OPTIMIZING HYBRIDISM: A CRITIQUE OF NATURALIST, NORMATIVIST AND PHENOMENOLOGICAL ACCOUNTS OF DISEASE IN THE PHILOSOPHY OF MEDICINE

Abstract

This dissertation represents an investigative critique of the philosophical approaches to defining health and disease, going beyond pure conceptual analysis and straight into historical-philosophical analysis in an attempt to unpack the very discourse which underpins the discussion. Drawing on the notion of language as a medium of social instruction, it problematizes various specific features of the debate’s intellectual format, for example pointing out that its preoccupation with linguistic precision ought to be replaced with a focus on expressing the complex multidimensional nature of disease in a relatable manner. After presenting evidence of clinical reasoning’s inherent susceptibility to bias, the thesis exposes naturalism’s historical roots as an ideologically driven counter-reaction to nineteenth century vitalism, thereby discrediting the ideal of neutrality. Despite this skeptical start, it rejects eliminativist positions that philosophical attempts to produce health/disease definitions are pointless and unnecessary, and argues that the debate needs to be maintained due to such discussions’ important implications for medical and social identities, patient narratives, the negotiation of treatment objectives, or even the effectiveness of public health programmes (as a population’s inclination to comply with state-mandated public health measures is directly influenced by the notions it holds about health and disease). This is followed by an exploration of the conceptual limitations faced by the most commonly applied strategies of defining disease, after which their advantages are re-combined in an optimized hybrid account of disease supported by a philosophical distinction between the categories of ‘symptoms’ and ‘clinical signs’. Finally, this account is tested on a wide range of problematic cases, to ensure its capacity to deliver the promised results whilst also overcoming challenging influences such as the ones posed by bias, discursively shaped diagnostic labels, or unwarranted pathologization.