What We Argue about when We Argue about Disease





Concepts of health and disease, Natural kinds, Conceptual analysis


The disease debate in philosophy of medicine has traditionally been billed as a debate over the correct conceptual analysis of the term “disease.” This paper argues that although the debate’s participants overwhelmingly claim to be in the business of conceptual analysis, they do not tend to argue as if this is the case. In particular, they often show a puzzling disregard for key parameters such as precise terminology, linguistic community, and actual usage. This prima facie strange feature of the debate points to an interesting and potentially instructive hypothesis: the disease debate makes little sense within the paradigm of conceptual analysis but makes good sense on the assumption that pathology is a real kind.


Boorse, Christopher. 1975. “On the Distinction between Disease and Illness.” Philosophy & Public Affairs 5, no. 1: 49–68. http://www.jstor.org/stable/2265020.

———. 1977. “Health as a Theoretical Concept.” Philosophy of Science 44, no. 4: 542–573. https://doi.org/10.1086/288768.

———. 1997. “A Rebuttal on Health.” In What Is Disease?, edited by James M. Humber and Robert F. Almeder, 1–134. Totowa, NJ: Humana Press. https://link.springer.com/chapter/10.1007/978-1-59259-451-1_1.

———. 2002. “A Rebuttal on Functions.” In Functions: New Essays in the Philosophy of Psychology and Biology, edited by Andre Ariew, Robert C. Cummins, and Mark Perlman, 63–112. Oxford: Oxford University Press.

———. 2011. “Concepts of Health and Disease.” In Philosophy of Medicine, edited by Fred Gifford, 13–64. Oxford: North-Holland.

———. 2014. “A Second Rebuttal on Health.” Journal of Medicine and Philosophy 39, no. 6: 683–724. https://doi.org/10.1093/jmp/jhu035.

Boyd, Richard. 1999. “Homeostasis, Species, and Higher Taxa.” In Species: New Interdisciplinary Essays, edited by Robert A. Wilson, 141–185. Cambridge, MA: MIT Press.

Cooper, Rachel. 2002. “Disease.” Studies in History and Philosophy of Science Part C: Studies in History and Philosophy of Biological and Biomedical Sciences 33, no. 2: 263–282. https://doi.org/10.1016/S0039-3681(02)00018-3.

———. 2004. “Why Hacking Is Wrong about Human Kinds.” British Journal for the Philosophy of Science 55, no. 1: 73–85. https://doi.org/10.1093/bjps/55.1.73.

———. 2018. “Understanding the DSM-5: Stasis and Change.” History of Psychiatry 29, no. 1: 49–65. https://doi.org/10.1177/0957154X17741783.

———. 2020. “The Concept of Disorder Revisited: Robustly Value-Laden despite Change.” Aristotelian Society Supplementary Volume 94, no. 1: 141–161. https://doi.org/10.1093/arisup/akaa010.

Cooper, Rachel and Roger K. Blashfield. 2016. “Re-evaluating DSM-I.” Psychological Medicine 46, no. 3: 449–456. https://doi.org/10.1017/s0033291715002093.

Culver, Charles M. and Bernard Gert. 1982. Philosophy in Medicine: Conceptual and Ethical Issues in Medicine and Psychiatry. Oxford: Oxford University Press.

Deutsch, Max. 2021. “Conceptual Analysis without Concepts.” Synthese 198, no. 11: 11125–11157. https://doi.org/10.1007/s11229-020-02775-0.

Fagerberg, Harriet. 2022. “Reactive Natural Kinds and Varieties of Dependence.” European Journal for Philosophy of Science 12, no. 4, article 72. https://doi.org/10.1007/s13194-022-00500-x.

———. 2023. “Medical Disorder Is Not a Black Box Essentialist Concept: Review of Defining Mental Disorder: Jerome Wakefield and His Critics, edited by Luc Faucher and Denis Forest.” Philosophy of Medicine 4, no. 1: 1–9. https://doi.org/10.5195/pom.2023.165.

Godman, Marion, Antonella Mallozzi, and David Papineau. 2020. “Essential Properties are Super-Explanatory: Taming Metaphysical Modality.” Journal of the American Philosophical Association 6, no. 3: 316–334. http://dx.doi.org/10.1017/apa.2019.48.

Horwitz, Allan V. and Jerome C. Wakefield. 2007. The Loss of Sadness: How Psychiatry Transformed Normal Sorrow into Depressive Disorder. Oxford: Oxford University Press.

———. 2012. All We Have to Fear: Psychiatry’s Transformation of Natural Anxieties into Mental Disorders. Oxford: Oxford University Press.

Khalidi, Muhammad Ali. 2013. Natural Categories and Human Kinds: Classification in the Natural and Social Sciences. Cambridge: Cambridge University Press.

———. 2018. “Natural Kinds as Nodes in Causal Networks.” Synthese 195: 1379–1396. https://doi.org/10.1007/s11229-015-0841-y.

Lemoine, Maël. 2013. “Defining Disease beyond Conceptual Analysis: An Analysis of Conceptual Analysis in Philosophy of Medicine.” Theoretical Medicine and Bioethics 34, no. 4: 309–325. https://doi.org/10.1007/s11017-013-9261-5.

Machery, Edouard. 2009. Doing without Concepts. Oxford: Oxford University Press.

Millikan, Ruth G. 1989. “In Defense of Proper Functions.” Philosophy of Science 56, no. 2: 288–302. https://doi.org/10.1086/289488.

———. 2000. On Clear and Confused Ideas: An Essay about Substance Concepts. Cambridge: Cambridge University Press.

———. 2017. Beyond Concepts: Unicepts, Language, and Natural Information. Oxford: Oxford University Press.

Murphy, Dominic and Robert L. Woolfolk. 2000. “Conceptual Analysis versus Scientific Understanding: An Assessment of Wakefield’s Folk Psychiatry.” Philosophy, Psychiatry & Psychology 7, no. 4: 271–293. https://muse.jhu.edu/article/28365.

Neander, Karen. 1991. “Functions as Selected Effects: The Conceptual Analyst’s Defense.” Philosophy of Science 58, no. 2: 168–184. https://www.jstor.org/stable/187457.

Nordenfelt, Lennard. 1987. On the Nature of Health: An Action-Theoretic Approach. Dordrecht: D. Reidel.

———. 1995. On the Nature of Health: An Action-Theoretic Approach. Dordrecht: Springer Science & Business Media.

———. 2001. Health, Science, and Ordinary Language. Amsterdam: Rodopi.

———. 2007. “The Concepts of Health and Illness Revisited.” Medicine, Health Care and Philosophy 10, no. 1: 5–10. https://doi.org/10.1007/s11019-006-9017-3.

———. 2018. “Functions and Health: Towards a Praxis-Oriented Concept of Health.” Biological Theory 13, no. 1: 10–16. https://doi.org/10.1007/s13752-017-0270-x.

Papineau, David. 2009. “The Poverty of Analysis.” Aristotelian Society Supplementary Volume 83, no. 1: 1–30. http://dx.doi.org/10.1111/j.1467-8349.2009.00170.x.

Reznek, Lawrie. 1987. The Nature of Disease. New York: Routledge.

———. 1995. “Dis-ease about Kinds: Reply to D’amico.” Journal of Medicine and Philosophy 20, no. 5: 571–584. https://doi.org/10.1093/jmp/20.5.571.

Sawyer, Sarah. 2020. “Truth and Objectivity in Conceptual Engineering.” Inquiry 63, no. 9–10: 1001–1022. https://doi.org/10.1080/0020174X.2020.1805708.

Spitzer, Robert L and Jean Endicott. 2018. “Medical and Mental Disorder: Proposed Definition and Criteria.” Annales Médico-psychologiques, revue psychiatrique 176, no. 7: 656–665. https://doi.org/10.1016/j.amp.2018.07.004.

Szasz, Thomas S. 1960. “The Myth of Mental Illness.” American Psychologist 15, no. 2: 113–118. https://doi.org/10.1037/h0046535.

Wakefield, Jerome C. 1992. “The Concept of Mental Disorder: On the Boundary between Biological Facts and Social Values.” American Psychologist 47, no. 3: 373–388. https://doi.org/10.1037//0003-066x.47.3.373.

———. 1997. “Diagnosing DSM-IV—Part I: DSM-IV and the Concept of Disorder.” Behaviour Research and Therapy 35, no. 7: 633–649. https://doi.org/10.1016/S0005-7967(97)00018-1.

———. 1999. “Evolutionary versus Prototype Analyses of the Concept of Disorder.” Journal of Abnormal Psychology 108, no. 3: 374–399. https://doi.org/10.1037//0021-843x.108.3.374.

———. 2000. “Spandrels, Vestigial Organs, and Such: Reply to Murphy and Woolfolk’s ‘The Harmful Dysfunction Analysis of Mental Disorder’.” Philosophy, Psychiatry & Psychology 7, no. 4: 253–269. http://dx.doi.org/10.1353/ppp.2000.0040.

———. 2007. “The Concept of Mental Disorder: Diagnostic Implications of the Harmful Dysfunction Analysis.” World Psychiatry 6, no. 3: 149–156. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2174594/pdf/wpa060149.pdf.

———. 2014. “The Biostatistical Theory versus the Harmful Dysfunction Analysis, Part 1: Is Part-Dysfunction a Sufficient Condition for Medical Disorder?” Journal of Medicine and Philosophy 39, no. 6: 648–682. https://doi.org/10.1093/jmp/jhu038.

———. 2015. “DSM-5, Psychiatric Epidemiology and the False Positives Problem.” Epidemiology and Psychiatric Sciences 24, no. 3: 188–196. https://doi.org/10.1017/S2045796015000116.

———. 2016. “Diagnostic Issues and Controversies in DSM-5: Return of the False Positives Problem.” Annual Review of Clinical Psychology 12 :105–132. https://doi.org/10.1146/annurev-clinpsy-032814-112800.

———. 2021. “Quinian Qualms, or Does Psychiatry Really Need the Harmful Dysfunction Analysis? Reply to Harold Kincaid.” In Defining Mental Disorder: Jerome Wakefield and His Critics, edited by Luc Faucher and Denis Forest. Cambridge, MA: MIT Press. https://doi.org/10.7551/mitpress/9949.003.0011.




How to Cite

Fagerberg, H. (2023). What We Argue about when We Argue about Disease. Philosophy of Medicine, 4(1). https://doi.org/10.5195/pom.2023.172



Original Research Articles (health, disease and illness)