Naturalism about Health and Disease: Adding Nuance for Progress

Abstract

The literature on health and diseases is usually presented as an opposition between naturalism and normativism. This article argues that such a picture is too simplistic: there is not one opposition between naturalism and normativism, but many. I distinguish four different domains where naturalist and normativist claims can be contrasted: (1) ordinary usage, (2) conceptually clean versions of "health" and "disease," (3) the operationalization of dysfunction, and (4) the justification for that operationalization. In the process I present new arguments in response to Schwartz (2007) and Hausman (2012) and expose a link between the arguments made by Schwartz (2007) and Kingma (2010). Distinguishing naturalist claims at these four domains will allow us to make progress by (1) providing more nuanced, intermediate positions about a possible role for values in health and disease; and (2) assisting in the addressing of relativistic worries about the value-ladenness of health and disease.

Medicalisation and Overdiagnosis: What Society Does to Medicine

“…14,15 The discussion whether disease can be defined entire value-free or is unavoidably value-laden remains unsettled, although all agree that values do have a role in the perception of disease. 16 Societal actors such as governmental agencies can press their values on the health system by policy-making or prioritising certain diseases or treatments. …”

Should phenomenological approaches to illness be wary of naturalism?

“…Doing so, they may commit to a non-stereotypical and modest form of naturalism, avoiding the risk of criticise a strawman or an arbitrary definition of biomedicine. 14 Indeed, there is room to engage in dialogue with naturalism, notably for instance, by taking a pluralistic stance (I am thinking here of pluralistic approaches in the philosophy of science, such as Longino, 1990;Solomon, 2015 Kingma, 2014;Chin-Yee & Upshur, 2017), some have defended hybrid theories (Traykova, 2017), and finally some have argued in favour of redefining altogether what should count as a naturalist approach to health and disease (Lemoine, 2015). If this path proves unsatisfactory, there is also room to draw inspiration from the phenomenological traditions that engage with naturalism.…”

“…Furthermore, at a time when the debate between naturalism and normativism in the philosophy of medicine seems to be moving beyond its former cartoonish stage (see for instance Kingma, 2014), it seems important not to let this kind of wary attitude hover over the conversation without providing articulated reasons. In brief, shoulddoes PhenoMed really ought to be wary of naturalism?…”

The overdiagnosis of what? On the relationship between the concepts of overdiagnosis, disease, and diagnosis

“…It has become commonplace to distinguish between naturalistic, normativistic, and hybrid/mixed/intermediate conceptions of disease (Ereshefsky 2009;Kingma 2014;Kovacs 1998). The first sees disease as given by nature, the second as given by culture, and the last as a combination.…”

“…By now it is widely acknowledged that disease is a value-laden concept (Agich 1983;Bolton 2008;DeVito 2000;Khushf 2007;Kingma 2014;Parsons 1958;Sade 1995;Stempsey 1999;Wakefield 2014). There is significant disagreement with respect to what values are involved, e.g., whether they are biological, social, or cultural.…”