Objectivist versus Constructivist in Health and Illness - Essay Example

?Running head: Objectivist versus constructivist Objectivist versus Constructivist in Health and Illness Objectivist versus Constructivist Introduction The delivery of healthcare services is considered one of the most essential social services of any country and government institution. All governments are expected to make healthcare services available to the public and to some extent, these services are freely available or partially available to the general population. Two theories are often utilized in order to adequately understand the delivery of health services and to understand the concepts of health and illness. This paper shall now consider the debate regarding the objectivist and constructivist concepts of health and illness. It shall argue for the acceptance of one philosophical account over the other. It shall provide an analysis, comparison, and evaluation of both theories in relation to health and illness. This study is being carried out in the hope of establishing a thorough and comprehensive understanding of these theories in relation to health and illness. Discussion The current trends in philosophical thinking have focused on defining disease concepts as those which involve experiential assessments on human physiology and on human behavior and well-being (Bloomfield, 2001). First and foremost, people have beliefs about the normal functioning of their bodies based on their natural and logical expectations of physiology. Secondly, people make generalizations about how a way or condition of life is true or not. These generalizations are based on normative principles which are concerned with the “extent to which a life is unnatural, undesirable or failing to flourish in some way” (Murphy, 2008). A crucial issue is on the judgments which people make about their physiology and whether they are also considered normative. A bigger question is on the impact of both judgments in the scientific field of medicine and in simple matters of common sense. A dilemma unearthed in understanding health and illness is the fact that our usual and traditional judgments determine who are considered ill or diseased. Such traditional views have not created as much impact on philosophy, but they have registered a significant impact in other areas, including humanities and social sciences (Kennedy, 1983). Some objectivists believe that there are details about the human physiology upon which the concept of diseases is founded. But constructivists point out that this is a major deception. Instead, these constructivists point out that the disputed cases indicate how the different beliefs of social groups come into conflict with each other, and agreements are sometimes ensured because the system of values have been generally accepted (Murphy, 2008). Kitcher has been one of the first who has considered the objectivism and constructivism concepts in healthcare (Sarkar and Plutynski, 2010). These two theories have also been referred to as naturalism and normativism. Kitcher’s analysis is based on unclear facts about the human body. It is therefore crucial to create definite generalizations for objectivism and constructivism. First and foremost, the objectivist understanding of disease is that our human body is made up of different organs which have normal functions upon which they can depart in different ways (Murphy, 2008). These departures can either be harmless or sometimes harmful to humans. Those which are harmful manifest as diseases. A disease in this understanding is therefore based on normal functioning of the body and a general judgment of a result being something ‘abnormal’ or a departure from the natural. Objectivists believe that establishing the presence of a disease is a matter for science and that normative evaluations are the foundations of such judgment (Boorse, 1997). In effect, the objectivists believe that disease is a physiological malfunction which causes a life to deteriorate. Such a malfunction can manifest in different ways. Diseases may not be of the natural kind, but they may consist of naturally occurring elements which are grouped together as a class (Murphy, 2008). Higher and super-ordinate classes are based on human interests and those grouped under it are natural classes with natures which can be assessed scientifically. On the other hand, constructivism sets forth that human interests are not there to delimit super-ordinate classes of disease (Chiari and Nuzzo, 2009). The human concerns, not the physiological abnormalities give logic to the judgments for subordinate members having relevant physiological qualities. Even if constructivists believe that the groupings of diseases are based on known or unknown physiological processes, they however do not agree that such processes can be referred to independently of human values (Murphy, 2008). Constructivist conceptualizations of disease are normative and traditional, however the actual number of crucial norms are different for various scholars. Nevertheless, the main constructivist argument is that there is no natural or normal set of human abnormalities or malfunctions which lead to disease. Instead, constructivists argue that to label a condition a disease is to rule that a person is going through some issue which is related to abnormal bodily processes (Murphy, 2008). However, in the objectivist sense, bodily processes are judged as not properly functioning; they are also assessed by most people as abnormal because they do not conform to our shared understanding of human nature. The significant difference between the two theories is that for objectivists, diseases are “objectively malfunctioning biological processes that cause harms. For a constructivist, diseases are harms that we blame on some biological process because it causes the harm, not because it is objectively dysfunctional” (Murphy, 2008). Constructivism is difficult to define with utter satisfaction because firstly its essential claim is based on the denial of the objectivist principles that diseases always involve physiological malfunctions. Due to the different views on the essence of the physiological processes seen in diseases which fit the denial of malfunction, the constructivists’ views are different across theories. Theorist Reznek (1987) denies the fact that malfunctions need to be present for a disease to manifest. He however also insists that diseases do involve physiological abnormalities; however, he does not further elaborate on this belief. Constructivists insist that disease judgments fit physiological processes which are to be understood in relation to human practices, not memberships in biologically-defined abnormalities (Murphy, 2008). Another reason why constructivism cannot be easily defined is the fact that it has often been based on value judgments in medicine or on disagreements about abnormal physiology. In effect, constructivists do not necessarily offer adequate conditions. Instead, they sometimes aim to reconstruct the basis of diseases according to the actual practice (Savulescu, 2011). Constructivism sometimes is understood as a thesis about how a research or issue is being resolved. First, a condition which is being disvalued is identified, then a review of biological processes affecting it is evaluated, and finally, a judgment of abnormality is made (Murphy, 2008). This highlight on the practices is common in the constructivist set-up, and for the objectivists, they emphasize more on assessing a concept which will establish what disease actually is, even if along the way, it encounters biases and issues. The medical practice and the general public perception more often than not impacts on disease concepts. As a result, there is a need to establish a second distinguishing quality for both concepts. Objectivism and constructivism can either be revisionist or conservative (Sarkar and Plutynski, 2010). Conservative views believe that the traditional and folk concept of disease interferes with the logical and theoretical understanding of health and disease as established by experts (Murphy, 2008). For revisionists, they believe that the contemporary concepts must be transformed based on the results of inquiry. Hence, a person may be a conservative or revisionist objectivist, and be a revisionist constructivist as well. The revisionist objectivist may contend that it is prudent to follow where science leads us and conceptualize ideas that advance scientific processes, even if people end up with bizarre and nonsensical conclusions (Sarkar and Plutynski, 2010). The revisionist constructionist on the other hand may set forth that our conclusions must assist in providing relief to oppressed groups. This type of thinking was essential in the 1970s, when there was a need to revise the concept of homosexuality being a mental illness which needed treatment. Various activists argued that homosexuality was labelled based on moral, not medical parameters (Murphy, 2008). The objectivists claimed that this situation is not similar to using constructivism to justify certain ends, but that of making psychiatrists understand that they were not actually applying their own objective principles, instead, they were exemplifying that there is really no good reason to maintain such diagnosis (Sarkar and Plutynski, 2010). There have been various issues which have set objectivists and constructivists against each other. The constructivists sought to unearth the role of moral and social values on medical diagnosis; and they have argued that disease labels are not adequately objectivist. The objectivists go more for conceptual conservatism and they often appeal to people’s intuition about illness which is often based on their emphasis on physiological malfunctions (Murphy, 2008). Such views assume that the current concepts of illness are secured and that both common sense and medicine have the same understanding of diseases; and that medicine must therefore respect the ordinary intuitions of disease. The conservative objectivists about disease think that folk conceptualizations underscore health and disease. The work of medicine then is to consider the world and assess if anything by nature can be qualified under the analysis. Among revisionists, such an understanding of the relation of common sense to science is unnecessarily compliant to traditional insights (Murphy, 2006). Constructivism seems to have an accurate understanding of diseases – that human activities are considered pathological because of values, not scientific evidence (Mishler, 1981). However, it is more difficult to prove that constructivism is also accurate about different concepts of disorder. The constructivist concept would seem to be accurate if there were no diseases. In other words, the issue of diseases is based on how people conceive and ‘construct’ diseases (Mishler, 1981). A problem with constructivists is seen in the fact that people make automatic distinctions between the sick and those we disapprove of. But disease concepts cannot always be based on the act of reducing the value of people or their personal qualities. There must be a reason for them to be treated as such. It is therefore wrong to claim that when a person does something wrong, he must be mentally sick (Kitcher, 1997). In effect, more often than not, when people act in unacceptable ways, their sanity is not questioned, but their morals are put under the microscope. Constructivists may also be considered revisionists because they usually set forth that concepts of health medicalize behaviour which does not follow normal patterns or which do not follow normal values (Sarkar and Plutynski, 2010). For example, people do not like anxiety, therefore, it can be considered a disease. People also do not like smokers and gamblers, so these issues also count as diseases. Constructivists are often experts at making mental health issues out of the above problems or unwanted occurrences. They are also social scientists whose interests may not blend well with various philosophical interests. They are not often concerned with conceptual analysis, but more into how social processes can be laid out over time. They are also not interested in determining whether an issue is actually a medical problem, but they are more concerned with the social foundations of the issue (Conrad, 2007). Constructivists sometimes point out that their theories uncover the common sense and practical understanding of diseases. Therefore, they may agree to the fact that the assessment of disease involves objective considerations which people adhere to when they believe that another person is ill. Society may assume that germs are inside a person and give rise to disease processes. However, for the constructivist, they argue that judgments of the presence or absence of disease come from social norms (Murphy, 2006). Based on the above discussion, I am inclined to consider the application of combined objectivist and constructivist approaches to health and illness. In which case, I can be an objectivist about bodily diseases, but a constructivist when it comes to psychology or mental health issues. The contention that medicine only treats conditions not normally considered as diseases are more applicable in the field of psychiatry. It may also be argued that our understanding of disease is already a combined manifestation of objectivist and constructivist concepts. We often choose to define some issues based on objective principles, and other conditions using constructivist principles. Conclusion Objectivism and constructivism cannot always be easily set apart from each other in the actual practice. This difficulty seems to stem from the fact that our understanding of diseases considers both human values and physiological phenomena, and it may not always be easy to understand how theorists explain such phenomena or to consider whether or not such considerations are restrictive. For objectivists, significant physiological processes are those which are not part of normal human functions, as judged by science. These biological issues stem from what is judged as struggles in living. For the constructivist, the issues which people face often have priority. Their physiological foundations are those which are considered abnormal because people have considered them to be important conditions that are not given much value and are topics of specific and medical practices. The issue faced in the successful establishment of objectivism is the problem of establishing an accepted distinction between what is normal and what is abnormal. Getting past this issue will need a tighter engagement by theorists in terms of crucial debates in understanding physiology. Among constructivists, the issue is why some things are judged as symptoms of disease and other human occurrences are qualified as evidence for someone being a criminal or possessed by demons. It is not usually true that when we see someone’s life turning badly that we also judge them to be unhealthy; therefore, constructivists need to specify what makes some judgments medicalized and what makes other judgments subjective. While theorists have considered the varying conceptualizations of medical judgments over time, the more accurate constructivist understanding needs analysis on medical thinking and how such thinking impacts on societies. Nevertheless, the constructivists offer perspectives of disease which may also be needed in making a more accurate and complete analysis of disease processes. And combining both concepts may help provide a balanced medical and situational understanding of the disease and of one’s health. Works Cited Bloomfield, P. (2001). Moral reality. London: Oxford University Press. Boorse, C. (1997). A rebuttal on health, in J. M. Humber and R. F. Almeder (Eds.), What is disease? London: Humana Press, 3–143. Chiari, G. & Nuzzo, M. (2009). Constructivist psychotherapy: a narrative hermeneutic approach. London: Taylor & Francis. Conrad, P. (2007). The Medicalization of Society. Baltimore: Johns Hopkins. Kennedy, I. (1983). The unmasking of medicine. London: Allen and Unwin. Kitcher, P. (1997). The Lives to Come: The genetic revolution and human possibilities, revised edition. London: Simon & Schuster. Mishler, E. (1981). Social contexts of health, illness, and patient care. London: CUP Archive Murphy, D. (2006). Psychiatry in the Scientific Image. Cambridge, MA: MIT Press. Murphy, D. (2008). Concepts of Disease and Health. Stanford Encyclopedia of Philosophy. Retrieved 02 June 2011 from http://plato.stanford.edu/entries/health-disease/ Reznek, L. (1987). The nature of disease. London: Routledge. Sarkar, S. & Plutynski, A. (2010). A Companion to the Philosophy of Biology. London: John Wiley and Sons Savulescu, J., ter Meulen, R., & Kahane, G. (2011). Enhancing Human Capacities. London: John Wiley and Sons Read More