How What We Call "Disease" Shapes Our Health
When you think of medical breakthroughs, you probably imagine lab coats, microscopes, and clinical trials. But some of medicine's most profound revolutions begin not in laboratories, but in the minds of philosophers.
Imagine two patients with identical medical results—same blood pressure readings, same cholesterol numbers, same genetic markers. One gets treatment, the other doesn't. Why? Because what counts as "disease" versus "normal variation" depends not just on biology but on philosophical assumptions we rarely question 1 .
This is the fascinating realm of philosophy of medicine, a field that examines the hidden foundations of medical knowledge and practice. While medicine and philosophy have been intertwined since ancient times—with figures like Hippocrates and Aristotle contributing to both—the professionalization of philosophy of medicine is a relatively recent development 5 .
Philosophy of medicine affects everything from your medical diagnosis to what treatments your insurance will cover. As philosopher Tristram Engelhardt noted, the concept of disease "acts not only to describe and explain, but also to enjoin to action."
This field doesn't just ponder abstract concepts; it has real-world consequences that affect everything from your medical diagnosis to what treatments your insurance will cover 1 . As philosopher Tristram Engelhardt noted, the concept of disease "acts not only to describe and explain, but also to enjoin to action. It indicates a state of affairs as undesirable and to be overcome" 1 .
| Domain | Sample Questions | Practical Implications |
|---|---|---|
| Metaphysics | What fundamentally is a disease? Are diseases real entities or social constructs? | Determines research priorities and diagnostic categories |
| Epistemology | How do we know what causes disease? What counts as good medical evidence? | Guides clinical trial design and treatment protocols |
| Ethics | Who gets to decide what counts as disease? How should resources be allocated? | Shapes healthcare policy and informed consent practices |
Table 1: Key Questions in Philosophy of Medicine
At the heart of philosophy of medicine lies perhaps its most fundamental question: How do we define health and disease? The answer seems obvious until you realize that throughout history, concepts of disease have shifted dramatically—what was once considered a disease (like masturbation or homosexuality) is now seen as normal, and what was once accepted as normal (like moderate lead exposure) is now pathological 1 .
Naturalists, like philosopher Christopher Boorse, argue that disease should be defined objectively in terms of biological function. Boorse's influential biostatistical theory defines disease as an internal state that impairs normal functional ability—where "normal" is defined statistically for a reference class of organisms of similar age and sex 1 .
For naturalists, health is simply the absence of disease, and diseases are value-free scientific concepts that we discover through biological research 3 .
Normativists counter that the concept of disease is inherently value-laden 1 . From this perspective, calling something a disease represents a social judgment that a condition is undesirable, not just a statement about biological functioning 1 .
They point to historical examples like masturbation being classified as a disease in the 18th and 19th centuries, or homosexuality being listed in the American Psychiatric Association's Diagnostic and Statistical Manual until 1973. These weren't reclassified because new biological facts emerged, but because social values changed 1 .
Jerome Wakefield attempted to synthesize these perspectives with his harmful dysfunction analysis, which defines disease as both a biological dysfunction (the naturalist component) and a condition that causes harm to the person (the normativist component) 3 .
This hybrid account explains why we don't treat left-handedness as a disease (no biological dysfunction) but do treat infertility as one when it causes distress.
| Perspective | Core Definition of Disease | Strengths | Weaknesses |
|---|---|---|---|
| Naturalist | Deviation from statistically normal biological function | Provides objective criteria; prevents medicalization of social deviance | Cannot explain value-driven changes in disease classification |
| Normativist | Socially disvalued condition | Acknowledges role of values; explains historical changes | Risks reducing disease to mere social construction |
| Hybrid | Harmful biological dysfunction | Combines strengths of both approaches; matches clinical intuition | Difficult to specify "harm" without circularity |
Table 2: Comparing Perspectives on Disease
Disease refers to biological dysfunction, Illness to subjective experience, and Sickness to social dimensions
If you think philosophical debates never leave the ivory tower, think again. A revolutionary new approach called experimental philosophy of medicine is now testing these theoretical debates against real-world evidence 3 6 .
Traditional philosophy of medicine relied on what experimental philosophers call the "method of cases"—philosophers would propose thought experiments and trust their own intuitions about whether something counted as a disease 3 .
Boorse himself characterized this back-and-forth as a game where "to call pregnancy per se unhealthy would strike at the very heart of medical thought; it is the analytic equivalent of the 'Game Over' sign in a video game" 3 .
The problem? Philosophers were making claims about what "we" consider diseases without systematically checking whether medical professionals or the public shared their intuitions 3 .
In 2024, a team of researchers in the Netherlands conducted one of the first qualitative interview studies to explore how health and disease concepts actually operate in medical practice 6 .
They interviewed 17 professionals from various healthcare fields, including clinicians, policy makers, patient representatives, and medical advisors.
The research team designed a semi-structured interview guide that allowed participants to describe in their own words how they conceptualize health and disease, what problematic situations they encounter, and whether they saw solutions to these issues 6 .
The interviews were conducted digitally, averaged 46 minutes, and were transcribed verbatim for qualitative analysis using NVivo software. The diverse participant pool ensured insights across different healthcare contexts 6 .
The study revealed that problematic situations frequently arise when current definitions of health and disease become insufficient for continuing healthcare practices or achieving their goals 6 . Five major types of conceptual problems emerged:
Uncertainty about whether certain conditions should be classified as diseases
Disagreement about when medical intervention is appropriate
Disputes about what conditions deserve healthcare resources
Tension about whether normal life experiences are being pathologized
Difficulties in discussing health and disease across different conceptual frameworks
| Professional Role | Conceptual Challenge | Representative Quote |
|---|---|---|
| Clinical Specialist | Determining disease thresholds | "Where do we draw the line between normal aging and disease? The statistics don't tell us everything." |
| Policy Maker | Resource allocation | "If we classify this as a disease, it automatically becomes eligible for funding—but is that medically appropriate?" |
| Patient Representative | Medicalization concerns | "Patients worry that their normal reactions to difficult life circumstances are being turned into medical disorders." |
| Primary Care Physician | Communication issues | "I struggle to explain why some concerning symptoms don't qualify as diseases under current guidelines." |
Table 3: Representative Quotes from Healthcare Professionals on Conceptual Challenges
Philosophy of medicine provides powerful conceptual tools for navigating complex medical landscapes. Here are some essential instruments from the philosopher's toolkit:
This concept helps distinguish between mere statistical abnormality and genuine pathology. Philosophers have shown that "normal" can refer to statistical averages, ideal types, or proper functioning—each with different implications for medicine 1 .
Disease typically refers to the biological dysfunction, while illness describes the subjective experience of being unwell, and sickness emphasizes the social dimensions of being identified as unwell 1 . This triad helps explain why a person can have a disease without feeling ill, or feel ill without having a recognized disease.
Philosophy examines why certain types of evidence (like randomized controlled trials) are privileged over others (like clinical observation) in evidence-based medicine 4 . This includes critical analysis of the randomization process, blinding, and placebo controls.
Medical diagnosis and treatment depend on concepts of causation—what causes disease, and what causes recovery? Philosophical analysis reveals that medicine employs different causal models at different levels, from molecular pathways to social determinants 5 .
The centuries-old debate between dualism (mind and body as separate substances) and monism (mind and body as unified) continues to influence medical approaches to conditions involving mental components 7 . The rise of the biopsychosocial model represents a more integrated approach.
The philosophy of medicine is far from an abstract academic exercise—it provides the conceptual foundation for virtually every aspect of healthcare. From determining what conditions merit research funding to shaping how doctors communicate with patients, philosophical assumptions operate behind the scenes of medical practice 6 .
The emergence of experimental philosophy of medicine represents a promising development, grounding theoretical debates in empirical evidence about how health concepts actually function across different medical contexts 3 6 .
This pragmatic turn acknowledges that concepts of health and disease must serve the practical needs of patients, clinicians, and healthcare systems.
As medicine continues to evolve—grappling with artificial intelligence, precision medicine, and global health challenges—the insights from philosophy of medicine will become increasingly vital.
By examining the hidden assumptions that shape medical knowledge and practice, this field helps ensure that medicine remains both scientifically rigorous and humanly meaningful 7 .
The next time you visit a doctor, remember that behind the stethoscopes and blood tests lies a rich philosophical landscape that shapes what counts as disease, what treatments are offered, and ultimately, what it means to be healthy.