Over recent years, the psychology of concepts has been rejuvenated by new work on prototypes, inventive ideas on causal cognition, the development of neo-empiricist theories of concepts, and the inputs of the budding neuropsychology of concepts. But our empirical knowledge about concepts has yet to be organized in a coherent framework. -/- In Doing without Concepts, Edouard Machery argues that the dominant psychological theories of concepts fail to provide such a framework and that drastic conceptual changes are required to make (...) sense of the research on concepts in psychology and neuropsychology. Machery shows that the class of concepts divides into several distinct kinds that have little in common with one another and that for this very reason, it is a mistake to attempt to encompass all known phenomena within a single theory of concepts. In brief, concepts are not a natural kind. Machery concludes that the theoretical notion of concept should be eliminated from the theoretical apparatus of contemporary psychology and should be replaced with theoretical notions that are more appropriate for fulfilling psychologists' goals. The notion of concept has encouraged psychologists to believe that a single theory of concepts could be developed, leading to useless theoretical controversies between the dominant paradigms of concepts. Keeping this notion would slow down, and maybe prevent, the development of a more adequate classification and would overshadow the theoretical and empirical issues that are raised by this more adequate classification. Anyone interested in cognitive science's emerging view of the mind will find Machery's provocative ideas of interest. (shrink)

Conceptual engineering is the design, implementation, and evaluation of concepts. Conceptual engineering includes or should include de novo conceptual engineering (designing a new concept) as well as conceptual re-engineering (fixing an old concept). It should also include heteronymous (different-word) as well as homonymous (same-word) conceptual engineering. I discuss the importance and the difficulty of these sorts of conceptual engineering in philosophy and elsewhere.

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)

The question of the relationship of the making of value judgments in a typically ethical sense to the methods and procedures of science has been discussed in the literature at least to that point which e. e. cummings somewhere refers to as “The Mystical Moment of Dullness.” Nevertheless, albeit with some trepidation, I feel that something more may fruitfully be said on the subject.

Conceptual engineering means to provide a method to assess and improve our concepts working as cognitive devices. But conceptual engineering still lacks an account of what concepts are (as cognitive devices) and of what engineering is (in the case of cognition). And without such prior understanding of its subject matter, or so it is claimed here, conceptual engineering is bound to remain useless, merely operating as a piecemeal approach, with no overall grip on its target domain. The purpose of this (...) programmatic paper is to overcome this knowledge gap by providing some guidelines for developing the theories of concepts and of cognition that will ground the systematic unified framework needed to effectively implement conceptual engineering as a widely applicable method for the cognitive optimization of our conceptual devices. (shrink)

Conceptual engineering is to be explained by appeal to the externalist distinction between concepts and conceptions. If concepts are determined by non-conceptual relations to objective properties rather than by associated conceptions (whether individual or communal), then topic preservation through semantic change will be possible. The requisite level of objectivity is guaranteed by the possibility of collective error and does not depend on a stronger level of objectivity, such as mind-independence or independence from linguistic or social practice more generally. This means (...) that the requisite level of objectivity is exhibited not only by natural kinds, but also by a wide range of philosophical kinds, social kinds and artefactual kinds. The alternative externalist accounts of conceptual engineering offered by Herman Cappelen and Derek Ball fall back into a kind of descriptivism which is antithetical to externalism and fails to recognise this basic level of objectivity. (shrink)

Underdetermination arguments support the conclusion that no amount of empirical data can uniquely determine theory choice. The full content of a theory outreaches those elements of it (the observational elements) that can be shown to be true (or in agreement with actual observations).2 A number of strategies have been developed to minimize the threat such arguments pose to our aspirations to scientific knowledge. I want to focus on one such strategy: the invocation of additional criteria drawn from a pool of (...) cognitive or theoretical values, such as simplicity or generality, to bolster judgements about the worth of models, theories, and hypotheses. What is the status of such criteria? Larry Laudan, in Science and Values, argued that cognitive values could not be treated as self-validating, beyond justification, but are embedded in a three-way reticulational system containing theories, methods, and aims or values, which are involved in mutually supportive relationships (Laudan, 1984). My interest in this paper is not the purportedly self-validating nature of cognitive values, but their cognitive nature. Although Laudan rejects the idea that what he calls cognitive values are exempt from rational criticism and disagreement, he does seem to think that the reticulational system he identifies is independent of non-cognitive considerations. It is this cognitive/non-cognitive distinction that I wish to query in this paper. Let me begin by summarizing those of my own views about inquiry in which this worry about the distinction arises. (shrink)

Accounts of the concepts of function and dysfunction have not adequately explained what factors determine the line between low‐normal function and dysfunction. I call the challenge of doing so the line‐drawing problem. Previous approaches emphasize facts involving the action of natural selection (Wakefield 1992a, 1999a, 1999b) or the statistical distribution of levels of functioning in the current population (Boorse 1977, 1997). I point out limitations of these two approaches and present a solution to the line‐drawing problem that builds on the (...) second one. (shrink)

Philosophy of Medicine provides a fresh and comprehensive treatment of the topic. It offers a novel theory of the nature of medicine, and proposes a new attitude to medicine, aimed at improving the quality of debates between medical traditions and facilitating medicine's decolonization.

This book explores a variety of conceptual and methodological questions about cancer and cancer research: Is cancer one disease, or many? If many, how many exactly? How is cancer classified? What does it mean, exactly, to say that cancer is “genetic,” or “familial”? What exactly are the causes of cancer, and how do scientists come to know about them? When do we have good reason to believe that this or that is a risk factor for cancer? How is cancer a (...) product or byproduct of multilevel evolution? Is cancer research unified? What sort of models, or theories, govern cancer research? This book takes a close look at these philosophical questions, by examining work in disciplines as diverse as cell and molecular biology, epidemiology, clinical medicine, and evolutionary biology. (shrink)

In this paper, I argue that an adequate meta-semantic framework capable of accommodating the range of projects currently identified as projects in conceptual engineering must be sensitive to the fact that concepts (and hence projects relating to them) fall into distinct kinds. Concepts can vary, I will argue, with respect to their direction of determination, their modal range, and their temporal range. Acknowledging such variations yields a preliminary taxonomy of concepts and generates a meta-semantic framework that allows us both to (...) accommodate the full range of cases and to identify a proper subset of concepts for special ameliorative consideration. Ignoring such variations, in contrast, leads to a restricted meta-semantic framework that accommodates only a subset of the particular projects while generating implausible accounts of others. (shrink)

Conceptual engineering means to provide a method to assess and improve our concepts working as cognitive devices. But conceptual engineering still lacks an account of what concepts are as cognitive devices and of what engineering is in the case of conceptual cognition. And without such prior understanding of its subject matter, or so it is claimed here, conceptual engineering is bound to remain useless, merely operating as a piecemeal approach, with no overall grip on its target domain. The purpose of (...) this programmatic paper is to overcome this knowledge gap by providing some guidelines for developing the theories of concepts and of engineering (viz. ‘cognitive engineering’) that are presumably needed so as to make conceptual engineering an actionable method for the cognitive optimization of our conceptual devices. (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)

In this paper we focus on some new normativist positions and compare them with traditional ones. In so doing, we claim that if normative judgments are involved in determining whether a condition is a disease only in the sense identified by new normativisms, then disease is normative only in a weak sense, which must be distinguished from the strong sense advocated by traditional normativisms. Specifically, we argue that weak and strong normativity are different to the point that one ‘normativist’ label (...) ceases to be appropriate for the whole range of positions. If values and norms are not explicit components of the concept of disease, but only intervene in other explanatory roles, then the concept of disease is no more value-laden than many other scientific concepts, or even any other scientific concept. We call the newly identified position “value-conscious naturalism” about disease, and point to some of its theoretical and practical advantages. (shrink)

Diagnosing the Diagnostic and Statistical Manual of Mental Disorders (Karnac, 2014) evaluates the latest edition of the D.S.M.The publication of D.S.M-5 in 2013 brought many changes. Diagnosing the Diagnostic and Statistical Manual of Mental Disorders asks whether the D.S.M.-5 classifies the right people in the right way. It is aimed at patients, mental health professionals, and academics with an interest in mental health. Issues addressed include: How is the D.S.M. affected by financial links with the pharmaceutical industry? To what extent (...) were and should patients involved in revising the classification? How are diagnoses added to the D.S.M.? Does medicalization threaten the idea that anyone is normal? What happens when changes to diagnostic criteria mean that people lose their diagnoses? How important will the D.S.M. be in the future? (shrink)

Consensus conferences are social techniques which involve bringing together a group of scientific experts, and sometimes also non-experts, in order to increase the public role in science and related policy, to amalgamate diverse and often contradictory evidence for a hypothesis of interest, and to achieve scientific consensus or at least the appearance of consensus among scientists. For consensus conferences that set out to amalgamate evidence, I propose three desiderata: Inclusivity, Constraint, and Evidential Complexity. Two examples suggest that consensus conferences can (...) readily satisfy Inclusivity and Evidential Complexity, but consensus conferences do not as easily satisfy Constraint. I end by discussing the relation between social inclusivity and the three desiderata. (shrink)

This is the first wide-ranging, multi-authored handbook in the field of philosophy of medicine, covering the underlying conceptual issues of many important social, political and ethical issues in health care. It introduces and develops over 70 topics, concepts, and issues in the field. It is written by distinguished specialists from multiple disciplines, including philosophy, health sciences, nursing, sociology, political theory, and medicine. Many difficult social and ethical issues in health care are based on conceptual problems, most prominently on the definitions (...) of health and disease, or on epistemological issues regarding causality or diagnosis. Philosophy is the discipline that deals with such conceptual, metaphysical, epistemological, methodological, and axiological matters. This handbook covers all the central concepts in medicine, such as ageing, death, disease, mental disorder, and well-being. It is an invaluable source for laypeople, academics with an interest in medicine, and health care specialists who want be informed and up to date with the relevant discussions. The text also advances these debates and will set the agenda for years to come. (shrink)

What kind of a thing are chronic diseases? Are they objects, bundles of signs and symptoms, properties, processes, or fictions? Rather than using concept analysis—the standard approach to disease in the philosophy of medicine—to answer this metaphysical question, I use a bottom-up, inductive approach. I argue that chronic diseases are bodily states or properties—often dispositional, but sometimes categorical. I also investigate the nature of related pathological entities: pathogenesis, etiology, and signs and symptoms. Finally, I defend my view against alternate accounts (...) of the nature of disease. (shrink)

I argue that ductal carcinoma in situ (DCIS), the tumor most commonly diagnosed by breast mammography, cannot be confidently classified as cancer, that is, as pathological. This is because there may not be dysfunction present in DCIS—as I argue based on its high prevalence and the small amount of risk it conveys—and thus DCIS may not count as a disease by dysfunction-requiring approaches, such as Boorse’s biostatistical theory and Wakefield’s harmful dysfunction account. Patients should decide about treatment for DCIS based (...) on the risks it poses and the risks and benefits of treatment, not on its disease status. (shrink)

The distinction between concept and conception has been widely debated in political philosophy, whereas in the philosophy of psychology is frequently used, but rarely focused on. This paper aims at filling in this lacuna. I claim that far from being explanatorily idle, the distinction makes it possible to provide an adequate description of phenomena such as genuine disagreement, and concept contestation, which would otherwise remain implausibly puzzling. I illustrate and assess three accounts of the concept-conception distinction. Finally I propose a (...) social externalist account, which relies on deference to experts, and builds on Tyler Burge’s ideas of many decades ago. The debate on concepts and conceptions thus shows a connection with the increasing research work on experts and expertise in psychology and social epistemology. (shrink)

Obesity has generated significant worries amongst health policy makers and has obtained increased attention in health care. Obesity is unanimously defined as a disease in the health care and health policy literature. However, there are pragmatic and not principled reasons for this. This warrants an analysis of obesity according to standard conceptions of disease in the literature of philosophy of medicine. According to theories and definitions of disease referring to internal processes, obesity is not a disease. Obesity undoubtedly can result (...) in disease, making it a risk factor for disease, but not a disease per se. According to several social conceptions of disease, however, obesity clearly is a disease. Obesity can conflict with aesthetic, moral, or other social norms. Making obesity a “social disease” may very well be a wise health policy, assuring and improving population health, especially if we address the social determinants of obesity, such as the food supply and marketing system. However, applying biomedical solutions to social problems may also have severe side effects. It can result in medicalization and enhance stigmatization and discrimination of persons based on appearance or behavior. Approaching social problems with biomedical means may also serve commercial and professionals’ interests more than the health and welfare of individuals; it may make quick fix medical solutions halt more sustainable structural solutions. This urges health insurers, health care professionals, and health policy makers to be cautious. Especially if we want to help and respect persons that we classify and treat as obese. (shrink)

Philosophers of medicine have formulated different accounts of the concept of disease. Which concept of disease one assumes has implications for what conditions count as diseases and, by extension, who may be regarded as having a disease and for who may be accorded the social privileges and personal responsibilities associated with being sick. In this article, we consider an ideal diagnostic test for coronavirus disease 2019 infection with respect to four groups of people—positive and asymptomatic; positive and symptomatic; negative; and (...) untested—and show how different concepts of disease impact on the disease and sickness judgements for these groups. The suggestion is that sickness judgements and social measures akin to those experienced during the current COVID-19 outbreak presuppose a concept of disease containing social harm as a component. We indicate the problems that arise when adopting this kind of disease concept beyond a state of emergency. (shrink)

Philosophers of medicine have long debated the possibility of a/the definition of health, but they have yet to fully reflect on the intriguing observation that there is still no theory of health within the medical sciences similar to general theories in other sciences. In this chapter, I provide some reasons for why this lack persists and why philosophers have not been particularly helpful or even interested in filling it. After clarifying why such a theory could be useful, I discuss five (...) general features of medical theories and how one could evaluate the utility of a given proposal. With these features in mind, I suggest that philosophers and scientists work together on analyzing actual medical research (experimental analysis), and the ways in which a theoretical construct of ‘health’ is being progressively identified and measured therein. I conclude by suggesting that research fields studying stress and aging might be particularly helpful in developing candidates for theory construction due to their broad scope, specificity, and potentially integrative explanations. (shrink)

Obesity is increasingly becoming a problem for Western societies, to the extent that politicians, scientists, patient organisations and the media now refer to it as ‘the obesity epidemic’. Concerns about the damaging effect of increasing body weight on public health has led to a strong growth in the amount of scientific work on the condition, with the medical professions leading the way. This article discusses that, first of all, scientific evidence for obesity-associated mortality is at best ambiguous, and proposes that (...) at least some of contemporary medical preoccupation with obesity has a moral origin in that it seeks to correct unwanted or immoral behaviour. It then continues to reflect on the effect of the conceptual transformation of healthy children into patients, and concludes with some reflections on the ethical implications of the obesity disease for the wellbeing of children. (shrink)