On the theory of individual health

Philosophy of Science, 1977

This paper argues that the medical conception of health as absence of disease is a value-free theoretical notion. Its main elements are biological function and statistical normality, in contrast to various other ideas prominent in the literature on health. Apart from universal environmental injuries, diseases are internal states that depress a functional ability below species-typical levels. Health as freedom from disease is then statistical normality of function, i.e., the ability to perform all typical physiological functions with at least typical efficiency. This conception of health is as value-free as statements of biological function. The view that health is essentially valueladen, held by most writers on the topic, seems to have one of two sources: an assumption that health judgments must be practical judgments about the treatment of patients, or a commitment to "positive" health beyond the absence of disease. I suggest that the assumption is mistaken, the commitment possibly misdescribed.

Journal of Evaluation in Clinical Practice, 2009

Every man has his particular way of being in good health. Emanuel Kant Emanuel Kant's description of health stands in stark contrast to accepted definitions of health. For example, the WHO defines 'health' as 'a state of complete physical, mental, and social wellbeing and not merely the absence of disease or infirmity' [1]. However, as people get on with day-today living, no one can achieve the goal of 'complete physical, mental and social wellbeing'. It is odd to define 'health' as a negative state that puts it beyond the reach of everyone [2]. This paper explores the idea of health being a personal state, health being the product of every man's particular way of making sense of his particular circumstances. Health defined as a negative state renders health an illusion, an illusion that fosters thinking about health in terms of disease [3]. Disease definitions are no more specific-'a physiological or psychological dysfunction', or 'a biological dysfunction [based on] well-known pathological or pathophysiological processes or a well-known etiology' [4]. Indeed such a loose definition perpetuates a feedback loop that allows disease to be continually 'generated' by lowering thresholds of normality [5, 6]. For Illich, however, health is a positive state that dynamically spans across the stages of life-'The ability to adapt to changing environments, to growing up and to ageing, to healing when damaged, to suffering and to the peaceful expectation of death' [7]. Illich's description points to health being an interconnected fluid state. Health cannot be thoroughly understood in terms of our best theories of physics, chemistry, molecular biology, anatomy and physiology, or sociology; health has multiple dimensions and dynamics. Just as the human body itself has organic structures and processes that organize lower-level ones, so the human person considered holistically lives and functions on various levels that supervene upon and organize other lower levels of bodily structures and functions interdependently [8, 9].

Anekaant: A Journal of Polysemic Thought, 2019

We generally take for granted the distinction between health and illness and we imagine the “sick” to be those individuals marked out by physiological impairment. I argue, however, that human health is an existential issue—it is a matter of how we embrace our freedom—and that therefore the illness and health of a person do not map neatly onto the distinction between those who have a physiological malady and those who do not. I use a range of case studies to illustrate more exactly what human health is, and how this relates to what we normally consider to be sickness.

In 1948 The World Health Organization (WHO) elaborated a Concept of Health as "a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity." 1. Since that affirmation, there are social factors inserted into such a concept. Until then, health was considered under the ancient phrase of the Roman poet Juvenal mens sana in corpore sano 2 , with some other affirmations as that one of Leriche in the 1930s, "health is life lived in the silence of the organs." 3. By the way, the word 'silence' was appropriated to the context of totalitarian governments in those days. However, we are not sure of the correlation between the affirmation and the repressive condition. After World War II, it was necessary to promote a politics of 'welfare' to people who suffered more under that conflict. So did the countries that had more losings under the War. In this line, WHO elaborated a concept of health as a kind of 'well-being,' introducing the social factor in health. Before that, health was just individual. With the social condition, we can perceive that collectivity crosses over individuals, and individuals cross over collectivity. That social vision benefits several individuals and communities beyond selfish thinking about health. Following the WHO definition, we can see that physical well-being corresponds to an 'objective' process. On the other hand, mental well-being is related to a 'subjective' process. It is essential to understand the use of these two words, 'objective' and 'subjective.' In the last decades of the twentieth century, 'objective' was more and more valorized, and the opposite happened to 'subjective'. The word objective is related to 'object' and subjective to 'subject'. So, society became very pragmatic, and a kind of 'objectification' of human being occurred together with dehumanization in medicine. So, we intend to use those words, objective and subjective related to interobjective and intersubjective to better understand the amplified concept of health.

The concepts, health and disease, have received considerable attention in philosophy of medicine. The first goal of this paper is to demonstrate that three prominent analyses of health and disease can be synthesized if one assumes that medicine is both theoretical and practical, and, therefore, value-laden. The second goal of this paper is to give an account of one route by which evaluative and factual claims come together in medical knowledge, during medical conversations between clinicians and patients. Accomplishing these two goals together yields an epistemology of medicine that moves past debates about health and disease. On this view the conceptual foundations of medicine rest on subjective and objective claims about health states and their evaluations. By making subjective and objective claims, patients and clinicians negotiate whether patients’ health states are sufficiently dysfunctional to warrant medical intervention, leading to the formation of complementary illness narratives, which are anchored to different degrees in personal experience and medical theory. On this view, health and disease are supplanted as the conceptual foundations of medicine. Rather, medicine is better understood in terms of two basic aims: The first aim of medicine is to fully understand patients in scientific and personal terms; the second aim is to intervene upon patients' states of illness in ways that are consistent with full understanding.

Ancient Science of Life, 1984

In an earlier article the authors had traced the defects in medical practice to the flaws in the medical knowledge. In the present paper they propose a plan for the rectification of these defects. As the current medical research is unsuited for this purpose there is a need to adopt an alternative method of research, consisting of three phases viz. a) Formulation of hypothesis b) Development of tools of assessment and c) Experimental verification of the hypothesis using the instruments of assessment. This method must be used to revise the concepts of human being, illness, etiology and treatment. The first topic that must be taken up for such consideration is the concept of human being. An outline of the various constituents of human being is given. Also the factors that account for individual difference s among human beings, are enumerated. Subsequent research aimed at revision of concepts of illness, etiology and treatment should be based upon such a totalistic and integrated concep...

Medicine Studies, 2010

Health and illness are key concepts of medicine but they also have essential significance for each and every one of our lives. For this reason, social value systems are inevitably integrated into medicine through the concept of health and illness. In turn, medical knowledge and medico-scientific notions are perpetually incorporated into societal perceptions of health and illness. Generally, such integration usually occurs via an extended concept of health and illness, which is to be discussed in the following. To a certain extent, medical and societal notions of health are mutually co-determined. The underlying dynamics deserve a closer look because if health and illness are societal and medical concepts alike this fundamentally impacts on the epistemological and the practical dimension of diagnosis and prognosis as discussed in this volume of Medicine Studies.

2014

The aim of this paper is to stress the role of psychosocial factors in definition of health and illness. This is a theoretical paper and its argument is that for universal care health has to be defined in a more holistic manner, incorporating psychosocial factors, community support and the cultural context. In traditional India, as in other traditions, this happened to be the case. During the last two centuries, however, the ideas of health and illness became unidimensional and statistical. This happened as implicitly or explicitly the definition of health accepted the biomedical model of health as axiomatic. This model focuses on disease and locates pathology or the symptoms of diseases in the biological processes. Thus a negative definition of health emerged. This definition of health, though producing a large number of quantitative and descriptive studies has marginalized the vulnerable groups by decontextualizing health. The paper suggests that there is now a need to develop a positive definition of health, congruent with the social and cultural context and the importance of human agency. Under the aegis of modernization, a number of factors contributed to emergence of medical perspective which got recognized as a true approach to health and illness, rejecting all other discourses. There are several reasons behind this. The major ones are: (a) constructs of scientific validity of the biomedical discourse against other 'prescientific' discourses; (b) concern for public health and desire to fight communicable diseases; (c) applied social science's increased dependence on indicators; (d) donor driven health policies, discarding cultural traditions and history of the developing countries (with which operations research is commonly associated); and (e) global priority-setting for research. This shift in conceptualization produced certain problems and now the postmodern turn is re-inventing the plural cultural conceptualizations of healthy life to mitigate the problems caused by various forms of vulnerabilities caused by the loss of agency.

I propose a clinic-epidemiological concept of health as the best description of what physicians actually think about health within medical practice. Its aim is to be an alternative to the best approach in the philosophy of medicine about health, Christopher Boorse's biostatistical theory. Contrary to Boorse's 'theoretical' approach, I propose to take health as a practical clinical concept. In the first two parts of the paper, I will present my complaints against Boorse's view that health is a theoretical concept, a 'species normal functional ability'. I will claim that Boorse's view is actually a view on normal physiology. My claim is that health is best described as the state of absence of chronic diseases or disabilities (clinic-epidemiologically associated with a morbimortality index higher than the risk of death, disease and disabilities for individuals of the same population group or reference class free of that chronic clinical conditions). Health, therefore, is not the mere absence of disease. Diseases that do not increase patients' morbimortality and disability indexes are not incompatible with health; after all, clinical health is compatible with appropriate health care and medical treatments. 2 On the clinical-epidemiological approach, see Fletcher and Fletcher's seminal introductory book [16]. bs_bs_banner