Butler Beaudoin

Summary

Disease is a complicated subject and can be discussed from the standpoint of how the medical community defines it as well as how it affects one’s everyday life. There are several distinct viewpoints which attempt to define disease.  Naturalism focuses solely on malfunctioning physiological systems, normativism focuses on generally disvalued states, and hybridism is a combination of both viewpoints. In contrast, eliminativism states there is no need for a clear-cut definition of disease.  Much like the topic of health, most disagreement regarding disease involves treating it as a decidedly concrete and objective concept versus treating it as a somewhat fluid and subjective concept.  As acknowledged in our class discussion, disease and health are deeply interconnected, so it is difficult to discuss disease without first considering health. Health, unlike disease, is examined through the lens of only two primary viewpoints: naturalism and normativism.  Naturalism claims health is simply the absence of disease while normativism regards it as a state of well–being.  Much like their counterparts which attempt to define disease, naturalism is rather objective, while normativism takes a more subjective approach with a particular focus on mental health.

Furthermore, disease can also be examined from a phenomenological standpoint by observing and assessing how it pervades numerous aspects of one’s life. I believe this practice can be highly beneficial for healthcare professionals today.  Utilizing Engel’s biopsychosocial (BPS) model of health and illness, we now understand biological, psychological, and social factors can all contribute to the presence or growth of a disease.  To further complicate matters, various interrelationships exist between the factors which can play a crucial role in promoting overall health.  I believe one practical application of this BPS model is to evaluate mental health and psychological disorders. For example, sustained stress brought on by social factors can influence biological and psychological factors (S–>B and S–>P), and, as mentioned in the discussion of neuroplasticity, psychological factors like learning new motor skills can influence biological factors such as neural pathways.  Both the negative relationship and the positive relationship can pertain to one’s mental health and are significant to the phenomenological discussion.  I feel that mental health is largely more susceptible to social and psychological factors, and, consequently, I believe mental health disorders can more easily be attributed to disvalued states, as normativism suggests.

These are the discussion questions for my presentation.  Although I was unable to address each one directly, I attempted to apply them to the discussion and was able to initiate interesting dialogue as a result.

• I thought it was interesting how Stegenga addressed four viewpoints concerning disease but only two on health. Why do you think that is?

 

• Do you believe we should have hybridism and eliminativism in reference to health?

What would that look like?

 

• Do we need a general concept of disease (Hesslow’s car mechanic analogy) or should we focus more on the phenomenological standpoint? (Using the car analogy, that would be like the mechanic asking how her driving experience is being affected by the car malfunctioning instead of arguing about whether the car is defective or not)?

 

• In my presentation, I really highlighted how I felt there should be a separation between physical and mental health when considering the topic of disease. Do you feel there should be a separation or are they one in the same?

 

• Do you feel that mental disorders should be viewed from the standpoint of normativism?

 

• All six potential pathways in the BPS model can potentially contribute to subjective well-being and to objective physical health outcomes. Which of these do you feel is most important in the medical field today?  (For example, I believe B–>S is very important right now.)

Class Discussion and Response

The discussion was largely dominated by the subject of mental illness.  Initially, it was somewhat challenging to reach a mutual agreement concerning the definition of disease in the context of mental health.  However, by utilizing hypothetical examples and actual cases in our discussion, we were able to approach the topic from a phenomenological perspective.  To clearly illustrate how some people who suffer from poor mental health claim to be healthy, one classmate referred to Hesslow’s car analogy discussed in Care and Cure, arguing that it was like driving with flat tires, either unknowingly or apathetically.  At another point, a classmate returned to another hypothetical situation from Care and Cure which discusses a monk who meditates inside a cave on a mountain and refrains from eating and sleeping.  It would appear this monk is unhealthy from the standpoint of modern medical practices, but he is content and highly functioning.  The case of the hypothetical monk presents us with an important question: how can we distinguish between healthy and sick people?  Several classmates felt that a person is sick when they have a condition which is harmful to them, in the sense that an unknown condition which is not impacting a person does not constitute a disease.  The argument was also made that unless a disease is communicable, implying it possesses potential to bring harm to others, many illnesses of both physical and mental varieties strictly affect the person with the condition.  In my opinion, a person is healthy when there is an absence of all mental and physical conditions.  If the lack of shelter, food, and sleep is causing the monk harm, I would say he isn’t healthy; however, he is also not diseased.  The class eventually arrived at the conclusion that we tend to treat physical ailments differently than mental disorders.  A person suffering from depression, for instance, may receive a prescription from a physician, but they will also likely be referred to a therapist for additional treatment.  While this isn’t a necessarily inappropriate step, the concern is whether doctors in the medical field today have completely isolated issues which pertain to mental health from physical disease.  In conclusion, I believe medical doctors should more frequently employ therapeutic practices.  This is not to say either physicians or psychologists are ineffective in their respective fields, but merely to suggest that the strategies of therapists and psychologists may be beneficial if implemented more widely in the modern medical field.

Works Cited

Stegenga, Jacob. “Disease” Care and Cure – The University of Chicago Press, 2018

Karunamunia, Nandini, Imayamab, Ikuyo Goonetilleke, Dharshini. “Pathways to well-being: Untangling the causal relationships among biopsychosocial variables” Social Science and Medicine, https://doi.org/10.1016/j.socscimed.2020.112846