Jonathan Sholl

Several philosophers have recently argued that phenomenology is well-suited to help understand the concepts of health, disease, and illness. The general claim is that by better analysing how illness appears to or is experienced by ill individuals—incorporating the first-person perspective—some limitations of what is seen as the currently dominant third-person or ‘naturalistic’ approaches to understand health and disease can be overcome. In this article, after discussing some of the main insights and benefits of the phenomenological approach, I develop three general critiques of it. First, I show that what is often referred to as naturalism tends to be misunderstood and/or misrepresented, resulting in straw-man arguments. Second, the concept of normality is often problematically employed such that some aspects of naturalism are actually presupposed by many phenomenologists of medicine. Third, several of the key phenomenological insights and concepts, e.g. having vs. being a body, the alienation of illness, the epistemic role of the first-person perspective, and the idea of health within illness, each bring with them new problems that limit their utility. While acknowledging the possible contributions of phenomenology, these criticisms point to some severe limitations of bringing phenomenological insights to bear on the problems facing philosophy of medicine that should be addressed if phenomenology is to add anything substantially new to its debates

Medicalization appears to be an issue that is both ubiquitous and unquestionably problematic as it seems to signal at once a social and existential threat. This perception of medicalization, however, is nothing new. Since the first main writings in the 1960s and 1970s, it has consistently been used to describe inappropriate or abusive instances of medical authority. Yet, while this standard approach claims that medicalization is a growing problem, it assumes that there is simply one “medical model” and that the expanding realm of “the medical” can be more or less clearly delineated. Moreover, while intended to establish the reality of this growing threat, this research often requires making arbitrary or unjustified distinctions between different practices. To better clarify the concept of medicalization, I will focus more on capturing the variety of medical practices than on the sociological aspects of medical discourse. In doing so, I will explore the distinction between medicalization and pathologization, a distinction that is often overlooked and that brings with it many conceptual and practical implications. After defining these terms, I will use some examples to show that while pathologizing is closely tied to medicalizing, both can occur independently. I will then further develop this distinction in terms of the different individual and social effects of these practices.

This essay explores the relation between repetition and thought in Bergson and Deleuze. In Bergson, this relation is seen in the method of intuition by which thought is made to think in time and in the ‘rhythms’ at work in how intuition is a contact with time or life, urging conceptual precision. This framework is used to clarify Deleuze's thought without image as that contingent encounter with the persistent forces of life that demand the perseverance of thought. Far from stressing difference alone, both link the repetition in life to the unsettling persistence required to develop a truly new thought

While aging research and policy aim to promote ‘health’ at all ages, there remains no convincing explanation of what this ‘health’ is. In this paper, I investigate whether we can find, implicit within the sciences of aging, a way to know what health is and how to measure it, i.e. a theory of health. To answer this, I start from scientific descriptions of aging and its modulators and then try to develop some generalizations about ‘health’ implicit within this research. After discussing some of the core aspects of aging and the ways in which certain models describe spatial and temporal features specific to both aging and healthy phenotypes, I then extract, explicate, and evaluate one potential construct of health in these models. This suggests a theory of health based on the landscape of optimized phenotypic trajectories. I conclude by considering why it matters for more candidate theories to be proposed and evaluated by philosophers and scientists alike.

Various scientists and philosophers have heavily criticized what they see as problematic forms of ‘nutritional reductionism’ or ‘nutritionism’ whereby studying food–health interactions at the level of isolated food components produces largely misguided science and misleading interpretations. However, the exact target of these diverse criticisms remains elusive, and its implications are overstated, which may hinder scientific understanding. To better identify the types of flaws supposedly hindering reductionist research, we disentangle three types of reductionist claims to better determine what the debate is about and to propose ways to move it forward. We then present a qualified defence of the reductionist programme that hinges on the ability to identify nutritional causes that make a difference, which we illustrate through central examples in the history of nutrition. This defence is taken further by using insights from the philosophy of mechanisms to analyse how the field of nutritional ecology offers a synthetic framework to explain, generate, and test predictions about nutrient–organism interactions, which is premised on the biological mechanisms of nutrient-specific appetite regulation. The result, which we call ‘synthetic reductionism’, avoids many, though perhaps not all, of the challenges raised by anti-reductionists, and also highlights the potential of reductionism to identify nutritional difference makers.

While philosophers of science have marginally discussed concepts such as ‘nutrient’, ‘naturalness’, ‘food’, or the ‘molecularization’ of nutrition, they have yet to seriously engage with the nutrition sciences. In this paper, I offer one way to begin this engagement by investigating conceptual challenges facing the burgeoning field of nutritional ecology and the question of how organisms construct a ‘balanced’ diet. To provide clarity, I propose the distinction between nutrient balance as a property of foods or dietary patterns and nutrient balancing as an evolved capacity to regulate nutrient intake. This distinction raises conceptual and empirical issues, such as what properties constitute this capacity and whether they are the same in all organisms. Additionally, while scientists use the term ‘balancing’, its intension and extension need further clarification. Based on the literature, the properties of external nutrient detection, internal sensing of nutrient levels, and organismal regulation could provide a basic recipe for nutrient balancing. Next, using an evolutionary lens, I examine nutrient acquisition in some prokaryotes, slime molds, simple multicellular eukaryotes, and in the quirks of multicellular metabolism to raise questions about the origins and universality of balancing. Finally, I build on this explication of balance and balancing by considering how obesity and cancer might respectively elucidate problems of organismal nutrient imbalances versus disrupted cellular nutrient balancing.

This essay discusses four key criticisms recently leveled against the main attempts to use conceptual analysis to understand health and disease. First, it examines the weaknesses of these attempts and suggests a better way to proceed. Next, it briefly discusses another disease debate concerning pathological mechanisms and suggests that this approach could be more fruitful than that of conceptual analysis. The final section demonstrates how Georges Canguilhem's biological philosophy of disease avoids some of the problems associated with conceptual analysis, and how he can contribute to both debates. Canguilhem's appeal to biological normativity is understood as contributing to a theoretical explanation, and a possible naturalization, of what is specific to healthy and pathological phenomena.

Defining the concepts of health and disease has proved rather difficult and many philosophers of medicine have simply concluded that we would be better off giving up on such endeavors. I feel that this view is misguided mainly because it seems to rest on a rather inadequate understanding of how philosophers use biology to clarify medical concepts. While some philosophers appeal to biology so as to clarify what we mean by the concepts of health and disease, others attempt to use biology to develop a theory thathelps to explain what health and disease are. In this dissertation, I examine the work of an often overlooked philosopher of medicine, Georges Canguilhem, who sought to understand medical concepts by starting from the biological properties of variation and variability. In other words, in order to define health and disease, Canguilhem first tried to establish how what is normal can vary between organisms and even within the same organism due to the dynamic relation between the organism and its environment. Simply put: what is normal for one organism could be pathological for another and what is normal in one environment could become pathological in another. Consequently, variation and variability need to be included in our understanding of health and disease. Throughout this dissertation, I explore how Canguilhem goes about developing the implications of these biological properties for medical concepts and this allows me to distinguish his approach from some popular ones in philosophy of medicine, e.g. those trying to develop an objective biological approach (naturalism) and those appealingto evolutionary principles. I establish the plausibility of definingmedical concepts relative to individual organisms and their environments, while showing some of its potential limitations, especially when it comes to human social environments. Ultimately, a more nuanced understanding of how the inseparability of organisms and environments canhelp to clarify health and disease provides an interesting way to get past the apparent stalemate in philosophy of medicine and firmly establishes the relevance of Canguilhem’s philosophy.

The unexpected roles of the microbiota in cancer challenge explanations of carcinogenesis that focus on tumor-intrinsic properties. Most tumors contain bacteria and viruses, and the host’s proximal and distal microbiota influence both cancer incidence and therapeutic responsiveness. Continuing the history of cancer–microbe research, these findings raise a key question: to what extent is the microbiota relevant for clinical oncology? We approach this by critically evaluating three issues: how the microbiota provides a predictive biomarker of cancer growth and therapeutic responsiveness, the microbiota’s causal role(s) in cancer development, and how therapeutic manipulations of the microbiota improve patient outcomes in cancer. Clarifying the conceptual and empirical aspects of the cancer-associated microbiota can orient future research and guide its implementation in clinical oncology.

One of the key criticisms of understanding health in terms of adaptation to one’s environment is that medical judgments should be able to apply across environments. If we say that a condition is pathological ‘for person X in environment E’, then we quickly run into problems of desirability and social values. However, many key concepts in biology entail an inability to separate the organism from its environment. In other words, it is precisely by referring to ‘organism X in environment E’ that we can determine what is ‘normal and natural’. In this chapter, I will argue that the role of this inseparability of organism and environment for understanding medical norms has been misunderstood and the implications of it for naturalistic theories of health and disease have gone largely unappreciated. To better understand this contextualist approach, I will discuss the ideas of John Ryle and Georges Canguilhem, focusing primarily on the latter. In Canguilhem’s work we find some key arguments for why organismic norms need to be understood relative to environments and how this can help to clarify the concepts of health and disease. I will explore his peculiar form of naturalism that was based on the dynamism and variability of organisms, show how it can be clarified through more recent biological research, and mention some of its limitations.

In one of his key publications on the harmful dysfunction analysis of mental disorder (HDA), Jerome Wakefield acknowledged that he has “explored the value element in disorder less thoroughly than the factual element. This is in part because the factual component poses more of a problem for inferences about disorder and in part because the nature of values is such that it requires separate consideration” (Wakefield 1992, 384). More than twenty years have passed since this remark, and yet a thorough consideration of the value component in Wakefield’s HDA is still lacking. Quite a few contributions to this volume promise to change that situation, and ours is one of these. In this contribution, we will analyze the harm or value component and argue that Wakefield’s dealing with it is so problematic that it undermines, at least indirectly, the viability of the HDA. In the first section, we explore Wakefield’s emphasis on the subjective nature of harm and his exclusive focus on social values. The second section is devoted to an analysis of Wakefield’s examples of conditions that are dysfunctional but harmless (fused toes, albinism, reversal of the heart, dyslexia in illiterate societies, etc.). We argue that these examples are quite problematic because they do not exemplify what they are supposed to exemplify. In the third section, we show how these two problems are connected: Wakefield uses the harmfulness of a condition as an implicit criterion to distinguish normal variation from dysfunction. In doing so, he blurs the distinction between the harm component and the dysfunction component, even though this distinction is central to his HDA.

Understanding the phenomenon of health is crucial for ageing research since there is often an implicit view on what constitutes health and how to measure it. We provide some reflections on how we might better understand and measure health, discuss the basic biological principles of survival, ageing, age-related diseases and eventual death, and end by tying these ideas together to rethink the nature of and implications for healthy ageing. We defend a more positive view on health understood in terms of various phenotypic parameters, such as robustness and resilience, and show how it relates to the aim to support these parameters over time to achieve healthy ageing. Together, these ideas suggest that the most effective strategies for healthy ageing may come from the outside-in by altering those aspects of the environment that prevent robust and resilient phenotypic responses and by supporting those aspects which ensure such responses.

Philosophers of medicine have long debated the possibility of a/the definition of health, but they have yet to fully reflect on the intriguing observation that there is still no theory of health within the medical sciences similar to general theories in other sciences. In this chapter, I provide some reasons for why this lack persists and why philosophers have not been particularly helpful or even interested in filling it. After clarifying why such a theory could be useful, I discuss five general features of medical theories and how one could evaluate the utility of a given proposal. With these features in mind, I suggest that philosophers and scientists work together on analyzing actual medical research (experimental analysis), and the ways in which a theoretical construct of ‘health’ is being progressively identified and measured therein. I conclude by suggesting that research fields studying stress and aging might be particularly helpful in developing candidates for theory construction due to their broad scope, specificity, and potentially integrative explanations.

Debates in fields studying the biological aspects of aging and longevity, such as biogerontology, are often split between ‘anti-aging’ approaches aimed largely at treating diseases and those focusing more on maintaining, promoting, and even enhancing health. However, it is far from clear what this ‘health’ is that would be maintained, promoted, or enhanced. Interestingly, what few have yet to fully reflect on is that there is still no theory of health within the health or aging sciences that would provide an integrative explanatory framework akin to other scientific theories. After clarifying why such a theory could be useful, I discuss five general features of medical theories that could be used to evaluate the utility of a given proposal. With these features in hand, I suggest that philosophers and scientists work together on analyzing actual medical research (experimental analysis), and the ways in which a theoretical construct of ‘health’ is being progressively identified and measured therein. I conclude by suggesting that research fields studying stress and aging might be particularly helpful in developing candidates for theory construction due to their broad scope, increasing specificity, and potential for providing integrative explanations.

In this concluding chapter, we gather the various contributions of this volume and attempt to extract some of the many key insights and challenges raised when it comes to the project of explaining health across the sciences. These insights were distilled down into a selection of the central concepts and issues defended or discussed by the authors, and were organized into a table to see, at a glance, where the attention was given. Reflecting on these insights will go some way towards addressing the question of whether these explanations can be brought together into a coherent or unifying framework or whether we are simply stuck with mutually exclusive views about the multifaceted phenomenon of ‘health’.

There is a broad consensus in nutritional-microbiota research that high-fat (HF) diets are harmful to human health, at least in part through their modulation of the gut microbiota. However, various studies also support the inherent flexibility of the human gut and our microbiota’s ability to adapt to a variety of food sources, suggesting a more nuanced picture. In this article, we first discuss some problems facing basic translational research and provide a different framework for thinking about diet and gut health in terms of metabolic flexibility. We then offer evidence that well-formulated HF diets, such as ketogenic diets, may provide healthful alternative fuel sources for the human gut. We place this in the context of cancer research, where this concern over HF diets is also expressed, and consider various potential objections concerning the effects of lipopolysaccharides, trimethylamine-N-oxide, and secondary bile acids on human gut health. We end by providing some general suggestions for how to improve research and clinical practice with respect to the gut microbiota when considering the framework of metabolic flexibility.

This edited volume aims to better understand the multifaceted phenomenon we call health. Going beyond simple views of health as the absence of disease or as complete well-being, this book unites scientists and philosophers. The contributions clarify the links between health and adaptation, robustness, resilience, or dynamic homeostasis, and discuss how to achieve health and healthy aging through practices such as hormesis. The book is divided into three parts and a conclusion: the first part explains health from within specific disciplines, the second part explores health from the perspective of a bodily part, system, function, or even the environment in which organisms live, and the final part looks at more clinical or practical perspectives. It thereby gathers, across 30 chapters, diverse perspectives from the broad fields of evolutionary and systems biology, immunology, and biogerontology, more specific areas such as odontology, cardiology, neurology, and public health, as well as philosophical reflections on mental health, sexuality, authenticity and medical theories. The overarching aim is to inform, inspire and encourage intellectuals from various disciplines to assess whether explanations in these disparate fields and across biological levels can be sufficiently systematized and unified to clarify the complexity of health. It will be particularly useful for medical graduates, philosophy graduates and research professionals in the life sciences and general medicine, as well as for upper-level graduate philosophy of science students.

We situate the well-trodden debate about defining health and disease within the project of a metaphysics of science and its aim to work with and contribute to science. We make use of Guay and Pradeu’s ‘metaphysical box’ to reframe this debate, showing what is at stake in recent attempts to move beyond it, revealing unforeseen points of agreement and disagreement among new and old positions, and producing new questions that may lead to progress. We then discuss the implications of the two-way benefits between medicine and philosophy when the latter is driven and constrained by medical science.