Medicine, Health Care and Philosophy

, Volume 20, Issue 3, pp 353–363 | Cite as

The form of causation in health, disease and intervention: biopsychosocial dispositionalism, conserved quantity transfers and dualist mechanistic chains

  • David W. EvansEmail author
  • Nicholas Lucas
  • Roger Kerry
Scientific Contribution


Causation is important when considering: how an organism maintains health; why disease arises in a healthy person; and, how one may intervene to change the course of a disease. This paper explores the form of causative relationships in health, disease and intervention, with particular regard to the pathological and biopsychosocial models. Consistent with the philosophical view of dispositionalism, we believe that objects are the fundamental relata of causation. By accepting the broad scope of the biopsychosocial model, we argue that psychological and social constructs be considered objects. We think that this ‘biopsychosocial dispositionalism’ offers the flexibility required to describe causation throughout health, disease and intervention pathways. When constructing mechanistic chains to describe causative pathways, we argue that an object will causally connect with others through actions; transfers of energy from one object to another, initiated by the manifestation of one or more dispositional property. Finally, our analysis of causative interactions utilises the concept that a common form of interaction exists between disease and intervention pathways. This common form will always be an object, but the mode of interaction will vary with each disease. We describe how intervention may act through objects being shared between converging mechanistic chains, or through the removal and/or insertion of objects in such chains. We believe that this analysis provides novel insight to the forms of causative transactions that can occur. In addition, we hope that the findings of this analysis represent the first step towards developing a framework for appraising the composition of mechanistic theories.


Causation Mechanisms Intervention Pathology Biopsychosocial Dispositionalism 


  1. Ajzen, I. 1991. The theory of planned behavior. Organizational Behavior and Human Decision Processes 50 (2): 179–211.CrossRefGoogle Scholar
  2. Anderson, P.W. 1972. More is different. Science 177 (4047): 393–396.CrossRefGoogle Scholar
  3. Bechtel, W. 2008. Mental mechanisms: Philosophical perspectives on cognitive neuroscience. London: Routledge.Google Scholar
  4. Bechtel, W., and A. Abrahamsen. 2005. Explanation: a mechanist alternative. Studies in History and Philosophy of Biological and Biomedical Sciences 36 (2): 421–441.CrossRefGoogle Scholar
  5. Bechtel, W., and R.C. Richardson. 1993. Discovering complexity: Decomposition and localization as strategies in scientific research. Princeton: Princeton University Press.Google Scholar
  6. Bogduk, N. 2001. Diagnosis, taxonomy and assessment. Australasian Musculoskeletal Medicine 6 (1): 9–19.Google Scholar
  7. Canguilhem, G. 1991. The normal and the pathological. New York: Zone Books.Google Scholar
  8. Craver, C.F., and W. Bechtel. 2007. Top-down causation without top-down causes. Biology and Philosophy 22: 547–563.CrossRefGoogle Scholar
  9. Dawkins, R. 1982. The extended phenotype: The long reach of the gene. Oxford: Oxford University Press.Google Scholar
  10. Dowe, P. 2000. Physical causation. Cambridge: Cambridge University Press.CrossRefGoogle Scholar
  11. Engel, G.L. 1977. The need for a new medical model: A challenge for biomedicine. Science 196: 129–136.CrossRefGoogle Scholar
  12. Engel, G.L. 1980. The clinical application of the biopsychosocial model. American Journal of Psychiatry 137: 535–544.CrossRefGoogle Scholar
  13. Evans, D.W., Lucas, N., and R. Kerry. 2016. Time, space and form: Necessary for causation in health, disease and intervention? Medicine, Health Care, and Philosophy 19 (2): 207–213.CrossRefGoogle Scholar
  14. Gifford, L.S. 1998. Pain, the tissues and the nervous system. A conceptual model. Physiotherapy 84: 27–36.CrossRefGoogle Scholar
  15. Hill, A.B. 1965. The environment and disease: Association or causation? Proceedings of the Royal Society of Medicine 58 (5): 295–300.Google Scholar
  16. Howick, J., Glasziou, P., and J.K. Aronson. 2010. Evidence-based mechanistic reasoning. Journal of the Royal Society of Medicine 103: 433–441.CrossRefGoogle Scholar
  17. Kistler, M. 2010. Causation and laws of nature. London: Routledge.Google Scholar
  18. Koch, R. 1884. Die aetiologie der tuberkulose. Mitt Kaiser Gesundh 2: 1–88.Google Scholar
  19. Machamer, P.K., Darden, L., and C.F. Craver. 2000. Thinking about mechanisms. Philosophy of Science 67 (1): 1–25.CrossRefGoogle Scholar
  20. Melzack R. 1999. From the gate to the neuromatrix. Pain S6:S121–6.CrossRefGoogle Scholar
  21. Melzack, R., and P.D. Wall. 1965. Pain mechanisms: A new theory. Science 150 (3699): 971–979.CrossRefGoogle Scholar
  22. Molnar, G. 2003. Powers: A study in metaphysics. Oxford: Oxford University Press.Google Scholar
  23. Mumford, S. 1998. Dispositions. Oxford: Clarendon Press.Google Scholar
  24. Mumford, S., and R.L. Anjum. 2011. Getting causes from powers. Oxford: Oxford University Press.CrossRefGoogle Scholar
  25. Nicholson, D.J. 2013. Organisms ≠ machines. Studies in History and Philosophy of Biological and Biomedical Sciences 44 (4B): 669–678.CrossRefGoogle Scholar
  26. Salmon, W.C. 1997. Causality and explanation: A reply to two critiques. Philosophy of Science 1: 461–477.CrossRefGoogle Scholar
  27. Schulkin, J., ed. 2004. Allostasis, homeostasis, and the costs of physiological adaptation. Cambridge: University of Cambridge Press.Google Scholar
  28. von Bertalanffy, L. 1968. General system theory: Foundations, development, applications. New York: George Braziller.Google Scholar
  29. Williams, G., and R.M. Nesse. 1996. Why we get sick: The new science of Darwinian Medicine. New York: Vintage Books.Google Scholar
  30. Woodman, G.F. 2010. A brief introduction to the use of event-related potentials in studies of perception and attention. Atten Percept Psychophys 72 (8): 2031–2046.CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media Dordrecht 2017

Authors and Affiliations

  1. 1.Research CentreBritish School of OsteopathyLondonUK
  2. 2.Sydney School of Public HealthUniversity of SydneySydneyAustralia
  3. 3.Division of Physiotherapy Education and Department of PhilosophyUniversity of NottinghamNottinghamUK

Personalised recommendations