Health and Diseases Discoveries or Cultural Inventions

If certain physiological and psychological functions can be identified as natural or essential to humans, then their absence can be used to define disease states. Leon Kass and Christopher Boorse have argued that one can specify those functions that are integral to being human, and thus secure accounts of disease that are not relative to a particular culture or set of values. Such understandings of health and disease could then be used to sort out essential from nonessential (if not proper from improper) applications of medicine. However, such naturalistic views may depend on particular understandings of what is natural. Others appeal to an evolutionary account of what should count as species-typical levels of species-typical functions appropriate for age and gender (Boorse 1976).

In contrast, Joseph Margolis, H. Tristram Engelhardt, and others have argued that definitions of disease and health depend on sociological, culturally determined value judgments, and that these definitions can be understood only in terms of particular cultures and their ideologies (Margolis). A value-free account of disease cannot be given, some have argued, because diseases are defined not by their causes, but by their effects (Resnek)—and their effects gain significance within a cultural context. K.W.M. Fulford has also indicated deeply hidden but still crucial evaluative elements in medicine. He has done this through a linguistic-analytic examination of how disease language appears to be value-free, while still entailing values, with the result that controversies in medical health are engendered where relevant values are sufficiently diverse. Fulford also argues that part-function analysis, which focuses on the proper function of each part of the body, fails with psychotic mental disorders where the rationality of the person as a whole is disturbed. Others have explored the nature of disease through the use of action theory and by placing concerns about disease and illness within the larger holistic context of health (Nordenfeldt, 1995, 2001). Still others ground disease language in a notion of malady dependent on the universal features of human rationality, thus eliminating culture as a factor (Clouser).

The view that the concepts of health and disease are culturally determined has been supported by feminist writings on healthcare. Many authors have pointed out that the practice of medicine has had an androcentric (masculine) focus, that women's issues have largely been ignored, and that experiences reported by women that could not be documented have been treated as invalid (Rosser; Oakley).

Partisans of the view that social and cultural ideas influence concepts of health and disease stress that a definition of disease tied to evolution makes disease concepts dependent on particular past environments and past adaptations. Successful adaptation must always be specified in terms of a particular environment, including a particular cultural context. A culture-dependent account of concepts of health and disease need not deny that there will be great similarities as to what will count as diseases across cultures, for certain symptoms and conditions will probably be understood as diseases in most cultures. Supporters of a value-infected, culture-dependent account of disease have argued that those who would attempt a purely evolutionary account of disease have not reconstructed the practice of medicine, but rather some practice of characterizing individuals as members of particular biological species (Engelhardt, 1975). The practice of medicine, in this view, depends on culturally constructed understandings of health and disease.

How one understands health and disease will in turn influence how one conceptualizes medical practice. Henrik Wulff has argued that an exclusively biological or empirical model of illness contributes to paternalistic medical practice, for if concepts of health and disease can be fully understood in biological terms, then there may be no need to assign the patient an active role in the decision-making process. If, however, determinations of health and disease are not just empirical concepts, but are also related to cultures and values, the patient will have a more active role in determining the burden of the disease and the extent of treatment.

The conceptualization of medicine will certainly be influenced by developments in genetic research, which hold the promise not only to correct diseases in patients, but to prevent them in future generations of patients (Anderson; Zimmerman). Thus, as the capacities of genetic medicine increase, preventive medicine will expand. Somatic and germ-line therapies will also be affected as choices are made about which genetic variances should be treated as disease abnormalities (e.g., homosexuality, alcoholism, shortness of stature).

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