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A Rebuttal on Health

  • Chapter
What Is Disease?

Part of the book series: Biomedical Ethics Reviews ((BER))

Abstract

Twenty years ago, in four papers,1 I offered a unified descriptive analysis of health, disease, and function. In recent philosophy of medicine, these papers are often treated as a standard defense of one pole on the spectrum of views about health: the extreme view that, at least at the theoretical foundation ofmodern Western medicine, health and disease are value-free scientific concepts. Theoretical health, I argued, is the absence of disease; disease is only statistically species-subnormal biological part-function; therefore, the classification of human states as healthy or diseased is an objective matter, to be read off the biological facts of nature without need of value judgments. Let us refer to this general position as “naturalism”—the opposite of normativism, the view that health judgments are or include value judgments. Following Nordenfelt (1987), let me call my specific naturalist theory the “biostatistical theory (BST),” a name emphasizing that the analysis rests on the concepts of biological function and statistical normality.2

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References

  • Agich, G. J. (1983) Disease and value: a rejection of the value-neutrality thesis. Theor. Med. 4, 27–41.

    Article  Google Scholar 

  • American Medical Association (1961) Standard Nomenclature of Diseases and Operations, 5th ed., Thompson, E. T. and Hayden, A. C., eds., McGraw-Hill, New York.

    Google Scholar 

  • American Psychiatric Association (1980, 1987, 1994) Diagnostic and Statistical Manual of Mental Disorders,3rd ed., Washington, DC: 1980 [DSM-III]; 3rd ed., rev. 1987 [DSM-III-R]; 4th ed., 1994 [DSM-IV].

    Google Scholar 

  • Bechtel, W. (1985) In defense of a naturalistic concept of health, in Biomedical Ethics Reviews: 1985, Humber, J. and Almeder, R., eds., Humana, Clifton, NJ, pp. 131–170.

    Google Scholar 

  • Bigelow, J. and Pargetter, R. (1987) Functions. J. Philosophy 84, 181–196.

    Article  Google Scholar 

  • Boorse, C. (1975) [DI] On the distinction between disease and illness. Philosophy and Public Affairs 5, 49–68.

    Google Scholar 

  • Boorse, C. (1976a) [MH] What a theory of mental health should be. J. Theory Social Behaviour 6, 61–84.

    Google Scholar 

  • Boorse, C. (1976b) [WF] Wright on functions. Philos. Rev. 85, 70–86.

    Google Scholar 

  • Boorse, C. (1977) [HTC] Health as a theoretical concept. Philos. Sci. 44, 542–573.

    Google Scholar 

  • Boorse, C. (1987a) [CH] Concepts of health, in Health Care Ethics: An Introduction, VanDeVeer, D. and Regan, T., eds., Temple University Press, Philadelphia, pp. 359–393.

    Google Scholar 

  • Boorse, C. (1987b) [PMS] Premenstrual syndrome and criminal responsibility, in Premenstrual Syndrome, Ginsburg, B. E. and Carter, B. F., eds., Plenum, New York, pp. 81–124.

    Book  Google Scholar 

  • Brenner, C. (1974) An Elementary Textbook of Psychoanalysis, rev. ed., Anchor Books, Garden City, New York.

    Google Scholar 

  • Brown, R. (1977) Physical health and mental illness. Philosophy and Public Affairs 7, 17–38.

    Google Scholar 

  • Brown, W. M. (1985) On defining `disease’. J. Med. Philos. 10, 311–328.

    Article  PubMed  CAS  Google Scholar 

  • Bullough, V. (1994a) Science in the Bedroom: A History of Sex Research, Basic Books, New York.

    Google Scholar 

  • Bullough, V. (1994b) The development of sexology in the USA in the early twentieth century, in Sexual Knowledge, Sexual Science, Porter, R. and Teich, M., eds., Cambridge, New York, pp. 303–322.

    Google Scholar 

  • Buss, D. M. (1994) The Evolution of Desire: Strategies of Human Mating, Basic Books, New York.

    Google Scholar 

  • Cassell, E. (1982) The nature of suffering and the goals of medicine. New Engl. J. Med. 306, 639–645.

    Article  Google Scholar 

  • Champlin, T. S. (1981) The reality of mental illness. Philosophy 56, 467–487.

    Article  Google Scholar 

  • Clouser, K. D., Culver, C. M., and Gert, B. (1981) Malady: a new treatment of disease. The Hastings Center Report 11, 29–37.

    Article  PubMed  CAS  Google Scholar 

  • Comfort, A. (1967) The Anxiety Makers, Nelson, London.

    Google Scholar 

  • Culver, C. M. and Gert, B. (1982) Philosophy in Medicine: Conceptual and Ethical Issues in Medicine and Psychiatry, Oxford, New York.

    Google Scholar 

  • Daniels, N. (1981) Health care needs and distributive justice. Philosophy and Public Affairs 10, 146–179.

    PubMed  Google Scholar 

  • Daniels, N. (1985) Just Health Care, Cambridge, New York.

    Book  Google Scholar 

  • Downie, R. and Telfer, E. (1980) Caring and Curing, Methuen, London.

    Google Scholar 

  • du Vivier, A. (1993) Atlas of Clinical Dermatology, 2nd ed., Gower Medical Publishing, London.

    Google Scholar 

  • Dubos, R. (1959) Mirage of Health, Harper, New York.

    Google Scholar 

  • Engel, G. (1961) Is grief a disease? Psychosomatic Medicine 23, 18–22.

    PubMed  CAS  Google Scholar 

  • Engelhardt, H. T., Jr. (1974) The disease of masturbation: values and the concept of disease. Bull. Hist. of Med. 48, 234–248.

    Google Scholar 

  • Engelhardt, H. T., Jr. (1975) The concepts of health and disease, in Evaluation and Explanation in the Biomedical Sciences, Engelhardt and S. F. Spicker, eds., Dordrecht, Reidel, 125–141.

    Chapter  Google Scholar 

  • Engelhardt, H. T., Jr. (1976a) Human well-being and medicine: some basic value judgments in the biomedical sciences, in Science, Ethics and Medicine, Engelhardt, H. T., Jr. and Callahan, D., eds., Hastings Center, Hastings-on-Hudson, New York, pp. 120–139.

    Google Scholar 

  • Engelhardt, H. T., Jr. (1976b) Ideology and etiology. J. Med. Philos. 1, 256–268.

    Article  Google Scholar 

  • Engelhardt, H. T., Jr. (1980) Doctoring the disease, treating the complaint, helping the patient: some of the works of Hygeia and Panacea, in Knowing and Valuing: The Search for Common Roots, Engelhardt, H. T. and Callahan, D., eds., Hastings Center, Hastings-on-Hudson, New York, pp. 225–249.

    Google Scholar 

  • Engelhardt, H. T., Jr. (1984) Clinical problems and the concept of disease, in Health, Disease, and Causal Explanations in Medicine, Nordenfelt, L. and Lindahl, B. I. B., eds., Reidel, Dordrecht, pp. 27–41.

    Chapter  Google Scholar 

  • Engelhardt, H. T., Jr. (1986) The Foundations of Bioethics, Oxford, New York.

    Google Scholar 

  • Erde, E. L. (1979) Philosophical considerations regarding defining “health,” “disease,” etc., and their bearing on medical practice. Ethics Sci. Med. 6, 31–48.

    PubMed  CAS  Google Scholar 

  • Farrell, B. A. (1979) Mental illness: a conceptual analysis. Psychological Med. 9, 21–35.

    Article  CAS  Google Scholar 

  • Feinstein, A. R. (1967) Clinical Judgment, Williams and Wilkins, Baltimore, MD.

    Google Scholar 

  • Fingarette, H. and Hasse, A. F. (1979) Mental Disabilities and Criminal Responsibility,University of California Press, Berkeley, CA.

    Google Scholar 

  • Fodor, J. A. (1964) On knowing what we would say. Philos. Rev. 73, 198–212.

    Article  Google Scholar 

  • Freud, S. (1917) Mourning and melancholia, in Standard Edition of the Complete Psychological Works of Sigmund Freud, vol. 15, 1957, Strachey, J., ed. and trans., Hogarth, London, pp. 243–258.

    Google Scholar 

  • Fulford, K. W. M. (1989) Moral Theory and Medical Practice, Cambridge, New York.

    Google Scholar 

  • Gert, B., Clouser, K. D., and Culver, C. M. (1986) Language and social goals. J. Med. Philos. 11, 257–264.

    Article  PubMed  CAS  Google Scholar 

  • Goodhart, C. B. (1960) The evolutionary significance of human hair patterns and skin coloring. Adv. Sci. 17, 53–59.

    Google Scholar 

  • Goosens, W. K. (1980) Values, health, and medicine. Philos. Sci. 47, 100–115.

    Article  PubMed  Google Scholar 

  • Guthrie, R. D. (1970) Evolution of human threat display organs, in Evolutionary Biology, vol. 4, Dobzhansky, Th., Hecht, M. K., and Steere, W. C., eds., Appleton-Century-Crofts, New York, pp. 257–302.

    Google Scholar 

  • Hamilton, J. B. and Mestler, G. E. (1969) Mortality and survival: comparison of eunuchs with intact men and women in mentally retarded populations. J. Gerontol. 24, 395–411.

    Article  PubMed  CAS  Google Scholar 

  • Hare, R. M. (1986) Health. J. Med. Ethics 12, 174–181.

    Article  PubMed  CAS  Google Scholar 

  • Hesslow, G. (1993) Do we need a concept of disease? Theor. Med. 14, 1–14.

    Article  PubMed  CAS  Google Scholar 

  • Holzman, P. S. (1970) Psychoanalysis and Psychopathology,McGraw-Hill, New York.

    Google Scholar 

  • Hull, D. L. (1965) The effect of essentialism on taxonomy: two thousand years of stasis. Br. J. Philos. Sci. 15, 314–326;

    Article  Google Scholar 

  • Hull, D. L. (1965) The effect of essentialism on taxonomy: two thousand years of stasis. Br. J. Philos. Sci. 16, 1–18.

    Article  Google Scholar 

  • Hull, D. L. (1974) The Philosophy of Biological Science, Prentice-Hall, Englewood Cliffs, NJ.

    Google Scholar 

  • International Statistical Classification of Diseases and Related Health Problems (1992) 10th rev. World Health Organization, Geneva.

    Google Scholar 

  • Isselbacher, K. J., Braunwald, E., Wilson, J. D., Martin, J. B., Fauci, A. S., and Kasper, D. L., eds. (1994) Harrison’s Principles of Internal Medicine, 13th ed., McGraw-Hill, New York.

    Google Scholar 

  • Kass, L. (1975) Regarding the end ofinedicine and the pursuit of health. The Public Interest 40, 11–42.

    Google Scholar 

  • Kendell, R. E. (1975) The concept of disease and its implications for psychiatry. Br. J. Psychiatry 127, 305–315.

    Article  PubMed  CAS  Google Scholar 

  • Kinsey, A. C., Pomeroy, W. B., and Martin, C. E. (1948) Sexual Behavior in the Human Male, Saunders, Philadelphia.

    Google Scholar 

  • Klein, D. F. (1978) A proposed definition of mental illness, in Critical Issues in Psychiatric Diagnosis, Spitzer, R. L. and Klein, D. F., eds., Raven, New York, pp. 41–71.

    Google Scholar 

  • Kleinman, A. (1988) The Illness Narratives: Suffering, Healing, and the Human Condition, Basic Books, New York.

    Google Scholar 

  • Ladd, J. (1982) The concepts of health and disease and their ethical implications, in Value Conflicts in Health Care Delivery, Gruzalski, B. and Nelson, C., eds., Ballinger, Cambridge, MA.

    Google Scholar 

  • Lavin, M. (1985) Doctors, psychiatrists and disease. Soc. Sci. Med. 20, 535–543.

    Article  PubMed  CAS  Google Scholar 

  • Lewis, A. (1955) Health as a social concept. Br. J. Soc. 4, 109–124.

    Article  Google Scholar 

  • Lewis, D. (1979) Scorekeeping in a language game../. Philos. Logic 8, 339–359.

    Google Scholar 

  • Lewontin, R. (1970) The units of selection. Annu. Rev. Ecol. Systematics 1, 1–16.

    Article  Google Scholar 

  • Margolis, J. (1976) The concept of disease. J. Med. Philos. 1, 238–255.

    Article  Google Scholar 

  • Martin, M. (1985) Malady and menopause. J. Med. Philos. 10, 329–337.

    Article  PubMed  CAS  Google Scholar 

  • Mayr, E. (1976) Typological versus population thinking, in Evolution and the Diversity of Life, Harvard University Press, Cambridge, MA, pp. 26–29.

    Google Scholar 

  • Mayr, E. (1988) Toward a New Philosophy of Biology. Harvard University Press, Cambridge, MA.

    Google Scholar 

  • McDiarmid, A., ed. (1969) Diseases in Free-Living Wild Animals, Academic, New York.

    Google Scholar 

  • Merskey, H. (1986) Variable meanings for the definition of disease. J. Med. Philos. 11, 215–232.

    Article  PubMed  CAS  Google Scholar 

  • Mischel, T. (1977) The concept ofinental health and disease: an analysis of the controversy between behavioral and psychodynamic approaches. J. Med. Philos. 2, 197–219.

    Article  Google Scholar 

  • Munson, R. (1981) Why medicine cannot be a science. J. Med. Philos. 6, 183–208.

    Article  PubMed  CAS  Google Scholar 

  • Murphy, E. A. (1976) The Logic of Medicine, Johns Hopkins, Baltimore, MD.

    Google Scholar 

  • Nesse, R. M. and Williams, G. C. (1995) Why We Get Sick: The New Science of Darwinian Medicine, Random House, New York.

    Google Scholar 

  • Newman, R. W. (1970) Why man is such a sweaty and thirsty naked animal: a speculative review. Hum. Biol. 42, 12–27.

    PubMed  CAS  Google Scholar 

  • Nordenfelt, L. (1987) On the Nature of Health: An Action-Theoretic Approach, Reidel, Dordrecht, The Netherlands.

    Google Scholar 

  • Nordenfelt, L. (1993) On the relevance and importance of the notion of disease. Theor. Med. 14, 15–26.

    Article  PubMed  CAS  Google Scholar 

  • Pawelzik, M. (1990) Disease as functional disorder: a critique of C. Boorse’s “objective” theory of disease [in German]. Analyse Kritik 12, 5–33.

    Google Scholar 

  • Pickering, N. (1991) Review of Fulford, K. W. M., Moral Theory and Medical Practice. Philos. Invest. 14, 179–183.

    Google Scholar 

  • Reznek, L. (1987) The Nature of Disease, Routledge and Kegan Paul, London.

    Google Scholar 

  • Richman, R. J. (1975) Review of Antony Flew, Crime or Disease? Philos. Rev. 84, 425–429.

    Article  Google Scholar 

  • Rose, M. R. (1991) Evolutionary Biology of Aging. Oxford, UK.

    Google Scholar 

  • Rosenberg, A. (1985) The Structure of Biological Science, Cambridge, New York.

    Book  Google Scholar 

  • Ross, A. (1979) Sygdomsbegrebet. Bibliotek for Laeger 171, 111–129.

    Google Scholar 

  • Ross, A. (1980) Det psykopathologiska sygdomsbegreb. Bibliotek for Laeger.

    Google Scholar 

  • Ruse, M. (1981) Are homosexuals sick? in Concepts of Health and Disease: Interdisciplinary Perspectives, Engelhardt, Caplan, and McCartney, eds., pp. 623–724.

    Google Scholar 

  • Scadding, J. B. (1988) Health and disease: what can medicine do for philosophy? J. Med. Ethics 14, 118–124.

    Article  PubMed  CAS  Google Scholar 

  • Schaffner, K. F. (1993) Discovery and Explanation in Biology and Medicine. University of Chicago Press, Chicago.

    Google Scholar 

  • Sedgwick, P. (1973) Illness—mental and otherwise. Hastings Center Studies 1, 19–40.

    Article  PubMed  CAS  Google Scholar 

  • Sober, E. (1980) Evolution, population thinking, and essentialism. Philos. Sci. 47, 350–383.

    Article  Google Scholar 

  • Sober, E. (1980) Reprinted in Sober, From a Biological Point of View, Cambridge, New York, 1994.

    Google Scholar 

  • Sober, E. (1984) The Nature of Selection, Massachussetts Institute of Technology Press, Cambridge, MA.

    Google Scholar 

  • Sodeman, W. A. and Sodeman, W. A., Jr. (1974) Pathologic Physiology: Mechanisms of Disease, 5th ed., Saunders, Philadelphia.

    Google Scholar 

  • Sommerhoff, G. (1950) Analytical Biology, Oxford University Press, London.

    Google Scholar 

  • Sommerhoff, G. (1959) The abstract characteristics of living organisms, in Systems Thinking, Emery, F. E., ed., Penguin, Harmondsworth, UK, pp. 147–202.

    Google Scholar 

  • Spitzer, R. L. and Endicott, J. (1978) Medical and mental disorder: proposed definition and criteria, in Critical Issues in Psychiatric Diagnosis, Spitzer, R. L. and Klein, D. F., eds., Raven, New York, pp. 15–40.

    Google Scholar 

  • Stedman ‘s Medical Dictionary,(1995) 26th ed., Williams and Wilkins, Philadelphia.

    Google Scholar 

  • Stroebe, M. S., Stroebe, W., and Hansson, R. (1993) Handbook of Bereavement: Theory, Research, and Intervention, Cambridge, New York.

    Book  Google Scholar 

  • Stroebe, W. and Stroebe, M. S. (1987) Bereavement and Health: The Psychological and Physical Consequences of Partner Loss, Cambridge, UK.

    Book  Google Scholar 

  • Symons, D. (1979) The Evolution of Human Sexuality, Oxford, UK.

    Google Scholar 

  • Szasz, T. S. (1974) The Myth of Mental Illness, rev. ed., Harper and Row, New York.

    Google Scholar 

  • Toulmin, S. (1975) Concepts of function and mechanism in medicine and medical science, in Evaluation and Explanation in the Biomedical Sciences, Engelhardt, H. T., Jr., and Spicker, S. F., eds., Reidel, Dordrecht, The Netherlands.

    Google Scholar 

  • van der Steen, W. J. and Thung, P. J. (1988) Faces of Medicine: A Philosophical Study, Kluwer, Dordrecht, The Netherlands.

    Google Scholar 

  • Wakefield, J. C. (1992a) The concept of mental disorder: on the boundary between biological facts and social values. Am. Psychol. 47, 373–388.

    Article  PubMed  CAS  Google Scholar 

  • Wakefield, J. C. (1992b) Disorder as harmful dysfunction: a conceptual critique of DSM-III-R’s definition of mental disorder. Psychol. Rev. 99, 232–247.

    Article  PubMed  CAS  Google Scholar 

  • Wakefield, J. C. (1993) Limits of operationalization: a critique of Spitzer and Endicott’s (1978) proposed operational criteria for mental disorder. J. Abnorm. Psychol. 102, 160–172.

    Article  PubMed  CAS  Google Scholar 

  • Walton, J., Barondess, J. A., and Lock, S., eds. (1994) The Oxford Medical Companion, Oxford, UK.

    Google Scholar 

  • Weatherall, D. J., Ledingham, J G G, and Warrell, D. A., eds. (1996) Oxford Textbook of Medicine, 3rd ed., Oxford, UK.

    Google Scholar 

  • Whitbeck, C. (1978) Four basic concepts of medical science, in PSA 1978, Asquith, P. D. and Hacking, I., eds., Philosophy of Science Association, East Lansing, MI.

    Google Scholar 

  • Williams, G. C. (1966) Adaptation and Natural Selection, Princeton University Press, Princeton, NJ.

    Google Scholar 

  • Williams, G. C. (1992) Natural Selection, Oxford, UK.

    Google Scholar 

  • Williams, M. B. (1978) Sexual selection, adaptation, and ornamental traits: the advantage of seeming fitter. J. Theor. Biol. 72, 377–383. Wright, L. (1973) Functions. Philos. Rev. 82, 139–168.

    Google Scholar 

  • Wulff, H. R., Pedersen, S. A., and Rosenberg, R. (1986) Philosophy of Medicine: An Introduction, Blackwell Scientific Publications, Oxford, UK.

    Google Scholar 

  • Wyngaarden, J. B. and Smith, L. H., eds. (1985) Cecil Textbook of Medicine, 17th ed., Saunders, Philadelphia.

    Google Scholar 

  • Wyngaarden, J. B. and Bennett, J. C., eds. (1992) Cecil Textbook of Medicine, 19th ed., Saunders, Philadelphia.

    Google Scholar 

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Boorse, C. (1997). A Rebuttal on Health. In: Humber, J.M., Almeder, R.F. (eds) What Is Disease?. Biomedical Ethics Reviews. Humana Press, Totowa, NJ. https://doi.org/10.1007/978-1-59259-451-1_1

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