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.

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)

Many physicians assert that new cost-control mechanisms inappropriately interfere with clinical decision-making. They claim that high costs arise from poorly practiced medicine, and argue that effective utilization of resources is best promoted by advancing the scientific and ethical ideals of medicine. However, the claim is not warranted by empirical evidence. In this essay, I show how it rests upon aesthetic considerations associated with diagnostic elegance. I first consider scientific rationality generally. After a review of analytical empiricist and socio-historical approaches in (...) the philosophy of science, a form of Kant's aesthetic is used to explain how scientific discovery and justification are linked, and to show how meta-theoretical considerations associated with the goals and method of science work together with exemplars of practice. This analysis enables us to understand how the ideals of medicine as a science guide the initial patient history and physical exam in such a way that a parsimonious use of tests is indicated. Aesthetic considerations unite the basic scientific and ethical commitments of the modern medical paradigm and are central for rightly understanding clinical judgment. (shrink)

It is commonly believed that disability disqualifies people from full participation in or recognition by society. This view is rooted in eugenic logic, which tells us that our world would be a better place if disability could be eliminated. In opposition to this position, I argue that that disability is inherent in the human condition and consider the bioethical question of why we might want to conserve rather than eliminate disability from our shared world. To do so, I draw together (...) an eclectic, rather than systematic, configuration of counter-eugenic arguments for conserving disability. The idea of preserving intact, keeping alive, and even encouraging to flourish denoted by conserve suggests that disabilities would be better understood as benefits rather than deficits. I present, then, a reading of disability as a potentially generative resource rather than unequivocally restrictive liability. In other words, what I consider here is the cultural and material contributions disability offers to the world. (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)

The Human Genome Project (HGP) has been criticised from an evolutionary perspective for three reasons: completely ignoring genetic variation; improperly treating either all or some genetic variation as deviation from a norm; and mistakenly seeking to define species in terms of essential properties possessed by all and only member organisms. The first claim is unfounded; the second and third claims are more on target. Nevertheless, it is a mistake to use the typological-population distinction to oppose molecular genetics and evolutionary genetics (...) in order to characterise HGP mapping and sequencing aims, especially the production of a DNA reference sequence, as 'anti-evolutionary' and 'pre-Darwinian.' These aims are consistent with certain strands in twentieth-century evolutionary thought: Muller's classical theory, Kimura's neutral and 'effectively neutral' theories, and, to a lesser extent, Dobzhansky's balance theory of the genetic structure of natural populations. In practice, population-based approaches to human genetic variation are similarly vulnerable to charges of 'typological' and 'essentialist' thinking in their treatment of genetic variation as deviation. This means that the Human Genome Diversity Initiative will not provide a population-based panacea for an overly typological HGP, as its proponents contend. Substituting related, and less rhetorically-charged, conceptual, empirical, and metaphysical distinctions for the typological-population distinction furnishes a better way to assess the concept of the normal genome from an evolutionary perspective. (shrink)

Recovery is a commonly used concept in both professional and everyday contexts. Yet despite its extensive use, it has not drawn much philosophical attention. In this paper, I question the common understanding of recovery, show how the concept is inadequate, and introduce new and much needed terminology. I argue that recovery glosses over important distinctions and even misrepresents the process of moving away from malady as "going back" to a former state of health. It does not invite important nuances needed (...) to distinguish between biomedical, phenomenological, and social perspectives. In addition, I claim that there are many conditions where we are making use of the concept of recovery, although the person recovered from the condition in question, has not regained the same degree of soundness. I show how the concept of recovery leads to conceptual discrepancies that can result in worsening patients' conditions. To gain a fuller understanding, I propose to rethink the direction of the process in question. I define the process of moving away from malady as a move forward towards a new state of soundness. I also suggest three terms, corresponding to different perspectives, to describe this movement forward: 'curing', 'healing', and 'habilitating'. This new terminology provides a more nuanced understanding of the states of both malady and soundness and an attentiveness as to how they differ and relate. (shrink)

This article elucidates the spatial order that underpins the politics of the Anthropocene – the ecological nomos of the earth – and criticizes its imperial origins and legacies. It provides a critical reading of Carl Schmitt’s spatial thought to not only illuminate the spatio-political ontology but also the violence and usurpations that characterize the Anthropocene condition. The article first shows how with the emergence of the ecological nomos seemingly ‘natural’ spaces like the biosphere and the atmosphere became politically charged. This (...) challenges the modernist separation between natural facts and political norms. It then underlines the imperial origins of this nomos by introducing the concept of air-appropriation understood as the colonization of atmospheric space by CO2 emissions. Instead of assuming that the ecological nomos represents a transition from a colonial to an ecological and cosmopolitan world order, focusing on air-appropriation highlights forms of ecological imperialism that go along with the new nomos. Accordingly, the article calls for a just redistribution of ecospace that takes into account the imperial legacies and ongoing effects of air-appropriation. (shrink)

: Even as feminist analyses have contributed in important ways to discussions of how gender is raced and race is gendered, there has been little in the way of comparative analysis of the specific mechanisms that are at work in the production of each. Feder argues that in Michel Foucault's analytics of power we find tools to understand the reproduction of whiteness as a complex interaction of distinctive expressions of power associated with these categories of difference.

Is it possible to distinguish, as sociologist Arthur Frank proposes, an ‘ideal of wonder’ within which ill persons could recover some of their former sense of life and flourishing, even within the constraints of ill-health? Beyond this, are there more general benefits in terms of health and well-being that could accrue from cultivating an openness to wonder? In this paper I will first outline and defend a notion of wonder that gives philosophical support to Frank’s proposal, noting why thinking about (...) medical treatment may readily provoke a sense of wonder. Second I will however limit the normative force of such an ‘ideal of wonder’ noting its demands and some of the challenges facing it. The paper goes on, third, to conjecture wider benefits within and beyond the clinical encounter arising from being mindful of the wonder of embodied human agency. Fourth the paper will consider alignments between the foregoing analysis and some theoretical commitments in recent work in health geography. Finally I will briefly reconsider the notion of the body-as-territory, and the role of the imagination in bringing it under wonder’s gaze. (shrink)

Causation is important when considering: how an organism maintains health; why disease arises in a healthy person; and, how one may intervene to change the course of a disease. This paper explores the form of causative relationships in health, disease and intervention, with particular regard to the pathological and biopsychosocial models. Consistent with the philosophical view of dispositionalism, we believe that objects are the fundamental relata of causation. By accepting the broad scope of the biopsychosocial model, we argue that psychological (...) and social constructs be considered objects. We think that this ‘biopsychosocial dispositionalism’ offers the flexibility required to describe causation throughout health, disease and intervention pathways. When constructing mechanistic chains to describe causative pathways, we argue that an object will causally connect with others through actions; transfers of energy from one object to another, initiated by the manifestation of one or more dispositional property. Finally, our analysis of causative interactions utilises the concept that a common form of interaction exists between disease and intervention pathways. This common form will always be an object, but the mode of interaction will vary with each disease. We describe how intervention may act through objects being shared between converging mechanistic chains, or through the removal and/or insertion of objects in such chains. We believe that this analysis provides novel insight to the forms of causative transactions that can occur. In addition, we hope that the findings of this analysis represent the first step towards developing a framework for appraising the composition of mechanistic theories. (shrink)

In this paper we examine aspects of Canguilhem’s philosophy of biology, concerning the knowledge of life and its consequences on science and vitalism. His concept of life stems from the idea of a living individual, endowed with creative subjectivity and norms, a Kantian view which “disconcerts logic”. In contrast, two different approaches ground naturalistic perspectives to explore the logic of life and the logic of the living individual in the 1970s. Although Canguilhem is closer to the second, there are divergences; (...) for example, unlike them, he does not dismiss vitalism, often referring to it in his work and even at times describing himself as a vitalist. The reason may lie in their different views of science. (shrink)

The article explores theoretical convergences between the work of Georges Canguilhem and Lucien Febvre on the theme of science and technique. In comparing the scholarship of both authors from the 1920s through 1940s, we endeavor to show that their critique of mechanistic determinism was rooted in the concept of the genres of life and its creative interaction with the environment.

Despite all attempts at restoring it, the great humanist tradition could not resist the double trauma of Auschwitz and Hiroshima in which the very idea of humanity had been swallowed up by its opposite. Yet, beyond the critique of humanism carried out by twentieth-century philosophers such as Heidegger, the ancient profile of man as essentially humanus delineates itself again. On the other hand, as soon as the Nietzschean anthropo-technical – or biopolitical – vector of artificial intervention into the characteristics of (...) human nature enters into synergy with the Darwinian presupposition about the contiguity with the animal world, the social consequences can be devastating. But is this the only – destructive and self-destructive – face of post-humanism? Is it necessary for it to turn into a form of patent anti-humanism? In opposition to both Heidegger’s foreclosure of biology and the animal as well as the biopolitical misuse of an immunitarian semantics that has led to the most brutal forms of homicidal eugenics, in this article I claim that the overbearing entrance of biological life into socio-political dynamics is not necessarily a danger from which we have to defend ourselves in the name of a self-centred purity of the individual and the species. It might also be regarded as the future of man, a threshold from which he could be stimulated in view of a more complex and open elaboration of his humanitas. (shrink)

Nietzsche assesses values, moralities, religions, cultures, and persons in terms of health. He argues that we should reject those that are unhealthy and develop healthier alternatives. But what is Nietzsche’s conception of health, and why should it carry such normative force? In this paper I argue for reading Nietzsche’s concept of health as the overall ability to meet the demands of one’s motivational landscape. I show that, unlike other interpretations, this reading accounts for his rejection of particular features of a (...) prevailing, then as now, model of health; for his association of health with strength and with psychic unity; and for his claim that health is compatible with, and can even be enhanced by, functional impairments such as those from which he personally suffered. Throughout I draw connections to recent literature on health and disability. (shrink)

Abstract In this paper I offer an anti-Humean interpretation of the causal interactions in somatic medicine. I focus on life-threatening pathological states and show how Nancy Cartwright’s capacities can offer a plausible epistemology for medical processes and the singular causal claims advanced in medical diagnoses. I argue that the capacities manifested in the emergence of symptoms and signs could be tracked down if healthy organisms are construed as nomological machines and suggest that the causal reasoning from current medical practice bears (...) a tacit adherence to anti-Humean assumptions. Content Type Journal Article Pages 1-28 DOI 10.1007/s12136-011-0141-1 Authors Stefan Dragulinescu, Drumul Taberei 20, Bucharest, Romania Journal Acta Analytica Online ISSN 1874-6349 Print ISSN 0353-5150. (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)

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)

Victims of disaster suffer, not only at the very moment of the disaster, but also years after the disaster has taken place, they are still in an emotional journey. While many moral perspectives focus on the moment of the disaster itself, a lot of work is to be done years after the disaster. How do people go through their suffering and how can we take care of them? Research on human suffering after a major catastrophe, using an ethics of care (...) perspective, is scarce. People suffering from disasters are often called to be in distress and their emotional difficulties ‘medicalised’. This brings them often into a situation of long term use of medication, and one can wonder if medication is of help to them in the long run. In our paper, we will explore another moral perspective, focusing on the importance of the victims’ narrative and their lived experiences. We will use Paul Ricoeur’s phenomenological reflections from ‘Suffering is not the same as pain’ for conceptualizing human suffering and how to apply it to victims of disaster. Ricoeur suggests that suffering is not a quantity that can be measured, but a characteristic that should be studied qualitatively in interpersonal and narrative contexts. Above all, the perspective of care and listening could offer an opportunity to reconcile people from their loss and suffering. (shrink)

Developments in biomedical science continue to transform our understanding of concepts such as health and disease. The creation of this expertise has also had a substantive role in changing the veterinary approach to animal diseases. Traditionally, companion animal veterinarians modelled their practices on developments in the diagnosis and treatment of human patients. As science and technology have realigned the boundaries between normalcy, intra-species variation and pathology in particular domains of expertise such as orthopaedic surgery, these patterns of knowledge translation have (...) changed. Not so long ago, treatments for the rupture of the cruciate ligament in human and canine patients were based on pathoanatomical comparison and designed to reestablish the stability of the joint by the functional restoration of ligament anatomy. Recently, a radically different characterization of the canine injury—with a corresponding alternative intervention—has been proposed within the field of veterinary orthopaedics. It views the normal anatomy of the canine knee as being in some way inherently pathogenic and proposes the surgical creation of an idealized structure as a remedy to dysfunction and disease. The veterinary focus on an ideal of patient performance, rather than a specific pathology, is now influencing how orthopaedists choose to approach analogous human injuries. In this article, I chart the history of canine ‘cruciate disease’ therapies as a means to map some of the epistemic assumptions, interplays of idealized and analogical reasoning and patterns of knowledge translation central to the biomedicalization of the science and practice of orthopaedic surgery. (shrink)

The aim of this paper is to make a comparison and build up a dialogue between two different philosophical approaches to values in evolutionary biology. First, I present the approach proposed by Alexander Rosenberg and Daniel McShea in their contribution to the contemporary debate on organic progress. i.e. the idea that there has been some kind of improvement concerning organisms over the history of life. Discussing organic progress raises the question of what “better” exactly means. This requires an explicit clarification (...) on what legitimately means to speak about “good” in evolutionary biology, thus to speak about values. Second, I move on to present an approach to values that has been proposed by Georges Canguilhem in the context of a different philosophical tradition. Canguilhem’s original theses are conceived in a Darwinian framework and clearly relate to the question of values in evolutionary biology. I shall then propose a comparison between these two heterogeneous perspectives on values by critically evaluating their common points and main differences. I will argue that both perspectives agree that the question of values in evolutionary biology takes on its full meaning with respect to the relationship between the organism and the environment. However, the framework for conceptualizing values in evolutionary biology provided by Rosenberg and McShea neglects a significant point highlighted by Canguilhem, i.e. the active role that the organism can play in evaluating the environment. In line with recent developments of biology, this point can be easily integrated into Rosenberg and McShea’s framework. Finally, I will point out some main differences between the two perspectives relative to the specificity of Canguilhem’s biological philosophy. (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)

In the face of increasing intervention in childbirth, ‘normal birth’ is currently being promoted by the World Health Organization, national governments, professional bodies and other organisations throughout the world. This paper takes a postmodernist stance and explores the idea of the ‘normal’ before going on to analyse normal childbirth, referring to concepts of the normal and the natural. It refers to historical developments in childbearing and lay organisations along with research relating to women’s views of childbirth, to question the appropriateness (...) of using ‘normal’ to describe the very individual experiences of childbirth. It laments the way in which women have been treated and arguably continue to be ‘cared for’ in maternity/obstetric services. It adds to the current discussion by recalling psychoanalytical theory and philosophical analysis to conclude with a call for future consideration of the ‘good‐enough’ birth instead of concentrating on promoting normal birth which is very difficult, if not impossible to define in retrospect, or to prospectively promote. (shrink)

Today, capitalism functions as a very complex tool of colonisation capturing our desires, dreams, and putting life itself at risk. Its effects lead us all to times of extreme anxiety increasing the number of people with mental health problems. This paper is concerned with the question of ‘critique’ within this context. How can critical legal scholarship engage with a theoretical mode that allows us to confront the politics of law with today’s capitalism? This analysis shows that contemporary capitalism, which operates (...) as an immanent desiring-machine, is investing in our unconscious. In this sense, we aim to rethink the idea of ‘critique’ as an opportunity to make it creative and effective. As such, this paper argues that the Deleuzian concept Critical and Clinical is particularly useful, as it opens new roots for the critical movement. Taking the literary strategy of Masochism and the experience of the Institutional Psychotherapy movement in France, the clinical–critical practice contributes to push and expand critical scholarship into new terrains of thought and practice. (shrink)

Drawing upon ethnographic data, this article analyses 'vocabularies of motive' amongst individuals who work out at a private health club in the Greater Manchester area (UK). The article draws a distinction between motives for starting at a gym and motives for continuing, and analyses each separately. It also seeks to draw out, in the latter case, the many motives which conflict with a stereotypical view of 'working out' found in some academic accounts. Working out is not only an instrumental means (...) of cultivating valued bodily attributes, it is argued, nor are its attractions necessarily all 'bodily' (at least narrowly defined) in nature. (shrink)

The technique of nuclear transplantation – popularly known as cloning – has been integrated into several different histories of twentieth century biology. Historians and science scholars have situated nuclear transplantation within narratives of scientific practice, biotechnology, bioethics, biomedicine, and changing views of life. However, nuclear transplantation has never been the focus of analysis. In this article, I examine the development of nuclear transplantation techniques, focusing on the people, motivations, and institutions associated with the first successful nuclear transfer in metazoans in (...) 1952. The conflict between embryologists and geneticists over the mechanisms of differentiation motivated Robert Briggs to pursue nuclear transplantation experiments as a way to resolve the debate. Briggs worked at the Lankenau Hospital Research Institute, a research facility devoted to the study of cancer. The goal of understanding cancer would play a role in the development of the technique, and the story of nuclear transplantation sheds light on the role that biomedical contexts play in biological research in the second half of the twentieth century. (shrink)

It is a matter of some irony that psychiatry's most trenchant critic for over four decades is himself a psychiatrist. I refer to Thomas S. Szasz. Szasz's core thesis may be succinctly rendered: mental illness is a “myth”, a “metaphor” which serves only to obscure the social and ethical “problems in living” we face as human beings. This paper reconsiders the conceptual bases of Szasz's assault on psychiatry and assesses recent counter-arguments of his critical interlocutors. It presents a defence of (...) the Szaszian conception and emphasises the continuing relevance of his earliest work. Additionally, the paper discusses Szasz's thesis in light of the work of the influential French philosopher of medicine, Georges Canguilhem. (shrink)

What is now familiarly referred to as the ‘embryonic stem (ES) cell’ is a recent biological category whose origins lie in research into benign and malignant teratomas carried out in the 1950s, 60s and 70s. In these studies, the question of the normal or pathological character of the ES cell was a matter of considerable debate and indeed the term ES cell was often used interchangeably with that of the embryonal carcinoma (EC) cell. This article argues that the indecisiveness of (...) the entity known as the ES cell—its refusal to commit to established demarcations between the normal and the pathological—continues to haunt the field of stem cell science. Exploring the prehistory of research into ES cells, early theories of cancer (in particular the embryonal theory expounded by Julius Cohnheim) and recent theoretical critiques of the somatic mutation theory, the article not only points to a shift in understandings of the normal and the pathological but asks under what conditions such shifts are able to take place. (shrink)

Background Biomedicine, i.e. the application of basic sciences to medicine, has become the cornerstone for the study of etiopathogenesis and treatment of diseases. Biomedicine has enormously contributed to the progress of medicine and healthcare and has become the preferred approach to medical problems in the West. The developments in statistical inference and machine learning techniques have provided the foundation for personalised medicine where clinical management can be fully informed by biomedicine. The deployment of precision medicine may impact the autonomy and (...) self-normativity of the patients. Understanding the relationship between biomedicine and medical practice can help navigate the benefits and challenges offered by precision medicine. Methods Conventional content analysis was applied to “Le Normal and le Pathologique” (Canguilhem G. The Normal and the Pathological. Princeton: Princeton University Press; 1991) and further investigated with respect to its relationship with techne and precision medicine using PubMed and Google Scholar and the Standford Encyclopedia of Philosophy to search for the following keywords singularly or in combination: “Canguilhem”, “techne”, “episteme”, “precision medicine”, “machine learning AND medicine”. Results The Hippocratic concept of techne accounts for many characteristics of medical knowledge and practice. The advances of biomedicine, experimental medicine and, more recently, machine learning offer, in contrast, the model of a medicine based purely on episteme. I argue that Canguilhem medical epistemology establishes a framework where episteme and data-driven medicine is compatible with the promotion of patient’s autonomy and self-normativity. Conclusions Canguilhem’s medical epistemology orders the relationship of applied medicine with experimental sciences, ethics and social sciences. It provides guidance to define the scope of medicine and the boundaries of medicalization of healthy life. Finally, it sets an agenda for a safe implementation of machine learning in medicine. (shrink)

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

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

In the late 1960s, Georges Canguilhem introduced the concept of ‘scientific ideology’. This concept had not played any role in his previous work, so why introduce it at all? This is the central question of my paper. Although it may seem a rather modest question, its answer in fact uncovers hidden tensions in the tradition of historical epistemology, in particular between its normative and descriptive aspects. The term ideology suggests the influence of Althusser’s and Foucault’s philosophies. However, I show the (...) differences between Canguilhem’s concept of scientific ideology and Althusser’s and Foucault’s respective concepts of ideology. I argue that Canguilhem was in fact attempting to solve long-standing problems in the tradition of historical epistemology, rather than following the lead of his younger colleagues. I argue that Canguilhem’s ‘refurbishment without rejection’ of Bachelard’s epistemology, which the concept of scientific ideology was aimed to implement, was necessary to justify the historical narratives that Canguilhem had constructed in his own work as a historian of concepts. A strict acceptance of Bachelard’s epistemology would have made it impossible to justify them. Canguilhem’s concept of scientific ideology therefore served as a theoretical justification of his practice as a historian. I maintain that the concept of scientific ideology was needed to reconcile Bachelard’s normative epistemology with Canguilhem’s view of the history of science and its aims, which differed from Bachelard’s more than it is generally acknowledged. (shrink)

I have been breathless for a long time. I lagged behind others when walking uphill. I became breathless when dancing. I couldn’t play tennis. But I somehow convinced myself that this was normal. I was getting older—perhaps in one’s mid-30s fitness drops like this, I thought? Perhaps I have “small lungs,” my husband speculated. But we were both physically active, and as we were living in Australia at the time, we enjoyed bush-walking, bike riding, and the sunshine that permeates outdoor (...) life down under. So I masked my breathlessness as best I could, and never went to see a doctor, despite my clear and increasing respiratory difficulties.Two years went by. We returned to live in the United Kingdom—in hilly Bristol.. (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)

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)

Medical discourse in the contemporary United States is rife with military metaphors. These metaphors have come under vigorous criticism over the last few decades but to no avail; the militaristic tendency has proven tenacious. This essay suggests that its tenacity stems, at least in part, from a dualistic understanding of medicine unaddressed by prior criticisms. For an alternative, this essay turns to Augustine of Hippo, balancing close readings of works that deal explicitly with medical themes—The Catholic Way of Life and (...) the Manichean Way of Life (De moribus) and The Nature of the Good (De natura boni)—with a constructive approach. By adapting Augustine's privative account of evil, we can understand disease as a condition of loss and treatment as a task of restoration. This reconfiguration shifts the focus of our interpretive discourses from malicious invaders to a fuller affirmation of the lived experiences of those who are ill. (shrink)

Judith Butler's (2006) account of vulnerability, resonant with other accounts offered by feminist theorists of embodiment (such as Margrit Shildrick [2000] and Rosalyn Diprose [2002]), underscores a "conception of the human . . . in which we are, from the start, given over to the other, one in which we are, from the start, even prior to individuation itself and, by virtue of bodily requirements, given over to some set of primary others" (31). She is concerned with how this state (...) of being—"not only constituted by our relations but also dispossessed by them as well" (24)—becomes recognized, or not, in the political production and recognition of vulnerability, and the suffering that occurs in the violent .. (shrink)

This article charts the history of mental testing in the context of the rise and fall of Russian child science between the 1890s and the 1930s. Tracing the genealogy of testing in scientific experimentation, scholastic assessment, medical diagnostics and bureaucratic accounting, it follows the displacements of this technology along and across the boundaries of the child science movement. The article focuses on three domains of expertise – psychology, pedagogy and psychiatry, examining the key guises that mental testing assumed in them (...) – namely, the experiment, the exam and the diagnosis. It then analyses the failed state-bureaucratic harnessing of mental testing in early Soviet attempts to manage mass education, discussing the peculiar dynamics of the legitimation of testing, as it swung between black-boxing and instrumentalization, on the one hand, and scandal and controversy, on the other. The article argues that mental testing thrived in Russia as a strategically ambiguous and flexibly interpreted ‘boundary object’, which interconnected a highly heterogeneous field, enabling the coexistence and cooperation of diverse occupational agendas and normative regimes. (shrink)