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The problem of processes and transitions: are diseases phase kinds?

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Abstract

In this paper I discuss a central objection against diseases being natural kinds—namely, that diseases are processes or transitions and hence they should not be conceptualized in the ‘substantish’ framework of natural kinds. I indicate that the objection hinges on conceiving disease kinds as phase kinds, in contrast to the non-phase, natural kinds of the exact sciences. I focus on somatic diseases and argue, via a representative comparison, that if disease kinds are phase kinds, then exact science kinds are phase kinds as well. On the other hand, if exact science kinds are non-phase kinds, then disease kinds are non-phase kinds as well. This objection should thus be rejected, under a certain caveat, though. If natural kind membership has an influence over the diachronic identity of kind members, then it is possible, in principle, to draw the phase/non-phase distinction such that an ‘ontological gap’ lies between medical kinds and exact science kinds. I show further that this caveat is unavoidable even in relation to substantive universals and ‘essential’ properties—two controversial, strong features that were traditionally associated to natural kinds.

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Notes

  1. See for instance Ellis (2001, pp. 87, 167–168, 2002, pp. 28–32), who actually dismisses all special science kinds because of this ‘transitory’, ‘process’ feature. None of the theorists defending diseases as natural kinds has attempted to seriously deal with this objection.

  2. Sulmasy adopts an Aristotelian position and this is worth noting because one of the most powerful obstacles, on an intuitive level, for conceiving of diseases as natural kinds, is the (un-clarified) heritage of the Aristotelian-Platonic scheme, with its medieval development. In scholastic philosophy, what we now call ‘natural kinds’ were supposed to be substantive universals, and these in turn were taken to be Ideas in God’s mind—paradigmatic ‘entities’ that pre-existed and (thus) shaped God’s creation of the world of particulars (Funkenstein 1989). In this picture, that diseases could be natural kinds appears not just paradoxical but almost blasphemous—when creating the world, God could not have considered that diseases needed to have a place among the substances constituting the reality, as it were. A medieval would have readily retorted that diseases can only be distortions of (substantive and non-substantive) universals’ instantiation in the sublunar realm, dominated by change, transitions and processes (Nandler 1998; Klima 2008). A similar type of paradox appears in the Platonic scheme; in fact, in “Parmenides”, the young Socrates is challenged to respond to the απορία of whether “trivial and undignified” phenomena also have a corresponding Form: “Are you also puzzled, Socrates, about cases that might be thought absurd, such as hair or mud or dirt or any other trivial and undignified objects? Are you doubtful whether or not to assert that each of these has a separate form distinct from things like those we handle?” (Plato, Parmenides, 130c–130d). Parenthetically, the young Socrates does not provide a satisfactory answer to the respective question. On a different note, I should point out that the present paper is written in the style and with the conceptual means of contemporary philosophy of science. I have only made these references to the history of philosophy in order to underlie the enormous intuitive obstacles that theorists of medicine viewing diseases as natural kinds need to face. Sulmasy is a very moderate Aristotelian—substantive universals are not mentioned in his paper and his main contention is that organisms possess essentially certain dispositions whose manifestation is required for their flourishing. This of course is consistent with diseases being natural kinds, provided one does not advance the absurd thesis that natural kinds as diseases lead to the flourishing of organisms. Later I will provide some discussion on how substantive universals (and ‘essential’ properties) bear on my argument, again, from the point of view of contemporary philosophy of science.

  3. I borrow Cooper’s terminology, from her (2005).

  4. An exception is Dupré who argues in his (1993) that any sorts of properties would do for identifying the resembling members of natural kinds. Note that the correct distinction between the ‘superficial’ and the ‘profound’ sets/patterns of properties involved in my discussion has causal grounds, i.e. it is the distinction between the properties attended by causal powers considered by scientific explanations and the properties and behaviours explained, as effects. Thus, it should not be assimilated to the distinction between observable and micro-structural properties because, for one thing, the ‘superficial’ properties might be micro-structural properties as well, and for another observable properties may also have causal powers. For expository reasons, I shall often refer to the observable/microstructural dichotomy in this paper however.

  5. The diagnosis of Graves disease is established by detecting in the blood a certain type of antibodies called TRAs (thyroid stimulating antibodies) and the high levels of thyroxin (the thyroidian hormone). These in turn represent parameters indicating the presence of specific biological micro-structural properties—including, beside ones mentioned above, the LDL and VDRL receptor lipase (responsible for reduced total and LDL cholesterol) increased osteocalcin, alkalin phosphatise and urinary N-telopeptide (responsible for osteopenia, osteoporosis and fractures), increased SERCA activity and serum creatine kinase (responsible for proximal muscle weakness, easy fatigability) increased fatty acid oxidation and sodium potassium ATPase (responsible for increased thermogenesis and oxygen consumption, perspiration and weight loss) etc. See Brent (2008).

  6. The bearers of these transitory events seem to be members of a more profoundly grounded kind, say, human organisms. We need not dwell upon what exactly this more profound kind of organism could be. What matters is that the pattern of determining properties of the GD kind appears like a phase in a transition undergone by organisms, which present a more stable/fundamental pattern of determining properties.

  7. The Graves disease kind is a representative kind for the life-threatening conditions in somatic medicine. I shall focus in this paper on the comparison between the GD kind and gold. What I argue about this kind of disease can, however, be generalised for all life-threatening conditions in somatic medicine.

  8. I use this term simply in the sense employed by chemists—as designating the transition of one chemical element to the other.

  9. For a discussion of the distinction between phase and substantial changes see Lowe (2001, p. 182–184) and also Wilson (1999, pp. 16–20).

  10. In the minimal sense of organisms whose survival is not threatened, by Graves disease at least. We need not be preoccupied here with what the precise details of the kind instantiated after/before the organisms lose/acquire the determining properties of the GD kind represents (or with the kind that is presumably instantiated all along the sickness time-period). Suffice it to say that it looks like a more fundamental kind, in relation to which the GD kind appears as representing a phase.

  11. In the quasi-majority of cases, the non-phase kind that appears saliently at the end of the phase had been instantiated all along the phase change—see for instance the transformation of tadpoles into frogs. I do not wish to exclude the case in which, after a phase, the non-phase kind indeed comes to be instantiated.

  12. These means are to be found, among others, in Lowe (2001), Millikan (1999), Boyd (1999), and Robinson (2004). They only represent an illustrative selection from the variegated reasons advanced in order to draw the phase/non-phase distinction, in the discussions concerning phase kinds as such, sortals or the concept of substance. Other examples of features advanced in order to shed light on the vein substances/non-phase kinds/substantial sortals are: being subjects of predication and bearers of properties, being the subjects of change, possessing unity in our spatio-temporal framework, being ontologically basic, being the crucial entities in a given system, etc.

  13. See Lowe (2001, p. 176) who claims that the phase changes should occur as effects of natural changes in the environment, and not due to drastic measures undertaken in laboratories. See also Robinson (2004) who approaches the phase/non-phase distinction as part of the broader discussion over the concept of substance and who mentions stability as well.

  14. The two authors discuss in their articles the differences between exact science kinds and special science kinds.

  15. ‘A change to an individual substance S, of kind K, is a phase change for S just in case it is a change which things of kind K survive as a consequence of the natural laws of development for Ks’ Lowe (2001, p. 186). Note that Lowe has different phase-conditions for objects belonging to different categories (the material, artefactual and biological). I employ here a few of his conditions for illustrative purposes. The laws of development are mentioned by Wiggins as well, as means to trace out phases (and phase sortals); see Wiggins (2001, p. 143).

  16. Mitchell (2000) makes this point when comparing biological with physical laws, but the ‘created’ nature of gold is just as relevant for the kinds discussion.

  17. And Lowe (the main proponent of the motive that the phase transformations are subject to laws) could not object that no laws are at work for the processes underwent by the GD kind members, since he rejects reductionism to the fizico-chemical level and admits himself that we could have laws with exceptions. See Lowe (1989, pp. 153, 154).

  18. Lowe delineates three categories of ‘objects’, each of them associated with different conditions of identity (Lowe 1989, pp. 8–15). These conditions are such that they preclude any individual to trespass the limits of a category and yet remain identical with itself (see the example of any dying organism or the statue/material discussion, approached in Lowe 1995). Within a category, insofar as the corresponding conditions are fulfilled, individuals can undergo all sorts of changes including changes of their kind membership, while remaining identical with themselves. In other words, Lowe adheres to the non-identity sense of carving nature at its joints. This aspect will become relevant a bit later.

  19. I do not exclude that these conditions might be useful to draw the phase/non-phase distinction in general, or in other particular cases. What I am precisely interested in, however, as regards these conditions and any other, is whether they can reveal an ontological discrepancy between the two kinds under comparison here, from the point of view of the phase/non-phase distinction.

  20. The claim is not made directly. Lowe simply insists that individuals’ swapping of natural kinds, within a category, could take place without any change in their identity; see his discussion of substantial kind change and individual substantial change in Lowe (2001, pp. 174, 175, 186). Since Lowe does not count the transformation of water into ice as attended by the losing of matter, presumably the gold-lead transmutation does not presuppose any loss of matter as well in his view. Note parenthetically that the identity at stake in the gold-lead transmutation is not numerical identity (since we are talking about samples of kinds of stuff), but diachronic identity in the broad sense, which is involved in our identifying of the same sample of a kind of stuff over time (see Lowe 2001, pp. 187).

  21. Of the sort Wilkerson (1995) for instance claims natural kinds have.

  22. Recall the distinction between determining and determined properties (the pattern [p1, p2,…pn] and [q1, q2,…,qn] of properties) I drew in the Introduction. The GD kind is indeed characterised by a pattern or cluster of such determining, microbiological properties.

  23. It might be that the divisions that are non-fuzzy in the actual world are metaphysically necessary so, i.e. are still non-fuzzy in all the possible worlds, perhaps as the result of causal interactions that agglutinate properties with more than physical necessity. Nonetheless, this aspect has to do with causation and other related aspects. It does not tell us anything about the metaphysical category of natural kind and the different sorts of divisions of nature that should be acknowledged under its scope. As to those properties characteristic of kinds which are called ‘essential’ (in the sense of being necessary and sufficient for membership) they lack a certain, additional de re ingredient. As Stephen Mumford (2005, p. 424) puts it “there should be something else, something else about the properties characteristic of kinds that makes them 'essential’ [for natural kinds]”.

  24. For one, the truth-makers of laws could simply be taken to be properties (Bird 2007). For another, the co-instantiation aspect can be explained without inflating our ontology, by appealing to properties and causal mechanisms, either internal or external, which produce the stability or unity of the determining properties at the level of kind members (Bird 2007). See also Heil (2006) for a more general critique.

  25. Lowe’s exposition of the advantages of embracing substantive universals can be found for instance in Lowe (2006, pp. 26, 132, 133, 147).

  26. Indeed, this was the construal of substantive universals in Aristotle and his medieval followers; see Dahl (1997, p. 233), Ayers (1991, p. 20). Oderberg is the only modern author who holds that kinds are substantive universals and claims explicitly that the phase/non-phase distinction should be drawn using the identity of kind members; see Oderberg (2007, p. 268), Oderberg (1996, pp. 150–152).

  27. Authors who believe that identity is crucial for drawing the phase/non-phase distinction, are Wilson (1999, p. 20) Hirsch (1982, pp. 52–57) Wiggins (2001), Oderberg (2007). Not all of them see kinds as substantive universals.

  28. The interested reader should consult Cooper (2005), which is, I think, the best defense in the literature offered so far for diseases as natural kinds. What makes Cooper’s arguments even more interesting is that they are concerned with psychiatry and psychiatric kinds. The somatic medical kinds are discussed in Reznek (1987) and D’Amico (1995)

  29. See for instance Teller (1975, pp. 238, 239). Teller argues that not even the (natural) kinds in physics satisfy this requirement. At any rate, in the context of our comparison, whether or not the determining properties of the gold kind, as they are commonly recognized, have an identity bearing over gold samples, is an issue that I will remain neutral on.

References

  • Ayers, M. 1991. Locke, vol. 1. London: Routledge.

    Google Scholar 

  • Bird, A. 2007. Nature’s metaphysics: Dispositions, laws, and properties. Oxford: Oxford University Press.

    Google Scholar 

  • Brent, G. 2008. Graves disease. New England Journal of Medicine 358: 2594–2605.

    Article  PubMed  CAS  Google Scholar 

  • Boyd, R. 1999. Homeostasis, species and higher taxa. In Species: New interdisciplinary essays, ed. R. Wilson, 141–185. Massachusetts: MIT Press.

    Google Scholar 

  • Cooper, R. 2005. Classifying madness. Dordrecht: Springer.

    Google Scholar 

  • Crane, J. 2003. Locke’s theory of classification. British Journal for the History of Philosophy 11(2): 249–259.

    Article  Google Scholar 

  • D’Amico, R. 1995. Is disease a natural kind? Journal of Medicine and Philosophy 20(5): 551–569.

    PubMed  Google Scholar 

  • Dahl, N. 1997. Two kinds of essence in Aristotle. The Philosophical Review 106(2): 233–265.

    Article  Google Scholar 

  • Dupré, J. 1993. The disorder of things. Cambridge, MA: Harvard University Press.

    Google Scholar 

  • Ellis, B. 2001. Scientific essentialism. Cambridge: Cambridge University Press.

    Google Scholar 

  • Ellis, B. 2002. The philosophy of nature. Toronto: McGill-Queen’s University Press.

    Google Scholar 

  • Funkenstein, A. 1989. Theology and scientific imagination. Princeton: Princeton University Press.

    Google Scholar 

  • Grady, R. 2007. Sortals. In The Stanford encyclopaedia of philosophy, ed. E. Zalta. http://plato.stanford.edu/entries/sortals/. Accessed 16 Aug 2010.

  • Haslam, N. 2003. Essentialist beliefs about mental disorders. Journal of Social and Clinical Psychology 21(6): 628–644.

    Article  Google Scholar 

  • Hirsch, E. 1982. The concept of identity. Oxford: Oxford University Press.

    Google Scholar 

  • Heil, J. 2006. Universals, paper delivered at the Lowe conference, Buffalo University. http://ontology.buffalo.edu/06/Lowe/Heil.pdf. Accessed 16 Sept 2010.

  • Klima, G. 2008. The medieval problem of universals, Stanford encyclopaedia of philosophy, E. Zalta ed. http://plato.stanford.edu/entries/universals-medieval/. Accessed 03 Oct 2010.

  • Lagerlund, H. 2009. John Buridan’s empiricism and the knowledge of substances. http://faculty.fordham.edu/klima/FILES/Talk%20Western%20Ontario%20Oct%20-09-revised.pdf. Accessed 3 Dec 2010.

  • Lowe, J. 1989. Kinds of being. Oxford: Blackwell.

    Google Scholar 

  • Lowe, J. 1995. Coinciding objects: In defence of the standard account. Analysis 55: 171–178.

    Article  Google Scholar 

  • Lowe, J. 1998. Entity, identity and unity. Erkenntnis 48: 191–208.

    Article  Google Scholar 

  • Lowe, J. 2001. The possibility of metaphysics. Oxford: Oxford University Press.

    Book  Google Scholar 

  • Lowe, J. 2006. The four category ontology. Oxford: Oxford University Press.

    Google Scholar 

  • Lowe, J. 2007. A problem for a posterior essentialism concerning natural kinds. Analysis 67(296): 286–292.

    Article  Google Scholar 

  • Lowe, J. 2008. Two notions of being: Entity and essence. Royal Institute of Philosophy Supplements 83(62): 23–48.

    Article  Google Scholar 

  • Millikan, R.G. 1999. Historical kinds and the “special sciences”. Philosophical Studies 95(1/2): 45–65.

    Article  Google Scholar 

  • Mitchell, S. 2000. Dimensions of scientific law. Philosophy of Science 67(2): 242–265.

    Article  Google Scholar 

  • Mumford, S. 2005. Kinds, essences, powers. Ratio 18: 420–436.

    Article  Google Scholar 

  • Nandler, S. 1998. Doctrines of explanation on late scholasticism and in the mechanical philosophy. In The Cambridge history of the seventeenth century philosophy, ed. D. Garber, and M. Ayers, 513–532. Cambridge: Cambridge University Press.

    Chapter  Google Scholar 

  • Noonan, H. 2006. Identity. In The Stanford encyclopaedia of philosophy, ed. E. Zalta. http://plato.stanford.edu/entries/identity/. Accessed 16 June 2010.

  • Oderberg, D.S. 1996. Coincidence under a sortal. The Philosophical Review 105(2): 145–171.

    Article  Google Scholar 

  • Oderberg, D.S. 2001. How to win essence back from essentialists. Philosophical Writings 18: 27–45.

    Google Scholar 

  • Oderberg, D.S. 2007. Real essentialism. London: Routledge.

    Book  Google Scholar 

  • Plato. Parmenides. In MIT internet classics archive. Trans. B. Jowett. http://classics.mit.edu/Plato/parmenides.html. Accessed 16 Nov 2010.

  • Reznek, L. 1987. The nature of disease. London: Routledge & Kegan Paul.

    Google Scholar 

  • Robinson, H. 2004. Substance. In The Stanford encyclopaedia of philosophy, ed. E. Zalta. http://plato.stanford.edu/entries/substance/. Accessed 16 Aug 2010.

  • Salmon, N. 1982. Reference and essence. Oxford: Blackwell.

    Google Scholar 

  • Sulmasy, D. 2005. Diseases and natural kinds. Theoretical Medicine and Bioethics 26: 487–513.

    Article  PubMed  Google Scholar 

  • Teller, P. 1975. Essential properties: Some problems and conjectures. The Journal of Philosophy 72(9): 233–248.

    Article  Google Scholar 

  • Uzgalis, W. 1988. The anti-essentialist Locke and natural kinds. The Philosophical Quarterly 38(152): 330–339.

    Article  Google Scholar 

  • Wilson, J. 1999. Biological Individuality: The identity and persistence of living entities. Cambridge: Cambridge University Press.

    Book  Google Scholar 

  • Wiggins, D. 2001. Sameness and substance renewed. Cambridge: Cambridge University Press.

    Google Scholar 

  • Wallerstein, G., I. Iben, and P. Parker 1997. Synthesis of the elements in stars: Forty years of progress. Reviews of Modern Physics 69(4). http://cococubed.asu.edu/papers/wallerstein97.pdf. Accessed 03 Feb 2010.

  • Wilkerson, T. 1995. Natural kinds. Aldershot: Ashgate.

    Google Scholar 

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Acknowledgments

This paper is based on my PhD thesis at Lancaster University, for which I gratefully acknowledge financial support from the UK Arts and Humanities Research Council (fees doctoral bursary, awarded July 2007, Ref. No. 2007/135148/Lancaster University) and the British Society for the Philosophy of Science (doctoral scholarship, awarded July 2007). Two anonymous referees of this journal provided valuable criticism and suggestions.

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    Stefan Dragulinescu

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Dragulinescu, S. The problem of processes and transitions: are diseases phase kinds?. Med Health Care and Philos 15, 79–89 (2012). https://doi.org/10.1007/s11019-011-9316-1

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