Philosophy of medicine is a branch of philosophy that examines issues, ideas, concepts, theories and practices in medicine and healthcare (Tosam, 2014). It is a contemporary philosophical field that started to gain traction in the second half of the 20th century. With specialized journals, professional organizations and a canon of scholarly literature, philosophy of medicine is an established, rich and prolific philosophical field (Reiss & Ankeny, 2022).
Although the philosophy of medicine as we know it today is recent, the connection of philosophy and medicine can be traced back to the ancient times. One of the key figures was Hippocrates, a Greek physician and philosopher who is considered the “Father of Western Medicine”. His significance extends to this day and age as medical students all over the world still take the Hippocratic oath, one of the oldest codes of medical ethics and a prime example of the ancient fusion of philosophy and medicine. Besides Hippocrates, Galen was another central figure of ancient medicine. His philosophical and medical contributions still have an enduring impact on contemporary medicine and philosophy (Tosam, 2014). Interestingly, Galen even argued that philosophy is essential to the physician’s training and development as it “enables the physician to discern between truth and illusion, or between reality and surface appearance which is so important in diagnosis” (Tosam, 2014, p. 77).
Since the ancient times, medicine has separated itself from philosophy as an independent field of scientific theory and practice. However, the ideas, concepts, problems, and practices of medicine still garner considerable philosophical attention. Numerous philosophical areas take interest in medicine – from more theoretical branches such as logic, metaphysics, epistemology, philosophy of science to more practical ones like ethics and political philosophy. There are also numerous subfields of philosophy of medicine that are concentrated on specialties in medicine. One such notable and expanding subfield is philosophy of psychiatry.
One of the central questions in philosophy of medicine and philosophy of psychiatry is the definition of disorder (Bolton, 2008). The aim of the debate on disorders is to find certain characteristics according to which we would be able to delineate pathological from nonpathological conditions. In other words, the idea is to offer criteria which a condition would have to satisfy to count as a disorder. It should be noted that a standard move in the debate is to use notions disease, disorder, illness, malady interchangeably unless strictly specified (Boorse, 1975). Here I use the notion of disorder. Additionally, the discussions on disorder and on mental disorder are parallel meaning that we can consider them as part of one large discussion. It is reasonable to consider them as such since the notion of mental disorder is subordinate to the notion of disorder more generally. The main positions of the debate on disorders are naturalism, normativism and hybrid theories.
Naturalism is a position according to which the notion of disorder can be analysed exclusively in value-free, objective terms (Kingma, 2014). It is a position that defines the notion of disorder in purely scientifically using the notions such as biological function and brain lesion. The naturalist accounts differ variously but what they all share is that the notion of disease is a value-free concept (Ananth, 2008; Boorse, 1977, 1997, 2014; Kendell, 1975; Scadding, 1988).
Normativism with regards to the definition of mental disorder is a position according to which the notion of disorder is necessarily, and in its essence, value-laden (Agich, 1994; Bolton, 2008; Clouser et al., 1997; Cooper, 2002; Engelhardt, 1976; Fulford, 1989; Nordenfelt, 1995, 2007; Reznek, 1987). This means that the concept of disorder can never be fully realized in value-free terms.
Hybrid accounts combine elements from both theories into a single account. They present a compromise between naturalism and normativism. One prominent hybrid account is Wakefield’s harmful dysfunction analysis (HAD) (Wakefield, 1992, 2020). On this account mental disorders contain two criteria, harm, and biological dysfunction – one normative and one naturalist. Both of these elements must be present for a condition to count as a mental disorder (Wakefield, 1992).
Although this debate on mental disorders has been longstanding and central to philosophy of medicine, the objections directed at the debate on mental disorders have been accumulating (Bortolotti, 2020; Cooper, 2020; Ereshefsky, 2009; Murphy, 2006; Schwartz, 2007). The lack of dynamic in the debate has been characterized by some as a “dull thud of conflicting intuitions” (Bigelow & Pargetter (1987, p. 196) as cited in Schwartz (2014, p. 576)). The contested elements of the debate in literature include the objections directed to the methodology of the project, namely conceptual analysis, to the nature of the concept of mental disorder, the scope, purpose and the utility of the concept of mental disorder, to the role of intuitions in the debate and the goals of the debate (Hofmann, 2001; Lemoine, 2013; Murphy, 2006; Nordby, 2016; Räikkä, 1996; Schwartz, 2007; Worrall & Worrall, 2001). As a result, innovative approaches started to emerge which challenge the centrality and necessity of the notion of disorder in medicine (Bortolotti, 2020; Hesslow, 1993) as well as rethinking the project and the methodology of defining disorder (Schwartz, 2014). Besides the rise in alternative ways of thinking about health and disease, there is a rise in projects that examine medicine and healthcare from a various other perspective. One of these is the application of the framework of epistemic injustice to the theory and practices of medicine and healthcare (Carel & Kidd, 2014; Kidd et al., 2022). Another is examining medicine through the lens of relational ethics (Deschenes & Kunyk, 2020; Jennings, 2019).
The centrality of the notion of disorder I presented earlier is representative of a broader framework in medicine and healthcare called the biomedical model. The biomedical model assumes that all mental and physical disorders result from some abnormality in the body in functioning and/or the structure of organs, it defines health as the absence of disease, it sees the patient as a passive recipient of healthcare whose cooperation is presupposed and expected (Wade & Halligan, 2004, p. 1398).
Besides moving away from the centrality of disorder with respect to the discussion on disorders, there is a trend of moving onto novel methodological and thematic landscapes on an even greater scale. As a result, the whole biomedical model and its precepts are brought into question. The alternatives to the biomedical model have been present for at least half of century (Fricchione, 2023) but as medicine progresses and its scope widens the image of medicine that is broader than just alleviating disorders is starting to crystalize. There is a growing interest in models of health like biopsychosocial model which take into account the psychological and social factors in health and disease rather than just the bodily structure and functioning (Aftab & Nielsen, 2021; Bolton, 2021; Maung, 2021; Sturgiss et al., 2022; Wade & Halligan, 2017). There is a move from disorder-centred to the patient-centred medical care (Hodges et al., 2020; Krist et al., 2023; Stewart et al., 2024) which sees the patient through a compassionate lens considering them as collaborators and agents (not just patients) in their improvement of health. Correspondingly, we observe a trend towards a more holistic medicine that takes the whole person into the account, contrasted with a reductionist view which deals with particular organs and organ systems (Krist et al., 2023). Lastly, there is an interest in the positive conception of health (Roy et al., 2015; Seligman, 2008) according to which being healthy does not just signify the absence of disorder, rather it includes habits, lifestyle choices and preventative medicine. It also includes concepts such as well-being, flourishing and living a good life (Huppert et al., 2004) which have a great and extensive philosophical tradition and exude potential for philosophical examination in the medical context.
This is undoubtedly an exciting time for philosophy of medicine. The field is expanding in fun and creative ways challenging much of the traditional and conservative precepts of medicine and healthcare. As the field of medicine is ever-changing and growing with scientific, social and political advancements, philosophy of medicine follows suit. May we keep on living in philosophically interesting times.
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