Abstract

It is an exciting time for the philosophy of medicine. For decades, the field’s core project, at least among those working within the Anglo-American analytic tradition, has been the conceptual analysis of health and disease. But recent years have witnessed mounting opposition to this prevailing approach, as the traditional sort of conceptual analysis on which it relies is increasingly viewed as incapable of satisfying key motivations for theorizing about health and disease. Now, greater attention is paid to other medical topics of philosophical interest, and new methods for theorizing about health and disease are under consideration within the philosophy of medicine’s nascent pragmatic turn. Proponents of this pragmatic turn advance methods that explicitly involve non-epistemic considerations to devise concepts of health and disease for implementation in specific contexts. I welcome these developments. However, the pragmatic turn’s positive proposal is often packaged with a negative proposal. From this perspective, any theorizing about health and disease that eschews non-epistemic considerations or that is general enough to apply to the entirety of clinical medicine is a pointless if not incoherent endeavor. So, the pragmatic turn’s negative proposal goes beyond criticism of traditional conceptual analysis to impugn any attempts at crafting descriptive, general theories of health and disease. But abandoning such efforts is premature if we have means apart from conceptual analysis that enable us to respond to important motivations that call for such descriptive, general theories. This dissertation wrestles with how theorizing about health and disease should proceed in light of the challenges faced by the prevailing approach of conceptual analysis. In each of the three subsequent chapters, I draw on work from areas of philosophy outside the philosophy of medicine to further our inquiry regarding health and disease: the categorical-dispositional distinction in Chapter 1, metalinguistic disputes in Chapter 2, and conceptual engineering’s functional turn in Chapter 3. Thus each chapter makes a dual contribution. First, I recruit this work from outside the philosophy of medicine to defend particular positions related to health and disease. In doing so, I elucidate how to harness this work to enhance our ability to theorize about health and disease. Chapter 1 (Disease: Categorical or Dispositional?) hews most closely to the perspective of those pursuing the prevailing approach to theorizing about health and disease. To wit, I focus on three goals endorsed by either Boorse (1977, 2014) or Wakefield (1992, 2014), who are prominent participants within the prevailing approach: Boorse’s goal of describing the pathologist’s concept of health, Wakefield’s goal of describing the concept of health held by everyone, and their shared goal of describing the fundamental concept that distinguishes medical from non-medical considerations in clinical practice. However, I take care to separate these goals, and I do not assume that conceptual analysis is the appropriate method for fulfilling them. Furthermore, rather than categorize theories of health and disease per the standard naturalist-normativist distinction, I categorize them per the categorical-dispositional distinction. I provide evidence that the concepts that Boorse and Wakefield seek to describe depend at least partly on some categorical property. So, this evidence undermines the view held by Boorse and Wakefield that disease is identical with lack of health and depends only on dispositional properties. The best option for salvaging a dispositional theory of disease on which disease remains intimately connected to health is, I propose, to maintain that health is not the absence of disease, but the absence of disease manifestations. Along the way, I promote the categorical-dispositional distinction as a helpful tool for theorizing about health and disease—I offer a framework for its application to this context, and I use it to clarify leading theories of disease and to uncover ambiguities in Cooper’s (2002) and Wakefield’s theories. In Chapter 2 (Addiction and Disease Debates as Metalinguistic Disputes), I attend to the contemporary debate over addiction’s disease status to explore whether at least some such disease debates are metalinguistic disputes. For not only is shedding light on individual disease debates a main motivation for many pursuing the prevailing approach, but the addiction debate is also the sort of narrow context, laden with non-epistemic considerations, that is touted by proponents of the pragmatic turn as a promising locus for theorizing about health and disease. After describing and evaluating several candidate interpretations of the addiction debate, I argue that it is best explained as a metalinguistic dispute wherein competing meanings of ‘disease’ are advanced primarily due to disagreements about the medicalization of addiction. This analysis shifts our understanding of what is centrally at issue in the addiction debate from empirical matters to normative concerns. Moreover, I contend that if this analysis is correct, then both the prevailing approach to theorizing about health and disease and the pragmatic alternative will fail to illuminate or ameliorate the addiction debate and others like it. The basic problem with these approaches vis-à-vis the addiction debate is that they aim at either describing a shared meaning of ‘disease’ or at devising the meaning of ‘disease’ that should be shared by some community. But the addiction debate’s interlocutors do not share the same concept of disease—so there is no shared meaning to describe—and it is in virtue of their conflicting concepts of disease that the interlocutors successfully communicate their disagreements about addiction—so devising a meaning of ‘disease’ for these interlocutors to share would confuse rather than improve the addiction debate. Accordingly, I suggest that normative and experimental research that foregrounds issues related to medicalization instead of disease is more likely to shed light on the addiction debate than the prevailing approach or the pragmatic alternative. Chapter 2 thus supplies not only a fruitful new account of the addiction debate, but also the groundwork for a better means of understanding and improving disease debates that are metalinguistic disputes. In Chapter 3 (Health as Constitutive Well-Being), I address head-on the pragmatic turn’s opposition to the prevailing approach. To do so, I draw on conceptual engineering’s functional turn, since its proponents build upon the same methodological foundations and hold similar commitments and concerns as the proponents of the pragmatic turn. Although those pursuing the prevailing approach do not have all the same goals for their theories, they do not merely talk past one another, as I show that they share a core topic of inquiry: what clinical medicine aims to provide to patients. This clarification of the prevailing approach’s core topic reveals that the fundamental deficiency of this approach is that it succumbs to the authority problem, a charge typically leveled against work in conceptual engineering. That is, I contend that the sort of conceptual analysis employed within the prevailing approach relies on sources of evidence that do not provide sufficiently strong reasons of the right kind to warrant adopting the concepts derived through this method for the purpose of representing clinical medicine’s aim. Meanwhile, the pragmatic turn succumbs to the Strawsonian challenge, since dismissing the ambition of describing clinical medicine’s aim amounts to changing the subject of theorizing about health and disease from the prevailing approach’s core topic. I maintain that this topic is important because people’s positions about many of the pressing issues related to clinical medicine that motivate much theorizing about health and disease are often premised on a particular view of clinical medicine’s aim. These pressing issues include controversies about the medicalization of purportedly non-medical problems, the effectiveness of medical interventions, and what clinical medicine should aim to provide to patients. So, developing a more accurate account of clinical medicine’s aim would both debunk less accurate accounts that undergird positions about such issues and offer a better foundation than these less accurate accounts from which to engage with these issues. Appraising the accuracy of accounts of clinical medicine’s aim requires evidence regarding what makes it the case that clinical medicine’s aim is realized. Accordingly, I look to clinical practice for the relevant paradigm cases: practices that uncontroversially realize clinical medicine’s aim and practices that uncontroversially do not realize it. On this basis, I argue for a new theory of health, health as constitutive well-being (HCW). On HCW, a person’s health is their intrinsic properties’ net ultimate prudential value for them. Roughly, this theory suggests that your health is how good your body and mind are for you in themselves, as opposed to how good they are for you instrumentally. Notably, HCW does not incorporate any specific account of dysfunction or well-being, since discrepancies between such accounts and the relevant paradigm cases demonstrate that these accounts are not reflected in clinical medicine’s aim. HCW does not need such an account to avoid overinclusiveness, because rather than take a person’s health to be determined by a causal connection between their well-being and their physical and mental attributes, I take a person’s health to be determined by the constitutive connection between their well-being and their physical and mental attributes. Since HCW is the most accurate available account of clinical medicine’s aim, in any context in which one would rely on some concept to represent clinical medicine’s aim, all else equal, one should rely on the concept specified by HCW. What emerges from these chapters is a perspective on theorizing about health and disease that is largely sympathetic to the pragmatic turn, though I am critical of it in several respects. I agree with the emphasis placed by proponents of both the pragmatic turn and conceptual engineering’s functional turn on the importance of a careful assessment of the goals of theorizing. And I accept that there are many legitimate goals for theorizing about health and disease that apply just to certain narrow contexts or that warrant attending to non-epistemic considerations, perhaps by consulting the values of stakeholders. However, there are some narrow contexts like the addiction debate for which it seems that describing or prescribing a shared concept of health or disease would be useful, yet a better strategy involves focusing on issues related to medicalization instead of disease. Moreover, we should not foreclose efforts to devise general theories of health and disease for epistemic reasons while there remain unsatisfied motivations for this sort of work and the means to fruitfully carry it out. In this transitional period for theorizing about health and disease, identifying the right tools for this work is crucial, and we should not be surprised if they derive from areas of philosophy outside the philosophy of medicine. My hope is that this perspective on theorizing about health and disease, along with the specific tools I discuss and the views I defend, will help this theoretical endeavor central to the philosophy of medicine continue to develop in a productive manner.

Committee Chair

Anya Plutynski

Committee Members

Carl Craver; Chandra Sripada; Elizabeth Barnes; Ron Mallon

Degree

Doctor of Philosophy (PhD)

Author's Department

Philosophy

Author's School

Graduate School of Arts and Sciences

Document Type

Dissertation

Date of Award

7-24-2026

Language

English (en)

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Available for download on Sunday, July 23, 2028

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