink)

How can we draw the line between health and disease? This crucial question of demarcation has immense practical implications and has troubled scholars for ages. The question will be addressed in three steps. First, I will present an important contribution by Rogers and Walker who argue forcefully that no line can be drawn between health and disease. However, a closer analysis of their argument reveals that a line-drawing problem for disease-related features does not necessarily imply a line-drawing problem for disease (...) as such. The second step analyzes some alternative approaches to drawing the line between health and disease. While these approaches do not provide full answers to the question, they indicate that the line-drawing question should not be dismissed too hastily. The third step investigates whether the line-drawing problem can find its solution in the concept of suffering. In particular, I investigate whether returning to the origin of medicine, with the primary and ultimate goal of reducing suffering, may provide sources of demarcation between health and disease. In fact, the reason why we pay attention to particular phenomena as characteristics of disease, consider certain processes to be relevant, and specific functions are classified as dys-functions, is that they are related to suffering. Accordingly, using suffering as a criterion of demarcation between health and disease may hinder a wide range of challenges with modern medicine, such as unwarranted expansion of disease, overdiagnosis, overtreatment, and medicalization. (shrink)

In current phenomenology of medicine, health is often understood as a state of transparency in which our body refrains from being an object of explicit attention. In this paper, I argue that such an understanding of health unnecessarily presupposes an overly harmonious alignment between subjective and objective body, resulting in the idea that our health remains phenomenologically inaccessible. Alternatively, I suggest that there are many occasions in which one’s body in health does become an object of attention, and that technologies (...) mediate how a relation with one’s body is formed. First, I show prominent accounts in current phenomenology of medicine understand health in terms of a harmonious alignment between objective and subjective body. Second, I argue that there are many occasions in which there is a disharmony between objective and subjective body, and suggest that also in health, we cannot escape being an object that we often relate to. Then, I draw on postphenomenology to show how technologies such as digital self-tracking applications and digital twins can be understood as mediating the relationship with one’s own body in a specific way. In conclusion, I argue that both technologies make present the objective body as a site for hermeneutic inquiry such that it can be interacted with in terms of health parameters. Furthermore, I point to some relevant differences in how different technologies make aspects of our own body phenomenologically present. (shrink)

Rather than ‘superbugs’ signifying recalcitrant forms of life that withstand biomedical treatment, drug resistant infections emerge within and are intricate with the exercise of social and medical power. The distinction is important, as it provides a means to understand and critique current methods employed to confront the threat of widespread antimicrobial resistance. A global health regime that seeks to extend social and medical power, through technical and market integration, risks reproducing a form of triumphalism and exceptionalism that resistance itself should (...) have us pause to question. An alternative approach, based on a postcolonial as well as a ‘post-colony’ approach to health and microbes, provides impetus to challenge the assumptions and norms of global health. It highlights the potential contribution that vernacular approaches to human and animal health can play in altering the milieu of resistance. (shrink)

Seeking a scientific basis for understanding and treating mental illness, and inspired by the work of Ivan Pavlov, American physiologists, psychiatrists and psychologists in the 1920s turned to nonhuman animals. This paper examines how new constructs such as “experimental neurosis” emerged as tools to enable psychiatric comparison across species. From 1923 to 1962, the Cornell “Behavior Farm” was a leading interdisciplinary research center pioneering novel techniques to experimentally study nonhuman psychopathology. Led by the psychobiologist Howard Liddell, work at the Behavior (...) Farm formed part of an ambitious program to develop new preventative and therapeutic techniques and bring psychiatry into closer relations with physiology and medicine. At the heart of Liddell’s activities were a range of nonhuman animals, including pigs, sheep, goats and dogs, each serving as a proxy for human patients. We examine how Pavlov’s conceptualization of ‘experimental neurosis’ was used by Liddell to facilitate comparison across species and communication between researchers and clinicians. Our close reading of his experimental system demonstrates how unexpected animal behaviors and emotions were transformed into experimental virtues. However, to successfully translate such behaviors from the animal laboratory into the field of human psychopathology, Liddell increasingly reached beyond, and, in effect, redefined, the Pavlovian method to make it compatible and compliant with an ethological approach to the animal laboratory. We show how the resultant Behavior Farm served as a productive “hybrid” place, containing elements of experiment and observation, laboratory and field. It was through the building of close and more naturalistic relationships with animals over extended periods of time, both normal and pathological, and within and outside of the experimental space, that Liddell could understand, manage, and make useful the myriad behavioral complexities that emerged from the life histories of experimental animals, the researchers who worked with them, and their shared relationships to the wider physical and social environments. (shrink)

The paper discusses two recent approaches to schizophrenia, a phenomenological and a neuroscientific approach, illustrating how new directions in philosophy and cognitive science can elaborate accounts of psychopathologies of the self. It is argued that the notion of the minimal and bodily self underlying these approaches is still limited since it downplays the relevance of social interactions and relations for the formation of a coherent sense of self. These approaches also illustrate that we still lack an account of how 1st (...) and 3rd person observations can fruitfully go together in an embodied account of disorders of the self. Two concepts from enactive cognitive science are introduced, the notions of autonomy and sense-making. Based on these, a new proposal for an enactive approach to psychopathologies of the self is outlined that integrates 1st and 3rd person perspectives, while strongly emphasising the role of social interactions in the formation of self. It is shown how the enactive framework might serve as a basis for an alternative understanding of disorders of the self such as schizophrenia, as a particular form of socially constituted self-organisation. (shrink)

ABSTRACTIn Foucault's later works, experience and embodiment become important for explaining the normative constitution of the subject: for norms to be effective, discourses are insufficient – they must be experienced and embodied. Practices of “discipline” inscribe power constellations and discourses into subjective experience and bodies. In his lectures on the Hermeneutics of the Subject, he turns this “violent” form of normative embodiment into an ethical perspective by referring to the Stoic tradition. Even though Foucault never developed a notion of experience (...) and embodiment himself, his ideas can be re-read and complemented from a phenomenological perspective.The article tries to investigate the role of bodily experience and practice in Foucault's Genealogy and to bring it into dialogue with Husserl and Merleau-Ponty's conceptions of the lived body. It will attempt to show that concepts like sedimentation and habituality can help to explain how cultural norms not only influence the way we think abou.. (shrink)

The following article presents preliminary reflections on a processual theory of health and disease. It does this by steering the discussion more toward an ontology of organisms rather than conceptual analysis of the semantic content of the terms “health” and “disease.” In the first section, four meta-theoretical assumptions of the traditional debate are identified and alternative approaches to the problems are presented. Afterwards, the view that health and disease are constituted by a dynamic relation between demands imposed on an organism (...) and individual presuppositions for adequate response is developed. In the last section, the paper takes stock of three possible objections to and clarifies some implications of this approach to the notions of health and disease. (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)

This is a review article of Elizabeth Barnes’ new book, Health Problems. In this article, I try to offer a sense of where this exciting sub-discipline of philosophy of medicine has got to. I do that in three ways. First, I make a few comments on the general idea that there are theories of health competing in the field of philosophy of medicine; second, I offer specific comments on the phenomenological approach; and finally, I comment on Barnes’ claim that health (...) is messy. I do not provide an overview of the book but a response to some of its themes. (shrink)

Placebos are commonly defined as ineffective treatments. They are treatments that lack a known mechanism linking their properties to the properties of the condition on which treatment aims to intervene. Given this, the fact that placebos can have substantial therapeutic effects looks puzzling. The puzzle, we argue, arises from the relationship placebos present between culturally meaningful entities, our intentional relationship to the environment and bodily effects. How can a mere attitude toward a treatment result in appropriate bodily changes? We argue (...) that an ‘enactive’ conception of cognition accommodates and renders intelligible the phenomenon of placebo effects. Enactivism depicts an organism’s adaptive bodily processes, its intentional directedness, and the meaningful properties of its environment as co-emergent aspects of a single dynamic system. In doing so it provides an account of the interrelations between mind, body and world that demystifies placebo effects. (shrink)

Overdiagnosis and disease are related concepts. Widened conceptions of disease increase overdiagnosis and vice versa. This is partly because there is a close and complex relationship between disease and overdiagnosis. In order to address the problems with overdiagnosis, we may benefit from a closer understanding this relationship. Accordingly, the objective of this article is to elucidate the relationship between disease and overdiagnosis. To do so, the article starts with scrutinizing how overdiagnosis can explain the expansion of the concept of disease. (...) Then it investigates how definitions of disease address various challenges of overdiagnosis. The article specifically investigates recent attempts to clarify the relationship between the concepts of disease and overdiagnosis. Several shortcomings are identified and lead to a closer analysis of overdiagnosis in the diagnostic process. Contrary to recent contributions to the field, it is argued that cases of overdiagnosis are not cases of disease. They are non-verified labelling of disease. It is revealed how overdiagnosis establishes an unwarranted link between indicative phenomena, such as polyps or cell changes, and harm, and thereby generates a link to disease. One implication of this study is that we should stop attributing disease language to indicative phenomena. That is, we should stop calling it “cancer screening” when we are actually searching for polyps. Another implications is that we should strive for scientific progress in differentiating phenomena that are of negative value to us from those that are not. In overdiagnosis we diagnose something that is not disease: it is over-diagnosis. (shrink)

This article combines the neo-Hegelian theory of recognition with an analysis of social pathologies to show how the populist formulations of political goals in struggles for recognition are – despite their potential positive motivating force – socially pathological. The concept of recognition, combined with the idea of social pathologies, can thus be used to introduce normative considerations into the populism analysis. In this article it is argued that, although populism is useful in the sense that it aims to ameliorate real (...) experienced lack of recognition through fostering political movements, it is also harmful. The simplified populist representations of collective identities are often guilty of essentializing and reifying identities. Furthermore, populist identities are also harmful for the populists themselves as the simplified view is applied also to oneself. This article claims that these dynamics can be understood as an obstruction of discursive identity-formation. From the perspective developed, populism leads to the lack of genuine mutual recognition between those who struggle to get their identities affirmed. (shrink)

What is considered normal determines clinical practice in medicine and has implications at an individual level, doctor-patient relationship and health care policies. With the increase in medical information and technical abilities it is urgent to have a clear concept of normality in medicine so that crucial discussions can be held with unequivocal terms.The different meanings for normality were analyzed throughout the literature and grouped according to their relevance in the academic community in models, namely the Biostatistical Theory (BST), Health, Ideal, (...) Process and Biological advantage. The BST is the most established naturalistic approach, however normal variability can arguably constitute a problem. Health is similar and raises the question of setting the boundaries of pathology. Normality as an Ideal is an useful tool but is naturally unrealistic. As a Process it is comprehensible but is hard to frame for practical purposes. If considered as a Biological Advantage, seems intuitive but abnormality should tend to disappear.After, three examples were presented to discuss these models. They were Anemia, Psychiatric diseases and Psychopathy. In the case of Anemia the BST was applied and the arbitrary boundaries but with social impact were exposed. Psychiatric diseases was discussed under the process of self-organization and non-suffering ideal. With Psychopathy the boundaries of biological advantage are questioned.This review appeals to the importance of redesigning of the concept of normality in medicine according to current times and stresses the importance of integrating concepts such as variability and autonomy. (shrink)

This study addresses the question of normative analysis of the value‐based aspects of nursing. In our perspective, values in science may be distinguished into (i) epistemic when related to the goals of truth and objectivity and (ii) non‐epistemic when related to social, cultural or political aspects. Furthermore, values can be called constitutive when necessary for a scientific enterprise, or contextual when contingently associated with science. Analysis of the roles of the various forms of values and models of knowledge translation provides (...) the ground to understand the specific role of values in nursing. A conceptual framework has been built to classify some of the classical perspectives on nursing knowledge and to examine the relationships between values and different forms of knowledge in nursing. It follows that adopting a normative perspective in the analysis of nursing knowledge provides key elements to identify its proper dimension. (shrink)