Dear Students!
Our next speaker on the 14th of February will be Somogy Varga and he will talk about: "Defining Mental Disorders"
He graciously let us have his whole book "Naturalism Interpretation and Mental Disorder", but you only need to read Chapter 7!
Please post your comments not later than Tuesday afternoon!
Varga, S. (2015). Naturalizing biological function. In Naturalism, Interpretation, and Mental Disorder. (pp. 145-182). Oxford, UK: Oxford University.
ReplyDeleteSeveral arguments exist to explain how to identify and characterize disorders. Natural function naturalism proposes that disorder is a failure of functioning, and highlights the fact that disease is theoretical; dysfunction in any system is relative to those being compared. This view is supported by the biostatistical account which claims that “health is the absence of disease” (p. 146), and the presence of disease is a statistically significant deviation from perfect health. This raises the question of who does and should have the epistemological authority to assign a diagnosis. A version of this account, the evolutionary-homeostasis concept of health, assumes that the homeostasis of an individual (i.e., health) is maintained by internal and external systems. This view explains the concept of health, but not disease; however, it emphasizes the utility of a normal "range." Finally, the harmful dysfunction account, in line with evolutionary theory, combines objective and value-added terms to define disease. In particular, it adds emphasis to what qualifies as dysfunction in the context of social norms.
In this chapter, Varga attempts to define diseases and disorders through the lens of natural function naturalism—that is, diseases and disorders involve a deviation from “natural” or “normal” functioning of an organism, and malfunctioning of parts of an organism due to disorder can be distinguished from proper health by scientific, objective, and value-free criteria. Specifically, Varga mainly focuses on two accounts of defining and differentiating health and disease: biostatistical theory (BST) and the harmful dysfunction account (HD). According to BST, health represents normality and the absence of disease, and normal function can be studied as the causal contribution to the goals pursued by the organism according to statistically typical behavior. Disease, therefore, is a deviation from the biological design of the species, whether an impairment of proper physiological or psychological functioning of the organism. Under the HD account, a disorder is a “harmful dysfunction” whereby “harmful” is judged negative by sociocultural standards and “dysfunction” is a scientific, factual term. Therefore, a disease causes some detriment or deprivation of benefit to the individual as judged by the individual’s culture. The HD account does acknowledge a “fuzziness” or lack of a clear boundary between disorder and non-disorder (reminiscent of Mundy’s view on autism spectrum disorder). While both the BST and HD account attempt to propose an objective, value-free definition of health and disease, Varga also outlines flaws and weaknesses of each argument in this chapter that may limit the potential scope of defining diseases and disorders in these ways.
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DeleteJessica Yoo
DeleteIn chapter 7, Varga talks about another naturalist perspective that all disorders are not “natural” and that they are aberrations from what is supposedly “normal”. He presents two theories of Boorse and Ananth that explain what is really “natural” functioning. Boorse’s biostatistical theory (BST) indicates that disease is only a weaker biological state and should be regarded objectively. Human’s healthy body's natural purpose is to survive and reproduce, and disease reduces this healthy state through weakening its functions. Normal functioning, therefore, equals health. While the term illness has negative connotations in medical field, Boorse states that disease simply describes a condition that has a neutral definition. One problem the BST theory faces is that the reference class has a fuzzy line of determining what is disease and what is health. Boorse claims that in order to understand what disease is, we have to see it from a biological point of view. However, he is aware of that different parts of biology may have different understandings of function and emphasizes that it is towards the physiological aspects of health. Varga raises a question of pathologists really having epistemic authority in BST theory, since different expert groups have different answers. Both statisticians and pathologists’ view on the theory may overlap. A modified Ananth’s view of Boorse’s theory (evoluntionary-homeostasis concept of health- EHCH) is explained later in the chapter, that when the organism’s internal parts are functioning that attributes to the healthy state of the organism as a whole, it is considered healthy. Environmental factor is also included to the reference class. Instead of focusing on the conceptual aspects, he focuses on an evolutionary foundation. Wakefield’s Harmful Dysfunction (HD) theory shares more similarity with that of BST in which they depend on conceptual analysis, along with social and cultural framework.
Chapter 7: Naturalizing Biological Function
ReplyDeleteThis chapter has discussed "natural function naturalism" term and attempted to objectively identify a particular condition as disease. Main point of this debate is that value-laden evaluations are not necessary in order to decide whether there is a dysfunction. Boorse biostatistical theory and Ananth's modification of the theory is viewed as objectively driven inferior part of biological state. A particularly stimulating version of natural function naturalism is also discussed in the last part of the chapter. Wakefield’s prominent “hybrid” account of mental disorder maintains the aim of providing a naturalist account of disease, is partly motivated by the desire to clarify mental health controversies and to contribute to discussions of categorical and dimensional criticism.
ReplyDeleteWhat is needed to deem something diseased or dysfunctional? According to the naturalist view, disease or dysfunction can be explained by natural functions. There are different ways that this concept can be understood. This chapter provided an overview of naturalist theories of the distinction between health and disease. First, Varga (2015) introduces the concept of Boorse’s biostatistical theory (BST) which is one of the first attempts to account for disease or mental illness through the biological functions of humans as goal-driven. Moreover, the BST attempts to account for “causal contributions” by using a “reference class” to create a norm for comparison. The text goes on to outline the premise of BST, potential limitations, and other naturalist theories (i.e. evolutionary-homeostasis concept of health (EHCH), harmful/hybrid distinction (HD), evolutionary theory, the persistence explanation, and the mismatch explanation). The chapter assigned for this week’s reading provided a great deal of information and methodology. As I currently understand it, the main argument of a natural function naturalist view is that disease can be explained by our biological functions and the underlying “subsystems”. By comparing groups that deviate from norms created from reference classes, the distinction between health and disease can be assessed statistically. The reference classes need to be chosen carefully and are an integral part of the theory. Because this group is being used for comparison, they must be carefully considered to be objective matches in sex and age to the group that deviates.
I found the concept of value-laden versus value-free difficult to understand. Is it that disease does not necessarily need to be viewed as harmful (value-laden) to the species but deviations from the norm (value-free)? As I understand it the naturalist view is value-free, leaning more toward pathology than medical evaluation to distinguish health and disease. Varga refers to this as “epistemic authority” or who should be trusted as the authority on making the distinction? I think this may be an oversimplification on my part, but I hope we unpack this part of the concept during our discussion.
In this chapter, Varga presents various approaches to defining disease within a naturalist framework that asserts that disease can be defined scientifically and objectively without resorting to value-laden judgements. A key principle of the naturalist framework of disease is that the dysfunction of a biological system is defined relative to the natural function of the biological system. Adherents of the naturalist framework argue that the natural function of a biological system or sub-system is objectively knowable. Varga analyzes the virtues and shortcomings of two similar approaches to defining disease within a naturalistic framework: Biostatistical Theory (BST) and Harmful Dysfunction Theory (HD). BST emphasizes that function and dysfunction can best be understood relative to the normative function of a particular reference class (e.g. gender and age groups). On the other hand, HD defines function and dysfunction in terms relative to the evolutionary purpose of a biological system or subsystem. Vargas argues that both BST and HD fall short when they fail to provide a consistent account for defining disease when faced with challenges regarding the standards used to determine the normality and purpose of biological systems.
ReplyDeleteNatural function naturalism is one approach to further defining the distinction between normal and disordered populations although admittedly this distinction is a fuzzy and somewhat arbitrary boundary. The primary goal of this approach is to provide a more objective, value-free description of health and disease. This view describes disease as "a deviation from the proper physiological or psychological functioning of parts of the human organism." Boorse's biostatistical theory (BST) suggests that disease must be related to a biological disadvantage as well as deviation from statistical normality in function. This theory heavily relies on the reference class and an epistemic authority's definition of disease. Wakefield's harmful dysfunction (HD) account is described as a hybrid theory that incorporates aspects of both dysfunction and value-laden "harm" to the individual founded in cultural context. This account also includes evolutionary influences; however, some explanations of these influences are also noted as potential limitations of this theory.
ReplyDeleteNaturalizing biological function. In Naturalism, Interpretation, and Mental Disorder.
ReplyDeleteThis chapter deals with identification and definition of diseases and lays a theoretical groundwork that any given ‘abnormality’ in a body must fit in order to be classified as a disease or disorder. Varga uses this theoretical groundwork as a means to also state that value-laden assessment is not required for classification of diseases. Two different theories pertaining physical and mental disorders are being used here to act as reference point for classification of diseases. Boore’s biostatistical theory (BST) and Wakefield’s harmful dysfunction (HD). BST defines health as an absence of disease while presence of a disease is classified as inconsistencies in perfect health. Varga provides few cases where BST fails to address or displays a distorted view to address a disease and even if its accepted as a disease, cure for it should not be necessary? Which raises the question of whether or not BST should be references for identification of all dysfunction in a body as disease. HD tries to devise a distinction in mental condition as disorder or it being a natural process of evolution. It does so by defining a mental disorder as a condition which results in the failure of one’s internal system to perform an action for which it was intended.