This essay replies to critics since 1995 of my “biostatistical theory” of health. According to the BST, a pathological condition is a state of statistically species-subnormal biological part-functional ability, relative to sex and age. Theoretical health, the total absence of pathological conditions, is then a value-free scientific notion. Recent critics offer a mixture of old and new objections to this analysis. Some new ones relate to choice of reference class, situation-specificity of function, common diseases and healthy populations, improvements in population (...) health, the practice of pathologists, “Cambridge changes” in health status, and comparative vs. absolute health concepts. I make no changes in doctrine, except to consider treating “normal aging” as pathological by taking young adults as the standard for all adults. (shrink)

I present and defend the generalized selected effects theory (GSE) of function. According to GSE, the function of a trait consists in the activity that contributed to its bearer’s differential reproduction, or differential retention, within a population. Unlike the traditional selected effects (SE) theory, it does not require that the functional trait helped its bearer reproduce; differential retention is enough. Although the core theory has been presented previously, I go significantly beyond those presentations by providing a new argument for GSE (...) and defending it from a recent objection. I also sketch its implications for teleosemantics and philosophy of medicine. (shrink)

Some ‘naturalist’ accounts of disease employ a biostatistical account of dysfunction, whilst others use a ‘selected effect’ account. Several recent authors have argued that the biostatistical account offers the best hope for a naturalist account of disease. We show that the selected effect account survives the criticisms levelled by these authors relatively unscathed, and has significant advantages over the BST. Moreover, unlike the BST, it has a strong theoretical rationale and can provide substantive reasons to decide difficult cases. This is (...) illustrated by showing how life-history theory clarifies the status of so-called diseases of old age. The selected effect account of function deserves a more prominent place in the philosophy of medicine than it currently occupies. _1_ Introduction _2_ Biostatistical and Selected Effect Accounts of Function _3_ Objections to the Selected Effect Account _3.1_ Boorse _3.2_ Kingma _3.3_ Hausman _3.4_ Murphy and Woolfolk _4_ Problems for the Biostatistical Account _4.1_ Schwartz _5_ Analysis versus Explication _6_ Explicating Dysfunction: Life History Theory and Senescence _7_ Conclusion. (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)

The literature on health and diseases is usually presented as an opposition between naturalism and normativism. This article argues that such a picture is too simplistic: there is not one opposition between naturalism and normativism, but many. I distinguish four different domains where naturalist and normativist claims can be contrasted: (1) ordinary usage, (2) conceptually clean versions of “health” and “disease,” (3) the operationalization of dysfunction, and (4) the justification for that operationalization. In the process I present new arguments in (...) response to Schwartz (2007) and Hausman (2012) and expose a link between the arguments made by Schwartz (2007) and Kingma (2010). Distinguishing naturalist claims at these four domains will allow us to make progress by (1) providing more nuanced, intermediate positions about a possible role for values in health and disease; and (2) assisting in the addressing of relativistic worries about the value-ladenness of health and disease. (shrink)

This paper argues that a minimal notion of function and a notion of normal-proper function are used in explaining how bodies and brains operate. Neither is Cummins’ notion, as originally defined, and yet his is often taken to be the clearly relevant notion for such an explanatory context. This paper also explains how adverting to normal-proper functions, even if these are selected functions, can play a significant scientific role in the operational explanations of complex systems that physiologists and neurophysiologists provide, (...) despite a lack of relevant causal efficacy on the part of such functions. (shrink)

This paper looks at the nature of normal-proper functions and the role they play in theories of representational content. More specifically: I lay down two desiderata for a theory which tries to capture what's distinctive of normal-proper functions and discuss two prominent theories which claim to satisfy them. I discuss the advantages of having normal-proper functions ground a theory of representational content. And, I look at both orthodox and heterodox versions of such theories.

We introduce a new type of pluralism about biological function that, in contrast to existing, demonstrates a practical integration among the term’s different meanings. In particular, we show how to generalize Sandra Mitchell’s notion of integrative pluralism to circumstances where multiple epistemic tools of the same type are jointly necessary to solve scientific problems. We argue that the multiple definitions of biological function operate jointly in this way based on how biologists explain the evolution of protein function. To clarify how (...) our account relates to existing views, we introduce a general typology for monist and pluralist accounts along with standardized criteria for judging which is best supported by evidence. (shrink)

Christie, Brusse, et al. argue that the selected effects theory of function (SE) doesn’t do what it’s supposed to do: namely, show how functions can be explanatory. They survey some well-known evolutionary dynamics such as arms races, frequency-dependent fitness, and environmental heterogeneity, some of which have been discussed in the functions literature for decades. They argue that SE only seems to work because SE theorists ignore these dynamics. Their argument fails because they misrepresent what functions are supposed to explain and (...) how they’re supposed to do so. One reason for this failure is that they overlook the role of functions in the broader conversation about teleology in biology, one that has been unfolding for over 2000 years. (shrink)

Natural selection comes in degrees. Some biological traits are subjected to stronger selective force than others, selection on particular traits waxes and wanes over time, and some groups can only undergo an attenuated kind of selective process. This has downstream consequences for any notions that are standardly treated as binary but depend on natural selection. For instance, the proper function of a biological structure can be defined as what caused that structure to be retained by natural selection in the past. (...) We usually think of proper functions in binary terms: storing bile is a function of the gall bladder, but making stones is not. However, if functions arise through natural selection, and natural selection comes in degrees, then a binary approach to proper functions is in tension with the biological facts. In order to resolve this tension, we need to revise our standard accounts of proper function. In particular, we may have to seriously consider the possibility that functions themselves come in degrees, in spite of the ramifications this will have for the way we speak about functions and related concepts such as dysfunction, disease, and teleosemantic content. (shrink)

The definitions and conceptualizations of health, and the management of healthcare have been challenged by the current global scenarios (e.g., new diseases, new geographical distribution of diseases, effects of climate change on health, etc.) and by the ongoing scholarship in humanities and science. In this paper we question the mainstream definition of health adopted by the WHO—‘a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity’ (WHO in Preamble to the constitution of (...) the World Health Organization as adopted by the international health conference, The World Health Organization, 1948)—and its role in providing tools to understand what health is in the contemporary context. More specifically, we argue that this context requires to take into account the role of the environment both in medical theory and in the healthcare practice. To do so, we analyse WHO documents dated 1984 and 1986 which define health as ‘coping with the environment’. We develop the idea of ‘coping with the environment’, by focusing on two cardinal concepts: adaptation in public health and adaptivity in philosophy of biology. We argue that the notions of adaptation and adaptivity can be of major benefit for the characterization of health, and have practical implications. We explore some of these implications by discussing two recent case studies of adaptivity in public health, which can be valuable to further develop adaptive strategies in the current pandemic scenario: community-centred care and microbiologically healthier buildings. (shrink)

In, I argued that Boorse's biostatistical theory of health is unable to accommodate diseases that are the normal result of harmful environments. Hausman disagrees: if the BST compares normal dispositional function against the whole population or reference class, rather than against organisms in similar circumstances as I proposed, then my challenge can be avoided. In this paper, I argue that Hausman's response fails: his proposal cannot accommodate a series of common physiological processes, such as sleep and those involved in reproduction. (...) In the course of this argument, I also offer a detailed discussion of the concept of functional efficiency, and reveal a link between the problem of environments and that of reference classes. 1 Introduction2 Kingma on Boorse3 Hausman on Kingma4 Response to Hausman5 Three Possible Replies5.1 Reference classes5.2 Temporary pathologies5.3 Adequacy of function6 Concluding Discussion. (shrink)

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

Several decades ago, Christopher Boorse formulated an influential statistical theory of normative biological functions but it has often been claimed that his theory suffers from insuperable problems such as an inability to handle cases of epidemic and universal diseases. This paper develops a new statistical theory of normative functions that is capable of dealing with the notorious problem of epidemic and universal diseases. The theory is also more detailed than its predecessors and offers other important advantages over them. It is (...) argued here that statistical theories of biological functions should not be so quickly dismissed. (shrink)

The paper engages Christopher Boorse’s Bio-Statistical Theory (BST). In its current form, BST runs into a significant challenge. For BST to account for its central tenet—that lower-level part-dysfunction is sufficient for higher-level pathology—it must provide criteria for how to decide which lower-level parts are the ones to be analyzed for health or pathology. As BST is a naturalistic theory, such choices must be based solely on naturalistic considerations. An argument is provided to show that, if BST is to be preserved, (...) such parthood choices are based on non-naturalistic considerations. We demonstrate that even when parthood choices are based on the best way to preserve BST, there are counterintuitive results which bring the central tenet of BST into question. (shrink)

Christopher Boorse’s Health care ethics: an introduction, Temple University Press, Philadelphia, pp 359–393, 1987; in Humber, Almeder, Totowa What is disease?, Humana Press, New York City, pp 1–134, 1997; J Med Philos, 39:683–724, 2014) Bio-Statistical Theory comprehends diseases in terms of departures from natural norms, which involve an objectively describable deviation from the proper physiological or psychological functioning of parts of the human organism. I argue that while recent revisions and additional considerations shield the BST from a number of issues (...) raised by critics, they give rise to significant new challenges. These are related to the attribution of epistemic authority, the possibility of multiple concepts in the authoritative literature, and the framing of BST as “philosophical explication.” The conclusion is that, in its current form, the BST is unable to provide a robust framework for a naturalist classification. (shrink)

Christopher Boorse’s Biostatistical Theory of Health has been the main contender among naturalistic accounts of health for the last 40 years. Yet, a recent criticism of this theory, presented by Elselijn Kingma, identifies a dilemma resulting from the BST’s conceptual linking of health and statistical typicality. Kingma argues that the BST either cannot accommodate the situation- specificity of many normal functions or cannot account for many situation-specific diseases. In this article, we expand upon with Daniel Hausman’s response to Kingma’s dilemma. (...) We propose that recalling Boorse’s specification that health is an intrinsic property of its bearers and explicating this intrinsic property in relation to the concept of homeostasis can illuminate how proponents of naturalistic accounts of health should deal with the situation- specificity of normal functions. We argue that beyond what Boorse and Hausman have delineated, the situation- specificity of normal function cannot be fully captured in a simple dichotomy between normal and abnormal environment or between relevant and irrelevant situations. By bringing homeostasis to the fore of the analysis of health, we set out a richer picture of what the various situations that affect living organisms’ functional performance can be. Accordingly, we provide a broader classification of these various situations which, we contend, better accounts for the main intuitions that philosophers of medicine have sought to accommodate than previous naturalistic theories of health. (shrink)

The crucial problem in the philosophy of psychiatry is to determine under which conditions certain behaviors, mental states, and personality traits should be regarded as symptoms of mental illnesses. Participants in the debate can be placed on a continuum of positions. On the one side of the continuum, there are naturalists who maintain that the concept of mental illness can be explained by relying on the conceptual apparatus of the natural sciences, such as biology and neuroscience. On the other side (...) of the continuum, there are normativists who maintain that the appropriate characterization of the concept of mental illness cannot avoid reference to epistemic, moral and other social values. Although, this article is primarily an introduction to the debate, we stress the importance of the normativist positions. (shrink)

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

The notion of harm has been a recurring and a significant notion in the characterization of mental disorder. It is present in eminent diagnostic manuals such as DSM and ICD, as well as in the discussion on mental disorders in philosophy of psychiatry. Recent demotion of harm in the definition of mental disorders in DSM-5 shows a general trend towards reducing the significance of harm when thinking about the nature of mental disorders. In this paper, we defend the relevance of (...) the notion of harm in the characterization of mental disorder against some of these attacks. We approach this issue by using the method of conceptual explication pioneered by Rudolf Carnap. Within this framework, we argue that keeping the notion of harm not only helps to discriminate what is pathological from the nonpathological but also prevents potential misuses of psychiatric authority. (shrink)

Mnoge biološke funkcije dopuštaju stupnjevanje. Na primjer, lučenje određenog hormona u organizmu može biti na višoj ili nižoj razini, u usporedbi s istim organizmom drugom prilikom ili u usporedbi s drugim organizmima. Koje razine funkcioniranja predstavljaju slučajeve disfunkcije; gdje da povučemo crtu? To je kvantitativni problem za teorije disfunkcije i bolesti. Cilj mi je braniti verziju bioloških teorija disfunkcije kako bih se uhvatio u koštac s ovim problemom. Međutim, također ću dopustiti da evaluativna razmatranja uđu u teoriju bolesti. Moj argument (...) se temelji na razlikovanju između biološke i kliničke perspektive. Prema mom mišljenju, bolest je ograničena na slučajeve koji spadaju u granice bioloških disfunkcija. Odgovor na kvantitativni problem ne zahtijeva proizvoljne odluke ili društveno vrijednosne sudove. Stoga se zalažem za nearbitrarnu metodu koja se temelji na činjenicama kako bi se riješio kvantitativni problem. Ipak, nisu sve biološke disfunkcije instance bolesti. Dodavanje kliničke perspektive omogućuje nam da spriječimo potencijalnu preveliku uključenost biološke perspektive, zato što postavlja dodatna ograničenja za određivanje granica bolesti. (shrink)

A distinguishing feature of neural computation and information processing is that it fits models that describe the most efficient strategies for performing different cognitive tasks. Efficiency determines a distinctive sense of teleology involving optimal performance and resource management through a specific strategy. I articulate this kind of teleology and call it efficient teleological function. I argue that efficient teleological function is compatible with mechanistic explanation and, most likely, neural computational mechanisms are efficiently functional in this sense. They are members of (...) a distinctive class of computational mechanisms whose efficiency is intertwined with their functionality. This is illustrated by widely discussed approaches to mind, such as Barlow’s efficient coding hypothesis or the ones associated with the so-called “predictive mind”, which propose that the brain employs highly efficient coding strategies to save energy resources that are critical to the organism’s survival. (shrink)

The core idea of statistical accounts of biological functions is that to function normally is to provide a statistically typical contribution to some goal state of the organism. In this way, statistical accounts purport to naturalize the teleological notion of function in terms of statistical facts. Boorse’s, 542–573, 1977) original biostatistical account was criticized for failing to distinguish functions from malfunctions. Recently, many have attempted to circumvent the criticism, 519–541, 2012, Journal of Medicine and Philosophy, 39, 634–647, 2014). Here, I (...) review such attempts and find them inadequate. The reason, ultimately, is that functional attribution depends on how traits would behave in relevant situations, a condition that resists statistical characterizations in terms of how they typically behave. This, I conclude, undermines the attempt to naturalize functions in statistical terms. (shrink)

The new life heralded by an artificial heart is hugely complicated: medically, socially, culturally, and experientially. In this paper, I argue that the compulsory presentation of medical data by artificial hearts can transform a patient’s prereflective experience of their own body and the world. First, I introduce the paracorporeal medical devices called artificial hearts. Second, I introduce the phenomenological approach of Merleau-Ponty, particularly his concern with prereflective, embodied awareness. Third, I consider how patients experience their bodies vis a vis their (...) hearts. I then argue that the representation of cardiac conditions by artificial hearts turns the body from the origin of experience to an object of experience. Fourth, I consider Merleau-Ponty’s notion of motor intentionality and a well-known interpretation by Dreyfus, known as absorbed or skillful coping. I argue that representations of cardiac conditions may interrupt prereflective experience and crowd-out coping. (shrink)

Our goal in this paper is to reassess the relationship between norms and life by drawing on the philosophy of Georges Canguilhem, particularly some of his unpublished lectures about teratology and sexual determination. First, we discuss the difficulties Canguilhem identified in the introduction of life and sexuality as objects of philosophical reflection. Second, we reassess Canguilhem’s understanding of normativity as rooted in life and the axiological activity of the living. Third, we analyze how Canguilhem drew from past and contemporary teratology (...) to conceive of the notions of anomaly and abnormality. Finally, we reconstruct Canguilhem’s analysis of a case of hermaphroditism, highlighting how he presented it as evidence that sexual determination is the result of a normative choice. One of the key contributions of the paper to scholarly literature on Canguilhem is a better understanding of his notion of choice, which was considered not the conscious and intentional act of a subject but rather an axiological activity of the living. We conclude by positioning Canguilhem’s concept of normativity and his belief that norms are produced by the living in relation to the naturalist/normativist divide in medicine. (shrink)

Ovaj je zbornik nastao kao rezultat istraživanja provedenog unutar istoimenoga znanstveno-istraživačkoga projekta na kojemu su urednici istovremeno bili i glavni istraživači, a ostali autori članovi istraživačke skupine. Kao svjedoci različitih vrsta otklona od prevladavajućeg, uobičajenoga, normalnoga, pozitivnog ili ponašanja koje se karakterizira kao asocijalno, zapitali smo se – što postojeće čini normom, treba li odstupanje od norme nužno smatrati devijacijom i kakvi su poželjni društveni odgovori na odstupanja od normi. Često se smatra ispravnim upravo ono što je prevladavajuće, a ono (...) što predstavlja otklon označava se kao devijacija u negativnome značenju onoga što nije ispravno, nije posve ispravno, ili čak onoga što treba sankcionirati. Naš je početni stav bio da ono što prevladava ne smije biti neupitna norma, kao što ni ono što je otklon nije po automatizmu devijacija. Međutim, ne smatramo ni da prevladavajuću normu, samom tom činjenicom što je prevladavajuća, nužno treba kritizirati te da je svaki otklon po sebi poželjan. Cilj našeg istraživanja bio je istražiti različite oblike deficita i devijacijau u domeni formiranja vjerovanja individualnih, grupnih, kolektivnih i institucijskih epistemičkih aktera (socijalna epistemologija) i u domeni društvenog i institucijskoga djelovanja (filozofija politike i filozofija psihijatrije). Nastavno na to, pokušali smo identificirati vrijednosti postojećih normi, koliko odgovaraju poželjnim vrijednostima te koji su poželjni društveni odgovori na otklone od normi. (shrink)

Radical embodied cognitive science (REC) tries to understand as much cognition as it can without positing contentful mental entities. Thus, in one prominent formulation, REC claims that content is involved neither in visual perception nor in any more elementary form of cognition. Arguments for REC tend to rely heavily on considerations of ontological parsimony, with authors frequently pointing to the difficulty of explaining content in naturalistically acceptable terms. However, many classic concerns about the difficulty of naturalizing content likewise threaten the (...) credentials of intentionality, which even advocates of REC take to be a fundamental feature of cognition. In particular, concerns about the explanatory role of content and about indeterminacy can be run on accounts of intentionality as well. Issues about explanation can be avoided, intriguingly if uncomfortably, by dramatically reconceptualizing or even renouncing the idea that intentionality can explain. As for indeterminacy, Daniel Hutto and Erik Myin point the way toward a response, appropriating an idea from Ruth Millikan. I take it a step further, arguing that attention to the ways that beliefs’ effects on behavior are modulated by background beliefs can help illuminate the facts that underlie their intentionality and content. (shrink)

During the 1990s, many philosophers wrestled with the problem of function indeterminacy. Although interest in the problem has waned, I argue that solving the problem is of value for biomedical research and practice. This is because a solution to the problem is required in order to specify rigorously the conditions under which a given item is “dysfunctional.” In the following I revisit a solution developed originally by Neander, which uses functional analysis to solve the problem. I situate her solution in (...) the framework of mechanistic explanation and suggest two improvements. (shrink)

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

This paper deals with the idea that ‘pathology’ can be defined in terms of reduced efficiency. I discuss the notion of efficiency in Boorse’s biostatistical theory and Hausman’s functional efficiency theory and argue that whereas Boorse does not provide a precise definition, Hausman’s definition is not suitable to apply in health evaluations. I then propose a precise definition of ‘efficiency’ and illustrate its use in health evaluations. I also show how the suggested definition contributes to solving Kingma’s dilemma.