Hostname: page-component-669899f699-ggqkh Total loading time: 0 Render date: 2025-05-02T00:33:57.770Z Has data issue: false hasContentIssue false
  • English
  • Français

Health as a Theoretical Concept

Published online by Cambridge University Press:  01 April 2022

Christopher Boorse
Christopher Boorse*
Affiliation:
University of Delaware
Get access Rights & Permissions [Opens in a new window]

Abstract

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 value-laden, 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.

Type
Special Section on Value Issues in Science, Technology, and Medicine
Information
Philosophy of Science , Volume 44 , Issue 4 , December 1977 , pp. 542 - 573
Copyright
Copyright © Philosophy of Science Association 1977

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

Article purchase

Temporarily unavailable

Footnotes

†

Among many people who helped improve this paper, special thanks go to Caroline Whitbeck, Drs. John and Sidney Cobb, Jerry Cohen, and the referees for Philosophy of Science. Partial support was provided by the Delaware Institute for Medical Education and Research and the National Institute of Mental Health (#R03 MH24621).

References

[1] Bernard, C. Introduction to the Study of Experimental Medicine. Translated by Green, H. C. New York: Dover, 1957.Google Scholar
[2] Boorse, C. “On the Distinction Between Disease and Illness.” Philosophy and Public Affairs (Fall 1975) 5:49–68.Google Scholar
[3] Boorse, C. “Wright on Functions.” Philosophical Review 85 (1976): 70–86.10.2307/2184255CrossRefGoogle Scholar
[4] Boorse, C. “What a Theory of Mental Health Should Be.” Journal for the Theory of Social Behaviour 6 (1976): 61–84.10.1111/j.1468-5914.1976.tb00359.xCrossRefGoogle Scholar
[5] Braithwaite, R. B. Scientific Explanation. New York: Harper, 1960.Google Scholar
[6] Cannon, W. B. The Wisdom of the Body. New York: Norton, 1939.10.1097/00000441-193907000-00031CrossRefGoogle Scholar
[7] Dobzhansky, T. Mankind Evolving. New Haven: Yale, 1962.Google Scholar
[8] Dubos, R. Mirage of Health. New York: Harper, 1959.Google Scholar
[9] Engel, G. “Homeostasis, Behavioral Adjustment and the Concept of Health and Disease.” In Mid-Century Psychiatry. Edited by Grinker, R. R. Springfield: Charles C. Thomas, 1953.Google Scholar
[10] Engelhardt, H. T. Jr. “The Concepts of Health and Disease.” In Evaluation and Explanation in the Biomedical Sciences. Edited by Engelhardt, and Spicker, . Dordrecht: Reidel, 1975.10.1007/978-94-010-1769-5CrossRefGoogle Scholar
[11] Engelhardt, H. T. Jr. “Ideology and Etiology.” Journal of Medicine and Philosophy 1 (1976): 256–68.10.1093/jmp/1.3.256CrossRefGoogle Scholar
[12] Engelhardt, H. T. Jr. “Is There a Philosophy of Medicine?” In PSA 1976 2. Edited by Suppe and Asquith. East Lansing: Philosophy of Science Association, 1977. Quotation from pre-publication manuscript.Google Scholar
[13] Flew, A. Crime or Disease? New York: Barnes and Noble, 1973.10.1007/978-1-349-00949-7CrossRefGoogle Scholar
[14] Grim, P. “Further Notes on Functions.” Analysis 37 (1977): 169–76.10.1093/analys/37.4.169CrossRefGoogle Scholar
[15] Hacker, F. J. “The Concept of Normality and its Practical Significance.” American Journal of Orthopsychiatry 15 (1945): 47–64.10.1111/j.1939-0025.1945.tb04916.xCrossRefGoogle Scholar
[16] Hartmann, H. Ego Psychology and the Problem of Adaptation. Translated by Rapaport, D. New York: International Universities Press, 1958.10.1037/13180-000CrossRefGoogle Scholar
[17] Hudson, R. P. “The Concept of Disease.” Annals of Internal Medicine 65 (1966): 595–601.10.7326/0003-4819-65-3-595CrossRefGoogle ScholarPubMed
[18] Jahoda, M. Current Concepts of Positive Mental Health. New York: Basic Books, 1958.10.1037/11258-000CrossRefGoogle Scholar
[19] King, C. D. “The Meaning of Normal.” Yale Journal of Biology and Medicine 17 (1945): 493–501.Google ScholarPubMed
[20] King, L. S. “What is Disease?” Philosophy of Science 12 (1954): 193–203.10.1086/287343CrossRefGoogle Scholar
[21] Macklin, R. “Mental Health and Mental Illness: Some Problems of Definition and Concept Formation.” Philosophy of Science 39 (1972): 341–65.10.1086/288455CrossRefGoogle Scholar
[22] Macklin, R. “The Medical Model in Psychotherapy and Psychoanalysis,” Comprehensive Psychiatry 14 (1973): 49–69.10.1016/0010-440X(73)90055-2CrossRefGoogle ScholarPubMed
[23] Margolis, J. Psychotherapy and Morality. New York: Random House, 1966.Google Scholar
[24] Margolis, J. “Illness and Medical Values.” The Philosophy Forum 8 (1969): 55–76.10.1080/02604027.1969.9971684CrossRefGoogle Scholar
[25] Margolis, J. “The Concept of Disease.” Journal of Medicine and Philosophy 1 (1976): 238–55.10.1093/jmp/1.3.238CrossRefGoogle Scholar
[26] Marston, King, and Marston, , Integrative Psychology. New York: Harcourt, Brace, and World, 1931.Google Scholar
[27] McCombs, R. P., Fundamentals of Internal Medicine, 4th ed. Chicago: Year Book Medical Publishers, 1971.Google Scholar
[28] Moravcsik, J. “Ancient and Modern Conceptions of Health and Medicine.” Journal of Medicine and Philosophy 1 (1976): 337–48.10.1093/jmp/1.4.337CrossRefGoogle ScholarPubMed
[29] Nagel, E. The Structure of Science. New York: Harcourt, Brace and World, 1961.10.1119/1.1937571CrossRefGoogle Scholar
[30] Offer, D. and Sabshin, M. Normality. New York: Basic Books, 1966.Google Scholar
[31] Ryle, J. A. “The Meaning of Normal.” Lancet 252 (1947): 1–5.10.1016/S0140-6736(47)91269-5CrossRefGoogle Scholar
[32] Smith, A. The Body. New York: Walker, 1968.Google Scholar
[33] Sommerhoff, G. Analytical Biology. London: Oxford, 1950.Google Scholar
[34] Sorabji, R. “Function.” Philosophical Quarterly 14 (1964): 289–302.10.2307/2217769CrossRefGoogle Scholar
[35] Szasz, T. S. “THe Myth of Mental Illness.” American Psychologist 15 (1960): 113–118.10.1037/h0046535CrossRefGoogle Scholar
[36] Temkin, O. “Health and Disease.” In Dictionary of the History of Ideas, 2, 395–407. New York: Scribner's, 1973.Google Scholar
[37] Thompson, E. T., and Hayden, Adaline C., editors. Standard Nomenclature of Diseases and Operations. Published for the AMA by McGraw-Hill, New York. Last edition 1961.Google Scholar
[38] Timiras, P. S. Developmental Physiology and Aging. New York: Macmillan, 1972.Google Scholar
[39] Wimsatt, W. C. “Teleology and the Logical Structure of Function Statements.” Studies in History and Philosophy of Science 3 (1972): 1–80.Google Scholar
[40] World Health Organization. Manual of the International Statistical Classification of Diseases, Injuries, and Causes of Death. Eighth revision. Geneva: WHO, 1967.Google Scholar