This 1983 book is a lively and clearly written introduction to the philosophy of natural science, organized around the central theme of scientific realism. It has two parts. 'Representing' deals with the different philosophical accounts of scientific objectivity and the reality of scientific entities. The views of Kuhn, Feyerabend, Lakatos, Putnam, van Fraassen, and others, are all considered. 'Intervening' presents the first sustained treatment of experimental science for many years and uses it to give a new direction to debates about (...) realism. Hacking illustrates how experimentation often has a life independent of theory. He argues that although the philosophical problems of scientific realism can not be resolved when put in terms of theory alone, a sound philosophy of experiment provides compelling grounds for a realistic attitude. A great many scientific examples are described in both parts of the book, which also includes lucid expositions of recent high energy physics and a remarkable chapter on the microscope in cell biology. (shrink)

To be effective, a medical intervention must improve one's health by targeting a disease. The concept of disease, though, is controversial. Among the leading accounts of disease-naturalism, normativism, hybridism, and eliminativism-I defend a version of hybridism. A hybrid account of disease holds that for a state to be a disease that state must both (i) have a constitutive causal basis and (ii) cause harm. The dual requirement of hybridism entails that a medical intervention, to be deemed effective, must target either (...) the constitutive causal basis of a disease or the harms caused by the disease (or ideally both). This provides a theoretical underpinning to the two principle aims of medical treatment: care and cure. (shrink)

Feminist critiques of science provide fertile ground for any investigation of the ways in which social influences may shape the content of science. Many authors working in this field are from the natural and social sciences; others are philosophers. For philosophers of science, recent work on sexist and androcentric bias in science raises hard questions about the extent to which reigning accounts of scientific rationality can deal successfully with mounting evidence that gender ideology has had deep and extensive effects on (...) the development of many scientific disciplines.Feminist critiques of biology have been especially important in the political struggle for gender equality because biologically determinist arguments are so often cited to ‘explain’ women’s oppression. They explain why it is ‘natural’ for women to function in a socially subordinate role, why men are smarter and more aggressive than women, why women are destined to be homebodies, and why men rape. (shrink)

This paper examines what it is for a condition to be a disease. It falls into two sections. In the first I examine the best existing account of disease (as proposed by Christopher Boorse) and argue that it must be rejected. In the second I outline a more acceptable account of disease. According to this account, by disease we mean a condition that it is a bad thing to have, that is such that we consider the afflicted person to have (...) been unlucky, and that can potentially be medically treated. All three criteria must be fulfilled for a condition to be a disease. The criterion that for a condition to be a disease it must be a bad thing is required to distinguish the biologically different from the diseased. The claim that the sufferer must be unlucky is needed to distinguish diseases from conditions that are unpleasant but normal, for example teething. Finally, the claim that for a condition to be a disease it must be potentially medically treatable is needed to distinguish diseases from other types of misfortune, for example economic problems and legal problems. (shrink)

"Toward a Feminist Theory of the State" presents Catharine MacKinnon's powerful analysis of politics, sexuality, and the law from the perspective of women.

The process of medicalization has been analyzed in the medical humanities with disapprobation, with much emphasis placed on its ability to reinforce existing social power structures to ill effect. While true, this is an incomplete picture of medicalization. I argue that medicalization can both reinforce and disrupt existing social hierarchies within the clinic and outside of it, to ill or good effect. We must attend to how this takes place locally and globally lest we misunderstand how medicalization mediates power and (...) justice. I provide concrete examples of how this occurs by considering dysesthesia ethiopsis, autism, chronic fatigue syndrome, depression, and HIV/AIDS. (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)

In this article I discuss the emergence of Female Sexual Dysfunction within American psychiatry and beyond in the postwar period, setting out what I believe to be important and suggestive questions neglected in existing scholarship. Tracing the nomenclature within successive editions of the American Psychiatric Association’s Diagnostic and Statistical Manual, I consider the reification of the term ‘FSD’, and the activism and scholarship that the rise of the category has occasioned. I suggest that analysis of FSD benefits from scrutiny of (...) a wider range of sources. I explore the multiplicity of FSD that emerges when one examines this wider range, but I also underscore a reinscribing of anxieties about psychogenic aetiologies. I then argue that what makes the FSD case additionally interesting, over and above other conditions with a contested status, is the historically complex relationship between psychiatry and feminism that is at work in contemporary debates. I suggest that existing literature on FSD has not yet posed some of the most important and salient questions at stake in writing about women’s sexual problems in this period, and can only do this when the relationship between ‘second-wave’ feminism, ‘post-feminism’, psychiatry and psychoanalysis becomes part of the terrain to be analysed, rather than the medium through which analysis is conducted. (shrink)

Many critics of medicalization express concern that the process privileges individualised, biologically grounded interpretations of medicalized phenomena, inhibiting understanding and communication of aspects of those phenomena that are less relevant to their biomedical modelling. I suggest that this line of critique views medicalization as a hermeneutical injustice—a form of epistemic injustice that prevents people having the hermeneutical resources available to interpret and communicate significant areas of their experience. Interpreting the critiques in this fashion shows they frequently fail because they: neglect (...) the ways in which medicalization may not obscure, but rather illuminate, individuals’ experiences; and neglect the testimony of those experiencing first-hand medicalized problems, thus may be guilty of perpetrating testimonial injustice. However, I suggest that such arguments are valuable insofar as they highlight the unwarranted epistemic privilege frequently afforded to medical institutions and medicalized models of phenomena, and a consequent need for greater epistemic humility on the part of health workers and researchers. (shrink)

Preventive medicine is sometimes criticised as it contributes to medicalization of normal life. The concept ‘medicalization’ has been introduced by Zola to refer to processes in which the labels ‘healthy’ and ‘ill’ are made relevant for more and more aspects of human life. If preventive medicine contributes to medicalization, would that be morally problematic? My thesis is that such a contribution is indeed morally problematic. The concept is sometimes used to express moral intuitions regarding the practice of prevention and health (...) promotion. Through analysis of these intuitions as well as some other moral concerns, I give an explication of the moral problems of medicalization within the context of preventive medicine. (shrink)

Feminist critiques of science provide fertile ground for any investigation of the ways in which social influences may shape the content of science. Many authors working in this field are from the natural and social sciences; others are philosophers. For philosophers of science, recent work on sexist and androcentric bias in science raises hard questions about the extent to which reigning accounts of scientific rationality can deal successfully with mounting evidence that gender ideology has had deep and extensive effects on (...) the development of many scientific disciplines.Feminist critiques of biology have been especially important in the political struggle for gender equality because biologically determinist arguments are so often cited to ‘explain’ women’s oppression. They explain why it is ‘natural’ for women to function in a socially subordinate role, why men are smarter and more aggressive than women, why women are destined to be homebodies, and why men rape. (shrink)

In this paper, my goal is to use an epistemic injustice framework to extend an existing normative analysis of over-medicalization to psychiatry and thus draw attention to overlooked injustices. Kaczmarek has developed a promising bioethical and pragmatic approach to over-medicalization, which consists of four guiding questions covering issues related to the harms and benefits of medicalization. In a nutshell, if we answer “yes” to all proposed questions, then it is a case of over-medicalization. Building on an epistemic injustice framework, I (...) will argue that Kaczmarek’s proposal lacks guidance concerning the procedures through which we are to answer the four questions, and I will import the conceptual resources of epistemic injustice to guide our thinking on these issues. This will lead me to defend more inclusive decision-making procedures regarding medicalization in the DSM. Kaczmarek’s account complemented with an epistemic injustice framework can help us achieve better forms of medicalization. I will then use a contested case of medicalization, the creation of Premenstrual Dysphoric Disorder in the DSM-5 to illustrate how the epistemic injustice framework can help to shed light on these issues and to show its relevance to distinguish good and bad forms of medicalization. (shrink)

“Female sexual dysfunction” is the type of contested disease that has sparked concern about the role of the pharmaceutical industry in medical science. Many policies have been proposed to manage industry influence without carefully evaluating whether the proposed policies would be successful. We consider a proposal for incorporating citizen stakeholders into scientific research and show, via a detailed case study of the pharmaceutical regulation of flibanserin, that such programs can be co-opted. In closing, we use Holman’s asymmetric arms race framework (...) as a tool for evaluating policies in industry-funded science. (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)

In this paper, I utilise the tools of analytic philosophy to amalgamate mono-causal and multi-causal theories of disease. My aim is to better integrate viral and socio-economic explanations of AIDS in particular, and to consider how the perceived divide between mono-causal and multi-causal theories played a role in the tragedy of AIDS denialism in South Africa in the early 2000s. Currently, there is conceptual ambiguity surrounding the relationship between mono-causal and multi-causal theories in biomedicine and epidemiology. Mono-causal theories focus on (...) single, typically microbial, sources of illness and are most concerned with infectious diseases. By contrast, multi-causal theories allow for multiple factors to underpin a disease’s aetiology, including socio-economic and behavioural factors, and they usually focus on chronic non-communicable diseases. However, if these theories are taken to be strictly distinct, this prevents the inclusion of both microbial and socio-economic factors in a single explanation of any particular disease. This strict distinction became a problem when trying to explain the disproportionate prevalence of AIDS in southern Africa and ultimately contributed to the tragedy of AIDS denialism in South Africa. In tandem with viewing how the perceived divide between multi-causal and mono-causal theories underpinned AIDS denialism, I examine Thabo Mbeki’s specific role, while acknowledging that AIDS is being deprioritised on a broader international level. Overall, I will demonstrate that any long-term plan to eliminate AIDS will require viral and socio-economic factors to be considered simultaneously and that such a theoretical approach requires a clearer understanding of the underlying concepts of disease aetiology. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Feminist Studies 41, no. 2. © 2015 by Feminist Studies, Inc. 259 Chloë Taylor Female Sexual Dysfunction, Feminist Sexology, and the Psychiatry of the Normal It is really weird that doctors should be the reigning experts on sex. —Leonore Tiefer1 The first volume of Michel Foucault’s The History of Sexuality provides a compelling and influential critique of the “sciences of sex.” In this work, Foucault suggests that there is (...) little that is scientific about the disciplines of psychoanalysis, psychiatry, and sexology that emerged in the nineteenth and twentieth centuries.2 In each case, Foucault argues that the authority of science is exploited to facilitate the regulation of sexuality in a biopolitical era in which the sex life of the population has become a crucial political stake.3 Sex, according to Foucault, is managed by doctors not so much to cure health problems as to enforce social norms, and sexual science does not provide the truth of sex or make people healthy, but naturalizes the monogamous, heterosexual, nuclear family.4 1. Leonore Tiefer, Sex Is Not a Natural Act and Other Essays (Cambridge, MA: Westview Press, 2004), 180. 2. Michel Foucault, The History of Sexuality: An Introduction (New York: Vintage, 1978). 3. Michel Foucault, The History of Sexuality: 133–160. See also Michel Foucault, Psychiatric Power: Lectures at the Collège de France 1973–1974 (New York: Palgrave -MacMillan, 2006) and Michel Foucault, Abnormal: Lectures at the Collège de France 1974–1975 (New York: Picador, 2003). 4. This is not to say that for Foucault doctors do not ever cure health problems or that their intentions are not to cure health problems. However, Foucault 260 Chloë Taylor Feminism has also posed powerful critiques of the sexual sciences. As Janice Irvine notes, feminist epistemology has rejected the purported neutrality of science, especially of the sciences that claim knowledge about sex and gender.5 Feminist and queer political theorists and activists have, moreover, “underscored the hollowness of solutions based on techniques” that are favored by sexologists; teaching men skills to resist premature ejaculation or to better stimulate their wives’ clitorises are not adequate resolutions to widespread and profound dissatisfactions with sex, gender, and marriage in a heterosexist and patriarchal society.6 As Irvine writes, Feminism and lesbian/gay liberation…challenged power inequalities between men and women and questioned the very concepts of maleness and femaleness, masculinity and femininity.…They presented alternatives to tradition and to expert power and authority. Therein lay their threat to American sexology.7 Given this antagonistic relationship, combining feminism and sexology has proved controversial. The work of feminist sexologist Shere Hite in the 1970s and 1980s was critiqued by sexologists and feminists alike: sexologists complained that the 1976 Hite Report was political and thus undermined the scientific prestige of sexology, while feminists criticized Hite for aspiring to a masculine scientific authority.8 Describing the relationship between feminism and sexology, Irvine notes that “the incompatibility of their concerns—science and market, on the one hand, versus shows that what we consider “healthy” is thoroughly political and that the effect of doctors’ practices is normalizing whatever their intentions may be. For two recent Foucauldian studies of the ways that medical and sexual science function to sexually normalize individuals and populations, see Ladelle McWhorter, Bodies and Pleasures: Foucault and the Politics of Sexual Normalization (Bloomington: Indiana University Press, 1999); and Ladelle McWhorter, Racism and Sexual Oppression in Anglo-America: A Genealogy (Bloomington: Indiana University Press, 2009). 5. Janice Irvine, Disorders of Desire: Sexuality and Gender in Modern American Sexology, rev. ed. (1990; repr., Philadelphia, PA: Temple University Press, 2005), 101. 6. Ibid. 7. Ibid. 8. Ibid., 117. Chloë Taylor 261 progressive political change, on the other—led…to a contentious and emotionally charged history.”9 Drawing on both Foucauldian and feminist perspectives, this article explores a new chapter in this history, examining self-described feminist sexologists’ responses to the psychiatric diagnoses of Female Sexual Dysfunction (FSD). While psychologists had pathologized female sexuality under the label of frigidity since the nineteenth century, sexual dysfunctions were relatively marginal in the first edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM), published in 1952. In the DSM-1, frigidity (like impotence) was... (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)

Today, phallocentrism is perpetuated by a flourishing medical construction that focuses exclusively on penile erections as the essence of men's sexual function and satisfaction. This article describes how this medicalization is promoted by urologists, medical industries, mass media, and various entrepreneurs. Many men and women provide a ready audience for this construction because of masculine ideology and gender socialization. While there may be some advantages to this construction, there are major disadvantages to men in terms of the inevitable failure of (...) the promised perfectible erection and the perpetuation of a falsely universalized and biologized vision of sexual experience. Any sexual interests of women in other than phallocentric sexual scripting are denied. (shrink)