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by: Melina Mermigas

mindandmedicineclassnotes.docx HPS0612

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Melina Mermigas
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Mind and Medicine with Professor James Woodward January 7-January 21, 2015
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This 12 page Reader was uploaded by Melina Mermigas on Sunday January 25, 2015. The Reader belongs to HPS0612 at University of Pittsburgh taught by in Spring2015. Since its upload, it has received 58 views.


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Date Created: 01/25/15
Mind and Medicine Class Notes 01072015 January 7 2015 What is a disease When does a condition count as a disease For example short stature In some circumstances such as a hormone de ciency it may be On the other hand you may just have short parents less willing to think the condition is a disease Physical conditions have two sides of the issues Mental conditions though becomes trickier ls alcoholism a disease or simply bad behavior Compulsive gambling behavioral condition 0 Many would claim it should be regarded as a disease or on the other hand it could be just a bad behavior Homosexuality o 1970 s vigorous debate removed the mental illness classi cation of homosexuality Repetomania when slaves ran away from their masters they were psychologically ill Need some conception of what a disease is to classify but on what basis Can disease be descriptive terms or logical terms Take the idea that disease is biological then there needs to be some normal baseline If you lack normal functioning then you have the disease if you function normally than you are healthy 0 This is the objectivist descriptive stance on disease classi cation Normative claim value judgment 0 Think that no in addition to biological component there is a subjective or value Descriptive claim true or false yes or no 0 He shot someone Evaluative claims have to do with values normative claims o It was bad to shoot someone Contrast between objective descriptive and subjective normative lf disease is medical then it is science based therefore it is objective 0 There is some natural appeal to the objective descriptive claim Objectivism ts with science value judgments don t enter in Example a short person is regarded as having a disease 0 Now they have more medical treatment and intervention becomes appropriate 0 This then factors into insurance and eligible medical care Why does is matter if it is a disease or not 0 Usually we don t hold people responsible if the condition in question is regarded as a disease 0 Ex committing a crime when you are mentally ill in our legal system there is less responsibility for this action 0 So saying someone has a disease then their behavior is not held accountable in the same way 0 Lees accountability for the actions that are cased by the disease Another issue you pathologize the condition 0 Make it some sort of malfunction as how the body or mind works 0 ln affect you say there is something abnormal or deviant with the behavior 0 Label a behavior as a disease is to patholgize the behavior there is something wrong about the behavior in question Labeling someone as ill has large implications and consequences Value judgments normative are struck by the willingness to label behavior 0 Taking value judgments and turning them into objective 0 when we label something as a disease there is a hidden value judgment when classi cation is done View that is adopted by Thomas Szasc The Myth of Mental Illness The case of most mental illness is that the people with the illness in question were just behaving in ways society disapproved of o In the case of mental illness if you can nd some lesion or dysfunction of the brain that appears to be abnormal you could connect then that may warrant the judgment 0 There had to be some identi able pathology in most cases there just isn t Basically when we labeled people we were just judging the behavior Borst Strong defender of an objectivist 0 Two forms of normativism o On one hand judgments are pure evaluations no descriptive content at all 0 Weaker form disease judgments have both descriptive and normativism 0 When we label it should mean that the condition is the result of some sort of biological malfunction or dysfunction The human body has many different organ systems 0 When functions are disrupted then there is a disease assigned What s wrong with normativism It is perfectly possible to be have a disease that is desirable vs the idea that the condition is undesirable The judgment that it could be bad could be seen as bene cial o Ex at feet was a desirable condition during the draft It is a condition that interferes with ability to walk long distances Therefore it quali es as a disease because it is a condition Ex people who are highly creative suffer from bipolar or depression mood swings However some artists believe that this is apart of the creative process From there point of view depression may be desirable There are undesirable conditions then there are conditions that legitimately are diseases Analogy Intelligence can be measured with IQ test that is an objective approach 0 However the judgment that you have intelligence is good or bad is an additional judgment January 12 2015 Defenders of normativism appeal to examples like the labeling of drapetomania form of mental illness that caused slaves to run away from their masters clearly a value judgment or homosexuality as disease to motivate their position 0 But Boorse s account provides a rather natural treatment of these cases when there is a claim of drapetomania there is no biological grounds for this 0 Key notion is some sort of notion of biological malfunction constitutes disease 0 There are many conditions we regard as undesirable without thinking of them as diseases 0 Opposed to the fact that disease is based on value the condition is bad Issuesproblems of Boorse s account 0 What exactly does biological dysfunction or malfunction mean 0 How can we tell whether such dysfunctions are present o Is there a sharp dividing line 0 This essay the line between normal and dysfunction is not just understood based on statistics 0 Example tooth decay still involves biological malfunction and should be regarded as a disease 0 Suggest that we can clarify things by distinguish between disease andiHness 0 Disease biological descriptive o Illness furtherjudgment that the disease is undesirable Boorse suggest that a disease is an illness if o It is undesirable o A title to special treatment 0 A valid excuse for normally criticizable behavior 0 We can identify disease in plants and in simply fruit ues which re ects the fact that the notion of disease is a biological notion Species typical means that the organ or structure performs in the way that is designed to perform for members of that species in terms of its contribution to survival and reproduction Important point Boorse talks in terms of functions and design does NOT mean that organisms have a designer 0 Rather biologists nd it natural to think of systems as if the were designed to achieve certain functions quotHealth as a Theoretical Conceptquot Boorse s Biostatistics Theory 0 Health is normal functioning 0 Which is statistically typical contribution of all the organism s overall goals of survival and reproduction 0 Group to which a contribution is statistically typical is the reference class speci cally an age group of a sex or race 0 Reference class normal for men is different from normal for women what is typical for a 10 year old is different from a 2 year old 0 Recognizes that statistical normality per se is neither necessary nor sufficient for health 0 Cannot be necessary because unusual can be normal example blood type 0 Teleology goal directed behavior conducing toward some goal 0 One worry this biology appeals to pre Darwinism biology o What is the notion of function at work here 0 The basic notion is the ability to alter behavior or adapt in ways suitable to a goal Ex thermostat maintains temperature if it gets hotter then the thermostat shuts down the system a Adjusts to constantly maintain a certain goal 0 The structures of biological systems function in a similar way This is valid at different levels on the body cells muscles organs 0 Most fundamental goal for the whole organism is survival and reproduction and physiological contribution to this 0 Have to understand this having to do with a trait s standard contribution in some population or reference class January 14 2015 Boorse says the crucial question to ask is quotthe organism as a whole are functioning in a normal wayquot and this normal is understood statistically in a sense that normal means quotnot rare in reference classquot 0 The idealization is statistical not moral or esthetic or normative in any other way 0 This is the typical species design o Is this inconsistent with Darwin No many traits driven to xation in population absence of signi cant genetic variation 0 Almost all individuals in the population will have the trait in ques on What about traits that are not universal o Polymorphic different forms of the traits o No one form of which is yet xes in the population can sometimes be included in the species design 0 Being on the tails of the distribution contribute to having or possessing such a dysfunction What about universal or statistically common diseases Gum disease lung irritation benign hypertrophy of the prostate in old men 0 Not statistically abnormal but Boorse says don t worry about this there could be other explanations to this The Normativist View opposed Boorse s view Maroglis is a normativist of disease 0 He does not think that judgments of disease can be grounded in claims about departure from natural biological function 0 Typically grounded in social expectations 0 quot a lapse of some sort with respect to given norms of healthquot Norms have little change of the years 0 Avoid many of the same bodily conditions that the ancient Greeks wanted to avoid Judgment of health and disease are norm dependent Role of value judgments become more obvious as medicine expands to include the concerns of mental health and mental illness Consider ageing Whether or not we regard something as a disease is whether or not it is treatable If there is a drug that treats age then society would begin to adjust its expectations and social arrangements to increase longevity Thinks this accounts forjudgment in cases like sick cell 0 Hard to defend claim that this involves biological dysfunction in any clear sense judgment of disease just founded o undesirability of condition Unlike Boorse Margolis says that there is no scienti c judgments he thinks we are importing some value judgment Some problems consider alcoholism Generally considered as undesirable state then conclude it is a disease Seems controversial in that there is something more involved in the judgment of disease January 21 2015 The Myth of Mental Illness the anti psychiatry movement 0 Emerges in the 1960 s Some Themes 0 Speci c de nitions of hundreds of diagnosis or disorder are vague and arbitrary 0 Fall to meet basic scienti c standards 0 Prevailing psychiatric treatments are often more damaging than helpful to patients 0 Patients who are odd different or eccentric have quotproblems living quot 0 Stigmatized as mentally ill 0 Why Unclear and ill de ned category of mental illness 0 Had real problems but questioned whether or not it could be mental illness Another thought 0 The people we think are suffering from mental illness were simply people that saw the world differently than us 0 Problems quotmentally illquot had were socially rather than individually caused The problems were truly caused by living in an alienated society rather than the problem with the individual o If you think about it this way treatment should not be the individual through drugs behavior change rather through society Key concepts Inappropriate overuse of medical concepts and tools to understand mind and society 0 Miscategorized of normal reactions to extreme situations as psychiatric disorders Overreliance on drugs to treat psychiatric problems o Tendency to downplay usefulness of other sorts of therapies such as talk therapies contrast between treating to conditions vs intervening the condition some other way 0 Abuse of power and authority relations when patients are treated or institutionalized against their will Suggests that mental illness is in roughly the same category as possession by witches or the devil or other supernatural explanations Szasz notion of illness only makes sense if you can give it a biological or physiologic phenomenon o It implies the notion of abnormal biological functioning There are certainly some cases in which mental illness is directly attributed to some sort of brain malfunction o Mentions untreated syphilis leading to brain lesions that are anatomical discernable and also to behavior that is described as insane Szasz does not deny that such people have problems but Denies that at least in many cases it is inappropriate to think of them as ill or sick 0 Rather problems in living 0 Usually these cases are thought as people that occupy some sort of position on a continuum 0 There is no reason to think some sort of brain dysfunction or abnormality is present Study Soup 0 Update once a week Study guides four days before the exam 0 Create a way for the students can access the notes January 12 2015 Argument 0 String of premises concepts that you think your audience will agree with 0 Example of premises all humans are mortal Socrates is a human 0 Conclusion Socrates is mortal Another example 0 Premise all dogs have fur ginger has fur Conclusion ginger is a dog 0 There are other things that Ginger could be Helpful strategy replace all the content terms with variables 0 Al B 0 C is A 0 Then C is B o This is called a deductive argument Boorse article Concludes that disease is equivalent to biological malfunction o What you want to show that disease shows malfunction and that malfunction shoes disease the two premises Function goal related some type of ending result 0 De nes notion as the reference class cases with what you compare the individual in question King Concludes that disease is abnormality Premises disease is abnormal abnormal is disease o What is the issue with this pregnancy is not the average state however it is not a disease this proves the second premise false therefore counters the argument 0 Another strategy would be to deny the rst claim show that tooth decay is recognized as a disease but is not abnormal fairly common Homosexuality Back away from the claim that it is a disease 0 Reference class well de ned notion that can be applied generally 0 No clear indication as to when you stop making the reference more narrow sexual preference 0 lmplicitly you have to be comparing homosexuals to heterosexuals but it is not clear if that is a sound comparison Descriptive capture in some sense the notion of disease Normative recommendation of de nite Is this person accurately describing the way we think of disease Is this practicable or notionable Bodily Illness Mental Illness and Natural Kinds Conclusion mental illness involves problems of living some of which many be moral in nature while bypassing the debate about the meaning of concept illness 0 Symptoms can be scienti cally explained o Cluster B PD still treated but is it just bad virtue Criteria for illness involves a deviation from the normal anatomical or physiological structure and functioning of the human body lllness has negative connotations just as health has positive ones Thinks we should aim to extract the scienti c core of the concept of iHness Deviations are said to be biologically de ned His claim mental illness is a deviation form psychosocial ethical and legal norms Cultural deviation a failure to conform to normal physical and psychological behavioral expectations lf science ultimately proves evidence for an organic biological basis for mental illness it would count as a real illness 0 Most likely be a deviation from the normal brain structure or functioning of a human brain Objection what is the de nition of illness 0 No measure for determining how much deviation is required for iHness lllness is a dysfunction which is likely to reduce life of reproductive expectancy Szasz holds two claims 0 Particular kinds of mental illness prove to be valid scienti c kinds 0 Concept of mental illness involves a deviation from psychosocial ethical and legal norms Water example 0 Concept of water is not determined by super cial properties RATHER determined by underlying scienti c properties such as chemical composition 0 Only something that has chemical composition and scienti c properties can be water Our concept of illness 0 Whether mental or physical lie at the interface of science and common sense of fact and value as well as a large degree of cultural and historical development and variation Scizophrenia example


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