ArgumentResearch into the biological markers of pathology has long been a feature of British psychiatry. Such somatic indicators and associated features of mental disorder often intertwine with discourse on psychological and behavioral correlates and causes of mental ill-health. Disorders of sociality – particularly psychopathy and antisocial personality disorder – are important instances where the search for markers of pathology has a long history; research in this area has played an important role in shaping how mental health professionals understand the conditions. (...) Here, I characterize the multiplicity of psychiatric praxis that has sought to define the mark of antisociality as a form of “ontological anarchy.” I regard this as an essential feature of the search for biological and other markers of an unstable referent, positing that uncertainties endure – in part – precisely because of attempts to build consensus regarding the ontology of antisociality through biomedical means. Such an account is suggestive of the co-production of biomarkers, mental disorder, and psychiatric institutions. (shrink)

The article addresses Jürgen Habermas’ theory of communicative action, which offers very productive tools for analysing disability. The Habermasian division of social reality helps examine positive and negative effects of tensions between the lifeworld of a person with disability and the system. By exploring such an individual's communicative action, one can obtain an insight into his/her validity claims and disruptions in the communication process and self‐understandings inscribed in group narratives. The study reported in the article used in‐depth interviews, which narratively (...) reveal the experiences of a person with disability in family, education, sports and labour. The key findings are, first, that the rationalization of lifeworlds of people with disability increases while processes in which they are colonized by the system intensify; second, that education and family are significant factors in the raising of validity claims; and third, that validity claims as tools of verbal communication should be augmented with arguments from non‐verbal language (e.g. gesture, empathy). (shrink)

The aim of the study was to demonstrate how Foucault's ethics, which we understand as a tension between exclusion and emancipation, helps both critically reassess two disability models that prevail in the contemporary literature concerning disability, that is the medical model and the social one, and support and inspire an ethical project of including people with disabilities in spheres of life from which they have been excluded by various power/knowledge regimes. We claim, following Foucault, that such a project should be (...) informed by critical reflection on exclusion‐generating forms of knowledge about people with disabilities and focused on individual ethical actions fostering self‐realization and emancipation of people with disability. (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)

In The Open, a series of reflections on the historical endeavours to define the essential features of the human figure in relation to the biological existence it shares with animals, Giorgio Agamben offers a detailed reading of Titian’s painting The Nymph and the Shepherd. He argues that the scene depicted enables the contemporary viewer to visualize the advent of radical freedom, the moment when the historical dialectic of nature and culture comes to a ‘stand-still’. In this article, I offer a (...) different reading of The Nymph and the Shepherd, whereby the advent of radical freedom and death become indistinguishable. This different reading, I argue, calls into question Agamben’s understanding of corporeal being. I conclude by suggesting more speculatively and tentatively that ‘bioart’, the field now emerging at the intersection of the creative arts and the bio-medical sciences, may provide a better site of reflection on the questions Agamben ultimately poses about the future of bio-political governmentality. (shrink)

Who is speaking in the history of social thought? The question of the authentic voice of social thought is typically posed in terms that tend to be either ambitiously theoretical or carefully methodological. Thus histories of social thought frequently offer either a résumé of general ideas about society (say from Montesquieu to Parsons) or a survey which gets bogged down in a rather tedious, nit-picking debate about empirical methodology. This paper is something of a preview of a pro jected attempt (...) on the part of the authors to capture the voice of social thought in rather different terms. Our three theses are: (1) that those who speak 'in the name of society' have just as frequently been doctors and bureaucrats as opposed to 'social philosophers' or professional sociologists; correlatively, (2) that the creative voice of social thought has more often been technical, problem-centred and tied up with par ticular rationalities of government as opposed to being either exclu sively theoretical or merely responsive to 'objective problems' in society; and, (3) that if sociology today struggles for a voice in which to speak this may be in some part due to the ways in which the past history of social thought has typically been conceived. (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)

Recent developments in the psychological and social sciences have seen a surge of attention to concepts of embodiment. The burgeoning field of embodied cognition, as well as the long-standing tradition of phenomenological philosophy, offer valuable insights for theorising how people come to understand the world around them. However, the implications of human embodiment have been largely neglected by one of the key frameworks for conceptualising the development of social knowledge: Social Representations Theory. This article seeks to spark a dialogue between (...) Social Representations Theory and embodiment research. It outlines the position the body occupies in the existing theoretical and empirical social representations literature, and argues that incorporating concepts gleaned from embodiment research may facilitate a more comprehensive account of the aetiology of social representations. The value of analytic attention to embodiment is illustrated with reference to a recent study of social representations of neuroscience, which suggested that embodied experience can shape the extent to which people engage with certain topics, the conditions under which they do so, and the conceptual and affective content of the ensuing representations. The article argues that expanding Social Representations Theory's methodological and conceptual toolkit, in order to illuminate the interplay between embodied experience and social communication in the development of common-sense knowledge, promises productive directions for empirical and theoretical advancement. (shrink)

The article focuses on the impact of the concept of self-care on persons who are understood as incapable of self-care due to their physical and/or mental ‘incapacity’. The article challenges the idea of this health care concept as empowerment and highlights the difficulties for persons who do not fit into this concept. To exemplify this, the self-care concept is discussed with regard to persons with Alzheimer’s disease (AD). In the case of persons with AD, self-care is interpreted in many different (...) ways—depending on the point of view, for instance as an affected person or a carer. To prevent a marginalisation of the growing group of elderly persons with dementia, the article argues that concepts such as those of personhood, wellbeing, autonomy, rationality and normality have to be re-thought with regard to an increasingly ageing population. Taking into account that AD as a socio-medical construct has to be understood in the context of power relations, the article focuses on the mutual influence between the concepts of self-care and of AD and its possible impact on governing dementia and AD in particular. Michel Foucault’s considerations on ‘technologies of the self’ provide the basis for the discussion of the self-care concept within existing societal power relations. (shrink)

The importance given by historian and philosopher of science Georges Canguilhem to the role of practice, techniques, and experimentation in concept-formation was largely overlooked by commentators. After placing Canguilhem’s contributions within the larger history of historical epistemology in France, and clarifying his views regarding this expression, I re-evaluate the relation between concepts and experimental practices in Canguilhem’s philosophy of science. Drawing on his early writings on the relations between science and technology in the 1930s, on the Essai sur quelques problèmes (...) concernant le normal et le pathologique , and on La formation du concept de réflexe aux XVIIe et XVIIIe siècles , I argue that the formation and rectification of concepts in Canguilhem’s sense are intrinsically bound with the experimental, material, technical, and cultural contexts in which concepts are operationalized. (shrink)

The tendency to idealise artificial intelligence as independent from human manipulators, combined with the growing ontological entanglement of humans and digital machines, has created an “anthrobotic” horizon, in which data analytics, statistics and probabilities throw our agential power into question. How can we avoid the consequences of a reified definition of intelligence as universal operation becoming imposed upon our destinies? It is here argued that the fantasised autonomy of automated intelligence presents a contradistinctive opportunity for philosophical consciousness to understand itself (...) anew as holistic and co-creative, beyond the recent “analytic” moment of the history of philosophy. Here we introduce the concept of “crealectic intelligence”, a meta-analytic and meta-dialectic aspect of consciousness. Intelligent behaviour may consist in distinguishing discrete familiar parts or reproducible functions in the midst of noise via an analytic process of segmentation; intelligence may also manifest itself in the constitution of larger wholes and dynamic unities through a dialectic process of association or assemblage. But, by contrast, crealectic intelligence co-creates realities in the image of an ideal or truth, taking into account the desiring agent imbued with a sense of possibility, in a relationship not only with the Real but also with the creative sublime or “Creal”. (shrink)

The practice of terminating a pregnancy following the diagnosis of a fetal abnormality raises questions about notions of bodily normality and the ways these shape ethical decision-making. This is particularly the case with terminations done on the basis of ostensibly minor morphological anomalies, such as cleft lip and isolated malformations of the limbs or digits. In this paper, I examine a recent case of selective termination after a morphology ultrasound scan revealed the fetus to be missing a hand . Using (...) the work of Georges Canguilhem, I show that a person with acheiria could be considered normal. Further, I show that this case reveals a kind of “undecidability” in the significance of fetal sex/gender and disability in termination. From this, I consider the conceptual interaction of disability with sex/gender, to argue that the ethics of disability termination are not as distinct from those of sex/gender selection as is commonly supposed. (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)

In this article, I critically analyze the anthropological foundation of the bioethics of philosopher Jean-François Malherbe, particularly as presented in his book, Pour une Éthique de la Médecine. Malherbe argues that such practices as organ donation and transplants, assisted reproduction, resuscitation, and other uses of biotechnologies in contemporary medicine are unethical because they go against essential human nature. Furthermore, he uses this position as a basis to prescribe public policy and institutional practice. In contrast, I argue not only that ‘human (...) nature’ is much more malleable and adaptive to changes in technology and society than Malherbe allows, but also that his criticisms of medicine and technoscientific development overstep the bounds of the social function of philosophical ethics, which is to inform and clarify public debate. Public policy and institutional practice is thus best left to the democratic political process under the parameters of the just rule of law. (shrink)

At once historical and philosophical, Michel Foucault used his genealogical method to expose the contingent conditions constituting the institutions, sciences and practices of the present. His analyses of the asylum, clinic, prison and sexuality revealed the historical, political and epistemological forces that make up certain types of subjects, sciences and sites of control. Although noting the originality of his work, a number of early critics questioned the normative framework of Foucault's method. Nancy Fraser argued that Foucault's genealogical method was ‘normatively (...) confused’ as it implied political critique yet claimed to be value-neutral. Jürgen Habermas and Charles Taylor also questioned the normative basis of Foucault's appeals to critique, arguing it was self-refuting as Foucault left no room for the subject to escape power. Although a debate among these scholars was planned for the mid-1980s, Foucault's death in 1984 meant this could not occur. A number of edited volumes sought to fabricate a debate, with defenders of Foucault excavating his published monographs to construct responses to his critics. While the monographs remain the central texts of Foucault's oeuvre, over the past decade his Collège de France lectures have been published and translated into English. This article offers a schematic survey of the influence of the Collège de France lectures in recasting different points in the debates over normativity, critique and resistance. (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 review assesses a rare and insightful philosophical examination of the ethics of the medical management of sex-atypical children. In Making Sense of Intersex, Ellen K. Feder crafts an ethics that would shift several common foci of the contemporary debate on her topic: from questions of gender to the ethics of normalization; from individual or parental autonomy to a general corporeal vulnerability; and from parental medical proxy rights to the interdependency of parent-child relations. The review identifies some seemingly unavoidable conundrums (...) that would remain unsolved after such shifts: the continuing role of gender in normalizing medical aims, the utility of an undifferentiated concept of vulnerability in medical decision making, and the place of cosmetic medicine in general. (shrink)

Definitions of health in terms of some kind of balance form a category of their own within the sphere of health definition. Such definitions have their roots in the beginnings of scientific medicine, and popular versions are common among lay people. It has even been claimed that balance is fundamental to health for all species. Several present-day definitions of health in terms of balance are presented here. Particular attention is given to the call for a definition of health applicable to (...) both humans and animals within the One Health approach, involving human medicine, veterinary medicine and ecology. Definitions in terms of balance have been suggested but none has been thoroughly analysed with regard to its suitability. There are therefore three concerns in this paper. The first is to introduce versions of the category of balance, as a first step towards a nomenclature of health definitions. The second is to analyse the claim made recently that balance is a universal criterion of health in all species including humans. The third is to ascertain whether any of the versions discussed is suited to the One Health approach. (shrink)

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)

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)

Félix Guattari spent his entire working life at La Borde psychiatric clinic where a radicalised form of psychoanalysis, ‘schizoanalysis’, was applied, based on the theory that emerged in Anti-Oedipus and was elaborated in A Thousand Plateaus. In the medium of this non-Oedipalised therapeutic plane lies the ‘body without organs, a body not fully organised but open to every form of expression and metamorphosis. The ideas and practice involved in schizoanalysis, which have now been in effect for fifty years in every (...) social and cultural field, have produced a new hybrid of Lacanian analysis and schizoanalysis, with the recent queering psychoanalysis expanding further the revolutionary character of the latter. The general logic and the determinate ideas of A Thousand Plateaus were applied as a reciprocal presupposition between content and form: free expression, interconnectedness, becoming-woman and -imperceptible, a deterritorialisation of models, roles and relations. (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)

What clinicians, biomedical scientists, and other health care professionals know as individuals or as groups and how they come to know and use knowledge are central concerns of medical epistemology. Activities associated with knowledge production and use are called epistemic practices. Such practices are considered in biomedical and clinical literatures, social sciences of medicine, philosophy of science and philosophy of medicine, and also in other nonmedical literatures. A host of different kinds of knowledge claims have been identified, each with different (...) uses and logics of justification. A general framework is needed to situate these diverse contributions in medical epistemology, so we can see how they fit together. But developing such a framework turns out to be quite tricky. In this survey, three possible frameworks are considered along with the difficulties associated with each of them. The essay concludes with a fourth framework, which considers any epistemology as part of a practice that is oriented toward overcoming errors that emerge in antecedently given practices where knowledge is developed and used. As medicine indirectly advances health by directly mitigating disease, so epistemology indirectly advances knowledge by directly mitigating error. (shrink)

“We have to be willing to consider stimulants as an option because we are not correcting students' disadvantages in other, more traditional ways,” writes Ray (2016), pointing out how limited and in...

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)

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)

The gulf between Christian and secular bioethics has far-reaching implications for public policy, healthcare organizations, clinicians, and patients and their families. There also are significant differences among various Christian approaches to bioethics. Differences and similarities between Christian and secular bioethics as well as among Christian approaches to bioethics are evident across three domains explored in this issue of Christian Bioethics. The first concerns different approaches to or methods for resolving ethical questions. The second concerns the ways in which understandings of (...) health and disease and human anthropology shape our judgments about what we may do in the pursuit of health or in response to disease. The third concerns how our perceptions of and regard for others affect judgments of moral worth and can influence healthcare decision-making. (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)

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)

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)

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)

In this paper, we bring together the concepts of affordance from ecological psychology and function from the organizational approach to philosophy of biology into a single integrative framework. This integration allows us to account for the biological basis of the notion of affordance, offering theoretical tools to address the normative interrelations between organisms and their environments.

This special issue of History of the Humane Sciences intends to shed light on a series of psychopathological entities that do not target well defined conditions and experiences, but rather aim at delimiting zones of uncertainty that defy psychopathology’s order of things: mild diagnoses or subthreshold disorders, borderline conditions, culture bound syndromes, or ideas of dimensions and dimensionality. While these categories have come to play an increasingly central role in psychiatric and psychological thinking during the last 50 years, historians and (...) social scientists have had remarkably little to say about how they have been created, what they have been used for, and what kind of realities they have helped to shape. In this introductory article we propose the concept of ‘psychopathological fringes’ to refer to these categories that are located somewhere at the border of psychopathological classifications and refer to zones of conceptual underdetermination. The notion of fringes serves to highlight both the conceptually and the socially marginal nature of the conditions, personal identities, and worlds delimited by these categories. The fringes of psychopathology are zones of vagueness, of epistemic uncertainty, and moral ambiguity. This introduction proposes a first incursion in these zones. It suggests some of the reason why they might have had attracted little interest in the past and why they may be more salient recently. It follows some analytical clues that might help chart a way through it and proposes a map through the collection of articles included in this issue. (shrink)

In this paper, we examine Shaun Gallagher’s project of “naturalizing” phenomenology with the cognitive sciences: front-loaded phenomenology. While we think it is a productive proposal, we argue that Gallagher does not employ genetic phenomenological methods in his execution of FLP. We show that without such methods, FLP’s attempt to locate neurological correlates of conscious experience is not yet adequate. We demonstrate this by analyzing Gallagher’s critique of cognitive neuropsychologist Christopher Frith’s functional explanation of schizophrenic symptoms. In “constraining” Gallagher’s FLP program, (...) we discuss what genetic phenomenological method is and why FLP ought to embrace it. We also indicate what types of structures a genetically modified FLP will consider, and how such an approach would affect the manner in which potential neurological correlates of conscious experience are conceptually understood and experimentally investigated. (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)

The “One Health” initiative promises to combine different health-related issues concerning humans and animals in an overarching concept and in related practices to the benefit of both humans and animals. Far from dismissing One Health, this paper nevertheless argues that different veterinary interventions are determined by social practices and connected expectations and are, thus, hardly compliant with only one single conceptualization of health, as the One Health concept suggests. One Health relies on a naturalistic understanding of health focusing on similar (...) bodies that show a similar etiology. However, logics, normativity, and practices exhibit differences when it comes to combatting infectious diseases, maintaining productivity of livestock animals or preventing companion animals from suffering. Therefore, drawing from Charles Rosenberg’s groundbreaking texts on framing disease, we suggest to conceive of health as dispersed in different frames. Thus, this paper proposes to interpret health as complex and multi-layered concept. We distinguish and introduce an objectivist, a functional, and a sentientistic frame of health. Instead of reducing the differential veterinary practices to one paradigmatic understanding, health is seen as a model case of Wittgenstein’s concept of family resemblance. Different and distinct perspectives on veterinary medicine show sufficient overlapping that allows for a common conceptualization, but there is not one single underlying logic suitable to understand and ethically reflect all veterinary interventions. This differentiability promises to reduce moral stress in veterinary professionals since it allows the interpretation of various, seemingly contradicting practices as dependent on multi-layered and socially determined scopes of responsibility. (shrink)

. The time of the real: When disease is ‘actual’. Cultural Values: Vol. 2, No. 2-3, pp. 243-260.

Discussions of the framework and terminology associated with the right to health tend to treat the indeterminacy of ‘health’ as conceptual noise that the construction of effective policy must not focus on, but find ways of bracketing out. On this basis, the right to health is broadly regarded as a social and economic, rather than a civil and political right. This article draws critically on literature about the implications of developments in medical biotechnologies, to argue that a positive acknowledgement of (...) the indeterminate character of health should transform, rather than simply hinder, the quality of debate over what is to be understood and expected in connection with a right to health. A focus on indeterminacy allows for the perception and the formulation of health-related demands that may not stem from the scarcity of material resources or technical means, but from the misplaced authority of particular voices in defining what possibilities are to be seriously envisaged. This proposition only becomes politically effective, it is argued, when ‘indeterminacy’ (and the capacity for normativity) is referred to life itself and not merely to social and moral judgements about life. Although more immediately pertinent to the concerns of relatively privileged populations, the focus on indeterminacy provides a key to generating a certain symmetry and complementarity of interest, across the privileged/underprivileged divide, in promoting health as a (human) right. (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)

Canguilhem criticized the concept of “public health”: health and disease are concepts that only apply to individuals, taken as organic totalities. Their extension to a different level of organization is purely metaphorical. The importance assumed by epidemiology in the construction of our knowledge of the normal and the pathological does, however, call for reflection on the role and the status of the population level of organization in our approach to health phenomena. The entanglement of the biological and the social in (...) human life and in contemporary societies justifies this level of analysis for better understanding the complexity and the interaction of health determinants both at the level of individuals and their interactions and at that of the population. But is this population level just a useful level of analysis that makes it possible to bring to light the social determinants of health at the individual level, or does it rest instead on characteristics of the population that are irreducible to individual characteristics, but which are nevertheless important for understanding and taking action with respect to both population and individual health? Defending this second alternative, I show how the epidemiological point of view, and in particular that of social epidemiology, leads us to rethink the possibility of a concept of “population health” that is not reducible to the sum of individual instances of health. (shrink)

The biopsychosocial model was initially proposed to overcome the normative assumption that human diseases are exclusively due to disordered biochemical and/or neurophysiological processes. The model attempts to explain how expectations, thoughts and feelings modify the patient’s motivations to deal with illness and recovery. By considering the physical health in this perspective, healthcare professionals may test the importance of socially and culturally shared principles in alleviating illness experience. The entire biopsychosocial hierarchy may thus appear as a complex network of relationships between (...) the strict logic of scientific explanations and the emotional sustainability with which beliefs may either be defended, changed or even refused. In this paper, we aim at reviewing some of the evidence-based biomedical and psychological findings that provide a unified framework for the biopsychosocial model as a multilevel integrative process. To tackle this objective, we propose to approach the model in biosemiotic terms. It is our contention that the entire biopsychosocial hierarchy could be better understood if approached biosemiotically and the multilevel interconnection of this hierarchy re-examined in the light of a collaborative meaning-making process. (shrink)

This paper explores the impact that developments in the field of neuroprosthetics will have on the ethical viability of healthy limb amputation, specifically in cases of Body Integrity Identity Dis...

Opponents of the provision of therapeutic, healthy limb amputation in Body Integrity Identity Disorder cases argue that such surgeries stand in contrast to the goal of medical practice – that of health restoration and maintenance. This paper refutes such a conclusion via an appeal to the nuanced and reflective model of health proposed by Georges Canguilhem. The paper examines the conceptual entanglement of the statistically common with the normatively desirable, arguing that a healthy body can take multiple forms, including that (...) of an amputee, provided that such a form enables the continuing ability to initiate new norms of existence. It concludes that the practice of healthy limb amputation in cases of Body Integrity Identity Disorder is not only compatible with the goal of medicine but is potentially the only method of achieving this goal in the face of a complex and often mischaracterized disorder. (shrink)