Ozan Altınok

Although our health-related concepts such as disease are strongly value bearing and action guiding, we seem to direct these actions towards one singular direction in a very crude sense in general. This singular direction in the contemporary West is the direction of health care. Although what we hold dear as health, and what we try to avoid as disease make a lot of meaning in our lives, the care we need rarely comes and even rarely comes in the form we want from healthcare. One particular problem that I have addressed throughout the work was the generality of disease concept and the diagnostics of the disease model that we have, which focuses on finding and curing particular diseases. There have been enormous developments that has been challenging the limited system of the organism that sees the boundaries as continuous rather than dichotomous. I have advocated for an evolutionary understanding which conceptualizes disease in a way that enables them to see it with reference to organism’s relationship to environment.

This book is about disease, but from a very specific perspective, namely that of evolutionary medicine. It explains evolutionary medicine in its current form, criticizes it, and tries to apply it not directly on disease instances or tokens of disease, but rather the concept of disease. Doing so, the aim of this book is to ask the question; how to build a better concept of disease? The parts of the answer to this question are answered in different chapters piece by piece, trying to give an account of a better concept first and giving an account of how to see the concept of disease grounded differently. This book is not about giving every possible account of disease, or even the major ones including the established or traditional concept. This book is not about providing a singular perspective on diseases in general, however it assumes a general orthodoxy of medicalized disease understanding.

In 1851, American physician Samuel A. Cartwright observed that the slaves were trying to escape captivity. Based on this observation, he tried to understand the reason why this was the case. Looking for causes of events from a biological and medical perspective of his day alone, the answer he found was a very straightforward one. The slaves who tried to run away were suffering from a mental illness, drapetomania (White in Annual Review of Genetics 38:681–707 2008). This mental illness was the cause they tried to run away. Much later, as an unrelated event, in 1973, American Psychiatric Association, decided by 58% of the votes that homosexuality should be removed from Diagnostic and Statistical Manual of Mental Disorders [DSM] (Australian and New Zealand Journal of Psychiatry 37(6):678–683, 2003) (They did not use a vocabulary or a conceptual framework that distinguished gender identity, orientation or behavior. What they meant was more similar to what we can call as sexual orientation now.). This would mean that homosexuality could not be “treated” by psychologists and psychiatrists anymore, since it was no longer a disease in their repertoire. Although they had to tools to “treat” homosexuality, they were not allowed to, since the intervention that they were aiming at was being aimed at a false “disease”.What do examples like these mean, or rather, what to make of these events? Is the concept of disease some kind of normative concept that is used to control and pathologize certain behaviours or traits without any kind of solid scientific grounding as some radical interpretations of constructivism claim? Alternatively, as the extreme counter position to that, are they merely anecdotal examples of the occasional misuse of science that does not even belong to this century due to the proclaimed immerse advancements in science as some naturalists claim? This chapter does not aim to answer this question directly. This chapter does not give a general concept of disease or analyse how the concept of disease have been used either. Instead, this chapter tries to lay out different elements effecting the concept of disease while discussing certain central issues in the discussion of the concept of disease, eventually arguing around the intersection of social aspects in its usage and the biological aspects of the disease concept. I will use a pragmatic approach towards philosophy of science to understand the different aspects of the concept.

The central idea of the chapter is, how new developments in evolutionary biology make us see inheritance in new ways, and these new ways create new possibilities to use them how to use them in medicine. The canonical understanding of evolutionary medicine as discussed so far, does two different things; it uses Environment of Evolutionary Adaptiveness (EEA) concept to define matches and mismatches through the evolutionary history of organisms firstly, and secondly it uses evolutionary perspectives to understand the behaviours of non-organismic entities such as cancer cells and hologenomes. EEA concept will be employed to account for an individualized and specified understanding of disease when it comes to diagnostics and intervention. From that point, I will further assess an understanding of the frontiers of evolutionary medicine and its new capabilities. The central idea is a very simple one; the theories and the tools we use to understand evolution are changing and in return, the general perspective in evolutionary medicine—if it is taken in the broad sense instead of the canonized vision—will change. Eventually, I claim that the new developments in evolutionary biology lead us to see disease in a way in which we must count in the environmental elements and see the concept of disease in an individualized way. This individualization comes in two counts, first as epistemic individualization of the explanation (connected to token character of medical explanations), and second, metaphysical individualization of disease.

Scientists use some concepts that are socially and ethically highly relevant in their research and other kinds of scientific activities. Some of these concepts determine many things in the social domain. How these concepts are related to their practical activity, and what to make of their usage of concepts is an ongoing question, which was made explicit already (Hacking, 1975). Philosophy of science, as well as “meta science” have been dealing with the relationship of scientists to the concepts not very much, preferring to deal with the concepts themselves only. Although within philosophy of science, the “philosophy of science in practice” perspective has put forward attempts to deal with that, and at earlier accounts of Frankfurt School already as well as Science and Technology Studies, there have been perspectives to restore or restructure the relationships between public and scientists, there has not been comprehensive accounts of such study of concepts and their interrelations within the scientific activities. In this regard, the connection between the “normative” elements of concepts and their “descriptive” counterparts have been institutionalized by large, at least within philosophy by separate structures. The aim of this chapter is to introduce the general understanding of “thick concepts”, the concepts that have both descriptive and evaluative properties to start the analysis of both philosophy of science in practice, and ethics of science coordinatively.

In this chapter, my aim is to discuss meaning theories to introduce a more social understanding of thick concepts within the debate, providing a social aspect which can work with Elstein and Hurka’s (Can J Philos 39(4):515–535, 2009) three part model. My main aim is to focus on the socio-linguistic element in the making of meaning rather than focusing on the meaning itself in the classical sense, also because I find it more important to focus on this issue due to the conceptual change I have in mind. In this chapter, I will lay out certain principles with respect to handling of thick concepts within meaning theories and concepts. The aim is not to give detailed accounts of meaning theories here, neither to find the most accurate or comprehensive meaning theory or approach to analyze thick concepts. My main point of departure in this chapter is to defend that, thick concepts are related to language and linguistic activity in many ways. I think there is reason to believe that in most cases meaning theories capture and explain certain aspects of language but fail to do so when the vast diversity of linguistic activity is considered. More generally, certain approaches to language are more suitable to analyze thick concepts for the most usages of thick concepts. When thick concepts are taken as particular phenomena of their own right within philosophy, as it has been central to the debate which approaches to concepts should be employed, it is understandable that there are many different philosophical approaches that are open for analysis. In the this chapter, I will try to employ different kind of usages of the language based not on specific definitions but meanings in their usage to understand the making of meaning. The general aim is to position concepts in general and thick concepts as tools, not only as lasting, truth corresponding elements of the language.

Evolution has a very strict definition and is very central to evolutionary biology itself when the canonized evolutionary understandings of population genetics is at work, which is as strict as “any change in the frequency of alleles within a population from one generation to the next” (Millstein and Skipper, 207, p. 26) in terms of microevolution, or any kind of “process that results in changes in the genetic material of a population over time”. However, when it comes to philosophical and everyday circles, it is difficult to point out the exact meaning of evolution. It can be used as gradual transformation, change in general or a certain kind of progress within public usage. In a sense, it can be said that evolution cannot be defined, but can be shown due to its many connections to other concepts within fields of biology. On the other hand, “evolutionary” has a particular meaning within the scientific community as well as public with respect to the contrast group, non-evolutionary. The contrast class of evolutionary within biology is generally seen as concept of stable from one perspective, and the concept of revolutionary from the other perspective. In this chapter, my usage of evolution and evolutionary are in line with the usages within the scientific community. In the beginning of discussion of evolutionary medicine, it makes sense to clarify the concept of evolutionary first, since medicine itself is a very broad area, towards which evolutionary understandings, perspectives and methods are directed by evolutionary medicine to explain medical phenomena.

The debates around the conceptual change of scientific terms and concepts have traditionally held correspondence theory of truth as the main truth criterion. Be it Kuhnian “paradigms” (Kuhn, The structure of scientific revolutions. University of Chicago Press, 1962), and the proposed solution to this problem with the reference of scientific concepts (Devitt, 1979; Scheffler in Bobbs-Merrill, 1967). I am more sympathetic towards a Lakatosian account of theory change as a larger framework within philosophy of science here, and the implied pluralism in his framework. The more nuanced approaches such as that of Brigandt (2020) and Brigandt and Rosario (2020) are more relevant, yet not the same to my understanding of conceptual change due to changes in research agendas. Here I take a pluralist stance, refusing the incommensurability thesis, following the practice-oriented understandings of concept usage in science, following Hacking (1983) and Cartwright (1983, 1999), which enables scientists to have greater autonomy in making of meaning. I believe that if we carry our focus in meaning to the practice and individual scientist and departmental distinctions shaping their making of meaning following different epistemic goals of making of inferential part of the meaning, we can have a more accurate understanding of conceptual change.