International Society for History, Philosophy, and Social Studies of Biology

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THURSDAY, JULY 9  /  15:30 - 17:00  /  DS-R515
Organized session / standard talks
Health, disease, and well-being

Sally Wasmuth (Indiana University – Purdue University Indianapolis, United States)

A model of health that takes into account both the biological functioning of an organism and psychosocial experiences of wellness matters to medicine. Thus a goal of this session is to detail a “theory” of health, sensitive both to human experience and biological function; a theory rooted in biological detail that doesn’t simplistically focus on absence of local dysfunctions. In this session, James Krueger will call into question Lennart Nordenfelt’s claim that an understanding of health must proceed from one of two dominant perspectives: the disease model, which locates pathology in biological and chemical abnormalities, and a holistic approach that draws on concepts from psychology, sociology, and anthropology to understand problems in human health/wellness. Phillip Honenberger will review the naturalist- normativist debate in the interpretation of health and disease concepts, arguing for a view that recognizes both the reality of norm-like structures in biological systems, and the plasticity of such structures, as well as the open-endedness of normative questions in general, within human lives and societies, thereby connecting issues of medical normativity to philosophical anthropology and biopolitics. Sally Wasmuth will discuss clinical findings from a study of 7 socially displaced individuals as they move from the disease of addiction toward efforts at striking a something like this ‘psycho-social balance’. Data illustrate how different kinds of detachment- compensatory participation show up as more or less contributory to experiences of wellbeing as defined by these individuals’ experiences.

Between illness and disease: Towards a more holistic holism?

James Krueger (University of Redlands, United States)

In On the Nature of Health, Lennart Nordenfelt suggests that there are two basic perspectives from which one can approach the understanding of health and disease. The analytic approach focuses on the parts of the organism and draws upon biological, chemical and statistical concepts in formulating an account. The holistic approach, by contrast, begins with the (human) organism as a whole, and draws upon concepts from such disciplines as sociology, psychology, and anthropology to construct an account. Nordenfelt goes on to argue that any account of health and disease is going to have to take one of these approaches, that there cannot be an adequate account that utilizes both perspectives simultaneously. One must be regarded as the more basic. It isn’t hard to understand why he claims this. It would seem that we either have to regard every underlying deviation as pathological (regardless of the effect that it might have on the whole organism) or we have to take holistic considerations as conceptually basic, constraining how we should regard underlying structural and functional features of the organism. At the same time, however, it seems odd to suggest that these are irreconcilable differences in perspective. Any adequate anthropology is going to have to take account of human beings as biological beings. The possible ways that human beings can live together (can live together healthily) is in no small part affected by how we function biologically. This suggests that concepts drawn from sociology, psychology and anthropology are not going to be wholly independent of biological concepts. This paper aims to evaluate Nordenfelt’s contention that an understanding of health must proceed from one of these two perspectives in part by asking if a biologically sensitive philosophical anthropology could ground an approach to health that integrates concepts drawn from each perspective.

Medical normativity between anthropology and politics

Phillip Honenberger (Consortium for History of Science, Technology, and Medicine, United States)

A longstanding debate in the philosophy of medicine concerns the question of how to understand the apparent normativity of medical concepts like health and disease. In particular, the question has been: Are health and disease natural kind concepts? Or are they rather social constructions that reflect culturally relative norms? Or, finally, are they some combination of the two? Through discussion of prior work by Marc Ereshefsky, Marjorie Grene, Hans-Georg Gadamer, Georges Canguilhem, and others, I argue for realism about certain norm-like structures, including in biological contexts, while expressing skepticism that such structures could foreclose debates about the content of normative medical concepts like health and disease, primarily because of the extraordinarily plastic operation of normativity in human social systems. From this perspective, medical normativity must either become self- limited and partial, or open to the higher-order normative question, ‘What should we (either as individuals or as societies) favor or do?’ This approach to medical normativity opens philosophy of medicine and medical ethics to evaluation from two previously underappreciated quarters: those lately taking shape under the headings of ‘philosophical anthropology’ and ‘biopolitics.’

A normative scale of compensatory action

Sally Wasmuth (Indiana University – Purdue University Indianapolis, United States)

Impoverished understandings of health and disease limit the goals and development of much-needed innovative treatments for addiction. For example, the predominant biomedical model locates the causes of craving, compulsive drug use, and diminished satisfaction with other typically rewarding engagements in dopaminergic reward center circuitry changes of the midbrain. These neurological changes, however, are not sufficient to produce the behavioral profile of addiction. Nor do treatments targeting these problems improve the lives of people trying to recover. Moving beyond biological targets, interventions targeting discrete psychosocial aspects of addictive behaviors also fail to result in lasting or noteworthy changes to overall function and experience of the human organism. In short, problem elimination whether at the level of biological disease or psycho-behavioral phenomena does not in itself yield health. A different approach is made possible by viewing addiction through the lens of a philosophical anthropological understanding of human action. From this perspective, the human organism shapes its life-world through engagement in social institutions (Gehlen). The way in which humans engage in institutions has the power to shape and reshape both how they experience their worlds and, as more recent research indicates, their biological structures (e.g. the restructuring of neural networks). However, the health value and/or potential harms inherent in different ways of engaging in the world are not straightforward or well-understood. In previous work a normative model of human compensatory action that balances compensatory structure and focus (Gehlen s relief ) with residual flexibility and autonomy was delineated, on which we could theoretically locate the gains and harms of addiction. In order to further detail how health and disease appear in this context, the current paper reports findings reflecting how individuals compensatory action changes as they move from the disease of addiction (and its self-reported harms) to self-reported experiences of wellness in recovery.