Abstract
In this paper I argue for the need of a positive, value-oriented, concept of health. I call it a holistic concept in that it involves looking upon health as having to do with the person as a whole. It is the person as a whole who is healthy or ill. Ill health is here taken to be the opposite of health. A distinctive feature of holistic health is that it is not identical with the absence of diseases or injuries. A concept of this general kind exists already in many areas in society. The most notable exponent of such a concept is the World Health Organization in its many characterizations of health and related concepts. But holistic analyses of health are advocated also by significant representatives of health care and public health and indeed by many theorists of medicine and nursing. A problem with many of these analyses, however, is that they are not carefully formulated and not presented within a strict conceptual theory. I will argue that my own proposal for a theory of health can do much of the work required. The paper has the following structure. First, I take a stand with regard to conceptual analysis and its role in determining the adequacy of definitions of health. Second, I make a brief survey of crucial characterizations of holistic health, both in policy documents and in the scholarly literature. In many of these conceptions the person’s abilities and subjective experiences come to the fore. Third, I consider the use of the term health in the standard medical encounter and in the formulation of goals of medicine. Fourth, I scrutinize some arguments concerning priorities in medicine, where a holistic concept of health plays a crucial role. Finally, I will give a brief outline of my own conceptual theory of holistic health.
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Notes
- 1.
A note on my terminology. I will use the term “holistic” for the kind of theory that I am defending. Most writers in the philosophy of medicine prefer to call such a theory “normativist”. My choice of term is motivated by the fact that a normativist theory need not presuppose that the bearer of health or ill health is the whole person.
- 2.
Most recently in this volume (See Chap. 9). Boorse has also claimed that his account defines a pathological concept of disease, not a practical one. It aims at a “pathologist’s concept of disease, not a clinician’s (…)” (1997, 11). Boorse is, however, not quite consistent on this point. Later in the same text (1997, 25) he claims that his concept of disease is “best reconstructed by medical classifications”. Medical classifications, as I have shown in Nordenfelt (2001, 21–24), indeed contain several items which are not captured by Boorse’s definition of disease.
- 3.
I introduced this distinction in Nordenfelt (1993).
- 4.
For a classical formulation of this point of view, see Daniels (1985, chapter 2). A more recent exposition of substantially the same idea can be found in Hope et al. (2010). It should be emphasized, though, that this point does not strike at Boorse’s views with regard to the relation between medical need-ascription and health. As he says in Boorse (1997, 12–13): “I have never doubted that medical practice is permeated by values, nor that a good doctor must have more tools than a scientific knowledge of pathophysiology.”
- 5.
Translated by Temkin (1963, 637).
- 6.
In a reply (2013) I have argued against this assumption and I have noted cases of illness or ill health where there is no negative experience at all.
- 7.
- 8.
Observe that my complete theory of health also includes definitions of the concepts of disease, injury and defect, where these are related to the holistic notion of health and not defined in any naturalistic way.
- 9.
In spite of this reasoning, I have declared that I am willing to reconsider the place of feelings with regard to health and ill health. The feeling element is so conspicuous and plays such a role in the identification of most paradigmatic illnesses that it should perhaps have a more prominent place in the defining characterization of ill health. A way of giving it such a place has been devised by Tengland (2007), who proposes a disjunctive characterization of ill health, using both the notion of disability and that of suffering.
- 10.
For a further discussion, see Nordenfelt (2001, 63–74).
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Nordenfelt, L. (2016). A Defence of a Holistic Concept of Health. In: Giroux, É. (eds) Naturalism in the Philosophy of Health. History, Philosophy and Theory of the Life Sciences. Springer, Cham. https://doi.org/10.1007/978-3-319-29091-1_12
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