Many theories define health as the absence of a medical disorder.
But this raises another question:
What is a medical disorder?
Is the concept of medical disorder essentially normative, essentially descriptive, or some combination of the two?
1. Health as an Essentially Normative Concept
One view is that the concept of medical disorder is essentially normative.
On this view, a disorder is something that harms us.
This view is not widely held, except in a certain class of cases.
For most cases, why is this not a commonly held view?
2. Health as an Essentially Descriptive Concept
Bio-Statistical Account
According to the Bio-Statistical Account, health is normal functioning, where normality is statistical and functioning is biological.
On this view:
- The normal is the natural.
- The natural is the healthy.
- The abnormal is the unnatural.
- The unnatural is disordered.
Health is a matter of biological science, not an evaluative decision.
Example for Discussion
Consider a person who is 103.
Genetic tests reveal that she is genetically predisposed to high cholesterol, but she has never developed any symptoms of heart disease.
According to routine medical tests, her cholesterol levels are significantly higher than the population average.
However, she lives an active lifestyle and feels physically well.
Should this person be considered unhealthy based on her biological predisposition, even though she experiences no current symptoms or dysfunction?
3. Health as Both Descriptive and Normative
Harmful Dysfunction Account
According to the Harmful Dysfunction Account, for a condition to be considered a disorder, it must involve both:
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A biological dysfunction: something in the body is not working as it should.
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Harm: the condition causes some form of negative impact on the individual.
Example for Discussion
Color blindness is often used as an example of a biological dysfunction that some argue is not harmful.
Wakefield, however, points out that color blindness does cause limitations, such as difficulties in specific tasks, making it harmful in certain contexts.
Is this enough to define it as a disorder?
4. An Alternative View
Health as Resilience Account
According to the Health as Resilience Account, an individual is healthy to the degree that they are resilient.
Here, resilience means the ability of an individual to maintain functionality, or not die, in many different environments.
The more elements of the world you can change while that person is still able to live, the healthier they are.
Example for Discussion
Consider a pregnant person thriving in a stable, supportive environment with access to modern healthcare, nutrition, and safety.
If placed in a more challenging environment, such as a remote area without adequate healthcare, extreme climates, or limited food and water, they may be less able to maintain functionality and survive because of the physical demands of pregnancy.
That same person, if they were not pregnant, might be able to survive.
According to the resilience-based view, would this pregnant person be considered less healthy because their ability to survive in more varied environments is temporarily diminished?
Questions
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Is health primarily about what is normal, what is natural, what is good for us, or some combination of these?
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Is a medical disorder always harmful? Can something be a disorder even if it does not currently make a person’s life worse?
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Should statistical abnormality matter when we decide whether someone is healthy or unhealthy?
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Can someone be medically abnormal but still healthy?
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Can someone feel healthy but still count as unhealthy according to a medical theory?
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Does the Bio-Statistical Account wrongly treat some harmless differences as disorders?
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Does the Harmful Dysfunction Account depend too much on social context? For example, if color blindness is harmful only in some environments, does that mean whether it is a disorder depends on the kind of society we live in?
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Does the resilience account give us a better way to think about health? Or does it create strange results, such as implying that pregnancy temporarily makes someone less healthy?
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Which account of health seems most useful for doctors? Which seems most useful for philosophers? Which seems most useful for ordinary people trying to understand their own lives?