Theorists of health have, to this point, focused exclusively on trying to define a state—health—that an organism might be in. I argue that they have overlooked the possibility of a comparativist theory of health, which would begin by defining a relation—healthier than—that holds between two organisms or two possible states of the same organism. I show that a comparativist approach to health has a number of attractive features, and has important implications for philosophers of medicine, bioethicists, health economists, and policy (...) makers. (shrink)

, Lawrie Reznek argues that disease is not a natural kind term. I raise objections to Reznek's two central arguments for establishing that disease is not a natural kind. In criticizing his a priori, conceptual argument against naturalism, I argue that his conclusion rests on a weaker argument that appeals to the empirical diversity in the symptoms and manifestations of disease. I also raise questions about the account of natural kinds which Reznek utilizes and his point that conventions for classification (...) are excluded by there being natural kinds. Keywords: Disease, natural kind, value judgement CiteULike Connotea Del.icio.us What's this? (shrink)

Now available in a Harper Colophon edition, this classic book has revolutionized thinking throughout the Western world about the nature of the psychiatric profession and the moral implications of its practices. Book jacket.

One INTRODUCTION 1. Background The theory of the nature of health and disease, or of the concepts of health and disease, has been central in modem ...

David Thomasma called for the development of a medical ethics based squarely on the philosophy of medicine. He recognized, however, that widespread anti-essentialism presented a significant barrier to such an approach. The aim of this article is to introduce a theory that challenges these anti-essentialist objections. The notion of natural kinds presents a modest form of essentialism that can serve as the basis for a foundationalist philosophy of medicine. The notion of a natural kind is neither static nor reductionistic. Disease (...) can be understood as making necessary reference to living natural kinds without invoking the claim that diseases themselves are natural kinds. The idea that natural kinds have a natural disposition to flourish as the kinds of things that they are provides a telos to which to tether the notion of disease – an objective telos that is broader than mere survival and narrower than subjective choice. It is argued that while nosology is descriptive and may have therapeutic implications, disease classification is fundamentally explanatory. Sickness and illness, while referring to the same state of affairs, can be distinguished from disease phenomenologically. Scientific and diagnostic fallibility in making judgments about diseases do not diminish the objectivity of this notion of disease. Diseases are things, not kinds. Injury is a concept parallel to disease that also makes necessary reference to living natural kinds. These ideas provide a new possibility for the development of a philosophy of medicine with implications for medical ethics. (shrink)

This paper argues that the medical conception of health as absence of disease is a value-free theoretical notion. Its main elements are biological function and statistical normality, in contrast to various other ideas prominent in the literature on health. Apart from universal environmental injuries, diseases are internal states that depress a functional ability below species-typical levels. Health as freedom from disease is then statistical normality of function, i.e., the ability to perform all typical physiological functions with at least typical efficiency. (...) This conception of health is as value-free as statements of biological function. The view that health is essentially value-laden, held by most writers on the topic, seems to have one of two sources: an assumption that health judgments must be practical judgments about the treatment of patients, or a commitment to "positive" health beyond the absence of disease. I suggest that the assumption is mistaken, the commitment possibly misdescribed. (shrink)

It is commonly thought that mental disorder is a valid concept only in so far as it is an extension of or continuous with the concept of physical disorder. A valid extension has to meet two criteria: determination and coherence. Essentialists meet these criteria through necessary and sufficient conditions for being a disorder. Two Wittgensteinian alternatives to essentialism are considered and assessed against the two criteria. These are the family resemblance approach and the secondary sense approach. Where the focus is (...) solely on the characteristics or attributes of things, both these approaches seem to fail to meet the criteria for valid extension. However, this focus on attributes is mistaken. The criteria for valid extension are met in the case of family resemblance by the pattern of characteristics associated with a concept, and by the limits of intelligibility of applying a concept. Secondary sense, though it may have some claims to be a good account of the relation between physical and mental disorder, cannot claim to meet the two criteria of valid extension. (shrink)

The invention of psychopathology -- Malingering -- Doctoring -- Inculpating -- Sheltering -- Cheating -- Lying -- The burden of responsibility.

The ontology of medicine—the question of whether disease entities are real or not—is an underdeveloped area of philosophical inquiry. This essay explains the primary question at issue in medical ontology, discusses why answering this question is important from both a philosophical and a practical perspective, and argues that the problem of medical ontology is unique, i.e., distinct, from the ontological problems raised by other sciences and therefore requires its own analysis.

I argued that a value-free account of our concept of disease cannot be given. Part of this argument consisted in showing that diseases as a class do not constitute a natural kind. To understand this, we need only see that we define and classify conditions into diseases and non-diseases not in terms of their causes but in terms of their effects. While no philosophical position is watertight, the arguments overwhelmingly favour the conclusion that diseases do not constitute a natural kind. (...) Keywords: Disease, natural kind, value-laden CiteULike Connotea Del.icio.us What's this? (shrink)

In this paper, I focus on life-threatening medical conditions and argue that from the point of view of natural properties, induction(s), and participation in laws, at least some of the ill organisms dealt with in somatic medicine form natural kinds in the same sense in which the kinds in the exact sciences are thought of as natural. By way of comparing two ‘divisions of nature’, viz., a ‘classical’ exact science kind (gold) and a kind of disease (Graves disease), I show (...) that there is no justifiable ‘ontological gap’ between disease kinds and exact sciences kinds. We have instead a difference of degree. (shrink)

Substantially revised to include a wealth of new material, the second edition of this highly acclaimed work provides a concise, coherent introduction that brings structure to an increasingly fragmented and amorphous discipline. Paul R. McHugh and Phillip R. Slavney offer an approach that emphasizes psychiatry's unifying concepts while accommodating its diversity. Recognizing that there may never be a single, all-encompassing theory, the book distills psychiatric practice into four explanatory methods: diseases, dimensions of personality, goal-directed behaviors, and life stories. These perspectives, (...) argue the authors, underlie the principles and practice of all psychiatry. With an understanding of these fundamental methods, readers will be equipped to organize and evaluate psychiatric information and to develop a confident approach to practice and research. Praise for the original edition: "This brilliant book illuminates psychiatry more clearly than any other work I know.... This is the best (and the shortest) single volume on psychiatry that anyone could read."-- New England Journal of Medicine "Every psychiatry department, regardless of ideology, should build a course around this... work. Open-mindedness might become fashionable."-- Journal of Clinical Psychiatry "An elegantly reasoned and eloquently written book that enriches our understanding of clinical events.... [It provides] an opportunity to open our eyes to new possibilities."-- Hospital and Community Psychiatry. (shrink)

It is commonly thought that mental disorder is a valid concept only in so far as it is an extension of or continuous with the concept of physical disorder. A valid extension has to meet two criteria: determination and coherence. Essentialists meet these criteria through necessary and sufficient conditions for being a disorder. Two Wittgensteinian alternatives to essentialism are considered and assessed against the two criteria. These are the family resemblance approach and the secondary sense approach. Where the focus is (...) solely on the characteristics or attributes of things, both these approaches seem to fail to meet the criteria for valid extension. However, this focus on attributes is mistaken. The criteria for valid extension are met in the case of family resemblance by the pattern of characteristics associated with a concept, and by the limits of intelligibility of applying a concept. Secondary sense, though it may have some claims to be a good account of the relation between physical and mental disorder, cannot claim to meet the two criteria of valid extension. (shrink)