A Schema for Approaching Concepts with Shared Medical and Biological Usage

Abstract

Although professionally distinct, there are areas of interest that both human biologists and those associated in various ways with clinical medicine increasingly have in common. The subject of disease, once a typically medical preserve, is now a topic of increasing academic interest, as is health. However, a particular problem arises concerning concepts such as these in that they are essentially non-technical terms belonging to ordinary speech. With the rise of modern biomedicine, these words continued to be used, without specialist qualification, even though their explanatory context continued to change. It is now the case that, unwittingly, these and other associated terms, are used somewhat uncritically and lack the level of scientific precision assumed of objects of serious academic interest. Rather than rely upon the supposed meanings of such words, it is important that attention is given to their conceptual basis so that they may achieve greater precision and distinctiveness. This poster forms the basis of a new updatable webpage allowing modifications and further developments will be presented periodically. Instead of a formal discourse, it takes the form of a structured schema whereby various concepts and issues may be addressed, expanded and added to in such a way that the subject may be built up from within.

The Need for Conceptual Analysis in Biomedicine

In the overlap of interests that clearly exists between medicine and biology, there is a tendency to overlook the fact that certain key terms such as illness, disease, health etc. are 'anthropological terms' rather than strictly medical or scientific ones (Nordenfelt 1995, 2001). Terms such as these are essentially lay concepts, existing first in ordinary speech, which have come to be used within a medical context. In so doing, these terms help facilitate communication between patient and clinician and must continue to operate in this manner. However, these and other related terms are increasingly coming to be used within biological contexts as a non-clinically orientated academic interest in 'Health Science' and 'Health Studies' continues to develop. While clinical practice is seemingly able to cope without the need for a significant degree of terminological precision, this is not the case where academic involvement is concerned and a much higher degree of precision is necessary. However, little attention appears to have been given to ensuring this to be the case and certain terms continue to be used uncritically by biologists to the extent that certain lay terms tend to be used as if they had scientific veracity. To this end, the on-going philosophical analysis of key medical terms (Boorse 1975, 1976, 1977, 1987, 1997; Fulford 1989, 1993; Nordenfelt 1986, 1993a, 1993b, 1995, 1997, 2000, 2001; Nordenfelt and Lindahl 1984; Reznek 1987) should be extended to include a conceptual analysis of the same from an essentially biological perspective. However, the question arises as to how this is best undertaken and, furthermore, as to how the findings of such an analysis can be made accessible to those who do not choose to follow the philosophical literature.

Building Conceptual Formulations

In order for biological scientists to become more aware of the conceptual analyses concerning terms with shared medical and biological usage, they must go outside their usual field of expertise and into that of the philosophy of medicine. This is perhaps not a field that many scientists would feel comfortable entering. It is made more daunting by the fact that various differences of opinion exist as to how various terms should be defined and there is much material in need of sifting and evaluation. Furthermore, a strictly biological approach to this matter has yet to be attempted so that one must contend with primarily medically-orientated material.

Thus, what the biologist needs is, firstly, some form of pre-structuring of relevant terms so that they do not all appear on a par but have some sense of order, and secondly, be provided with a synopsis or collection of material that can be easily consulted. Ideally, both of these should be easily revisable as necessary.

Presented below is a schema that offers, in diagrammatic form, a way of going about this by setting out certain key terms commonly found where medicine and biology intersect.

A note on the use of schemata –

The word schema comes from the Greek word 'σχήμα' (skhēma) meaning a shape or a plan. A schema may be considered as being a representation or formal way of trying to organize a set of concepts (or the like) that can be revised as new information appears.

See: Updated Version

The Schema

The present schema has two parts: an axis, which consists of a link between 'Questions in Biomedicine' – via 'Potential Solutions' (to these questions) – to 'Implications for Biomedical Thinking' (which result therefrom) plus a set of bracketed terms running alongside. Here the phrase 'Questions in Biomedicine' is used in a generic sense and does not necessarily refer to a specific set of questions – although, in the philosophy of medicine, these are indeed formulated from time to time (Edwards 1972; Nordenfelt 2001; Reich 1995). Since solutions to such questions inevitably have implications for the development of further thinking, a feedback loop exists as shown.

The questions asked frequently rely upon a conceptual understanding of certain key terms. It is these that are shown bracketed to the left and running parallel to the axis. (An indication of the linkage between the two is given by the dashed line.) The conceptual meaning of each of the bracketed terms is important as they inform and affect both the meaning of the questions asked, their potential solutions and the thinking that ensues.

The order in which the bracketed terms is given is significant. It is suggested here that the order in which different terms are considered influences both how they are understood and how subsequent terms in the sequence may be understood.

Here, the terms are set out beginning with one of the three modes of 'unhealth' discussed by Marinker (1975): illness. (The other two modes of 'unhealth' – disease and sickness – appear lower down in the sequence and not in the order Marinker used.) It is the author's contention that the notion of illness is fundamental to our understanding of all other associated terms; that next, the concept of pathology (and that which is 'pathogenic') needs to be understood separately from and prior to disease and that the juxtaposition of lesion and pathology is needed to demonstrate the looseness with which the latter is currently used – and, as a consequence, help combat this.

Health appears below the aforementioned modes of 'unhealth' not because it is assumed that health is simply the absence of these states but because the author also contends that health can only be fully understood by comparison with and contrast to different states of 'unhealth'. This is in marked contrast to the position outlined by Khushf (in Nordenfelt 2001). Health is also juxtaposed with the terms 'normal' and 'neutral'. There is a tendency in some quarters to equate being healthy with being 'normal' – where 'normal' refers to some notion of statistical average for a population or a species. But there is an alternative: that of equating health with a more 'neutral' (Galen in Nordenfelt 1997) or silent (Leriche in Canguilhem 1966 (trans 1978)) biological state of the individual as an organism.

Sickness, Marinker's final mode of 'unhealth', is included under the heading 'Other Terms' because, although it is sometimes used synonymously with illness and even disease, it also has an accepted technical sense that is quite separate: 'Sickness is a social role, a status, a negotiated position in the world, a bargain struck between the person henceforward called 'sick', and a society which is prepared to recognise and sustain him' (Marinker 1975).

Not only are there implications for biomedical thinking when various questions in biomedicine are formulated and addressed, there are also implications for the understanding of more fundamental biological notions such as the concept of the organism and that of life itself. An indication of this, and how this also feeds back into the formulation of subsequent biomedical questions, has also been included.

The production of a web-based version of this diagram is being explored. This is intended to provide a means whereby those working outside the field of the philosophy of medicine can gain access to web pages providing a synopsis of how different terms are currently viewed by different authorities. It is intended that the initial version be based upon this diagram and use hyperlinks from terms currently underlined and italicized to sub-pages where updateable material can be collected.

References

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Boorse, C. (1976) What a Theory of Mental Health Should Be. Journal for the Theory of Social Behaviour 6: 61-84.

Boorse, C. (1977) Health as a Theoretical Concept. Philosophy of Science 44: 542-573.

Boorse, C. (1987) Concepts of Health. In: Health Care Ethics: An Introduction. D. Van De Veer and T. Regan. Philadelphia, Temple University Press: 359-393.

Boorse, C. (1997) A Rebuttal on Health. In: What Is Disease? J. Humber and K. Almeder. Totowa, New Jersey, Humana Press.

Canguilhem, G. (1966 (trans 1978)) On the Normal and the Pathological. Dordrecht, D. Reidel Publishing Company.

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