Disease, Disorder, and Disability
What is disease? Are diseases purely biological conditions, or does society shape our conception of what a disease is? What does it mean to be healthy, or normal? Are psychiatric disorders real? Are disabilities medical conditions or social ones? Answering questions like these requires considering unresolved problems in the philosophy and history of biology, psychology, and medicine. In this seminar we will explore these problems, focusing on issues like biological concepts of normality, the relation between scientific theory and medical practice, the nature of mental illness, and the classification of mental disorders like depression, autism, and schizophrenia. No previous background in philosophy, science, or medicine is required.
Course materials
Introductory stuff for the first weeks:
Syllabus, Fall 2021 (subject to change; see TCU Online for most up-to-date version)
Student Skills packet (please read the “Guidelines for Reading,” also available online)
“Philosophical Methods” (7 pages; please read before attempting the “Identifying ideas” assignment)
Course texts:
This course uses a textbook. We will be reading most of the book, so please get a copy:
Caplan, Arthur L., James J. McCartney, and Dominic A. Sisti (Eds.). (2004). Health, Disease, and Illness: Concepts in Medicine. Washington, D.C.: Georgetown University Press. (Amazon; or order through your favorite independent bookstore!)
Other readings will be available on TCU Online for free.
You have the option to purchase a course reader that contains hard copies of the required readings. Hard copies may be easier to read, comment on, and keep track of for some students. Readers can be purchased from TCU Printing & Copying by calling 817-257-5992, or by emailing Bob Goode and Melinda Portillo. The reader costs about $21. Unfortunately I can no longer provide readers for free.
Philosophy/medicine in the media
[There’s a lot of medicine in the media these days—if you find something particularly relevant to this class, let me know!]
25 October, 2018 – Kurt Eichenwald discusses his experiences with epilepsy and stigma. Hear him discuss it in an interview on KERA’s Think with Krys Boyd.
25 October, 2016 – Mental health advocates are calling for popular Halloween attractions to forego stereotypical and damaging portrayals of mental illness, the Washington Post reports.
29 September, 2016 – The WNYC radio show The Takeaway did a short segment on some social complications faced by obese patients, such as prejudiced doctors and attributions of responsibility for obesity.
26 August, 2016 – The podcast Decode DC offers a discussion of sodium, hypertension, and public health. There is an instructive discussion about scientific disagreement, and there are some interesting connections to be made between their episode and our discussions about the “creep” of disease labels toward symptoms and risk factors.
21 August, 2016 – Radiolab released an episode focusing on triage. I think it’s a great piece highlighting some of the more dramatic dilemmas of medical ethics. It doesn’t focus on the nature of disease per se, but I thought it was good listening. Be forewarned that some of it is rather harrowing.
Other content relevant to class
The medicalization of deviance
In connection with our discussion of medical treatment vs. enhancement (“leveling the playing field”), I thought you might enjoy a short story by Kurt Vonnegut. If you have a few minutes, I recommend reading “Harrison Bergeron.”
In his famous TED talk, Sir Ken Robinson discusses the medicalization of behavior that traditional schools find difficult to accommodate, but that other schools might nurture.
Criteria for disease
There has been some dramatic disagreement between physicians over how to define hypertension (high blood pressure). There’s a detailed write-up in Forbes.
If you’d like to learn more about “Typhoid” Mary Mallon, there’s a Radiolab story about her.
Normality as a biological concept
One of my favorite podcasts, 99% Invisible, has an episode reflecting on the history of considering “the average man” (it was usually men) in science and design during the 19th and 20th centuries. I think it’s definitely worth looking at their article, or listening to the audio episode if you’ve got 20 minutes sometime.
Disability
See Stella Young’s TEDx talk about disability and “inspiration porn.”
NPR’s TED Radio Hour did a segment on Daniel Kish and his echolocation. Personally I think the audio segment is much better than the original TED talk (embedded in the link above).
For a history of (some of) the Disability Rights Movement in the U.S., listen to this podcast episode of NPR’s Throughline on the Americans with Disabilities Act.
If you want to hear Elizabeth Barnes talk about her own view, she gives a frank and energetic interview for the UnMute Podcast.
Or you can hear Elizabeth Barnes discuss disability and hermeneutical injustice in this lecture at Ohio State University, from when she was still writing her book. (For more on hermeneutical injustice, read Miranda Fricker or take my course on social justice!)
Listen here to learn about the history of curb cuts: how disability rights activists fought for them, what people think of them now, and how the concept has been applied to other domains (like service counters and software design). A story from 99% Invisible.
If you’re looking for more about cultural assimilation through education policy, there’s an episode of Radiolab about the Carlisle Indian School. Actually, the episode focuses on the early history of American football. It’s a good listen.
You can see Heather Artinian talk as an adult about growing up between the Deaf and hearing worlds in her talk at TEDx Georgetown in 2013.
Causal explanation
There is a segment from NPR’s TED Radio Hour about uncertainty and cancer treatment (10 mins.) that touches on a number of themes relevant to diagnosis, disease entities, medical science, and uncertainty. The linked talk (the video; 17 mins.) also touches on themes relevant to disease mechanisms, the discovery of proper functioning.
99% Invisible has an episode on the history of the stethoscope, which is relevant to our discussion of symptom-based vs. causal criteria for disease.
The Undiscovered podcast has a story about chronic fatigue syndrome, and a dispute between researchers and patients.
Genetic disease
If you want to hear more about “beanbag genetics” and domesticated foxes, you can check out Radiolab’s story “New Nice.”
Radiolab has a series on the troubled history of the scientific concept of intelligence (listen from bottom to top). This episode on eugenics is particularly relevant to our discussion.
Texas created a genome registry in 2016 to track complications of chronic obesity in the U.S. There are stories from Texas Standard and from Houston Public Media (this one has text). I think this is worth considering alongside Eric Juengst’s discussion of genetic disease and the Human Genome Project.
Scientists have begun experimenting with methods to modify the genes of healthy human embryos. See write-ups at Live Science or at NPR.
If you want to know more about preformationism (mentioned in Kendler 2005), there’s an interesting wee bit of history to be heard at the beginning of the Radiolab story “Why So Many Sperm?” (or see my transcript of the episode; be aware that the rest of the episode involves a frank description of animal sex practices, some of which are rather unsavory.)
Mental illness
Carl Hart argues in a short op-ed piece in Nature that addiction is not a brain disease, and that this common perception is harmful.
The podcast Reply All has an episode on people with tulpas—an interesting mental health phenomenon that was new to me. There is some discussion of prevailing criteria for mental illness among psychiatrists, as well as an exploration of the personal and social ramifications of unusual conditions.
WNYC’s On the Media opened a show during the 2016 election with a discussion of the Goldwater Rule—which forbids psychiatrists from making diagnoses of public figures—and Donald J. Trump. (See also this post on the topic, at the blog of the American Psychiatric Association.) The last segment of the episode also includes a discussion of sex/gender, normality, and fair play in athletics, focusing on the case of South African runner Caster Semenya and the Olympics.
WNYC’s On the Media broadcast a story at the intersection of medicine, psychiatry, disability, and law (and Texas). They discuss an upcoming Supreme Court case concerning the death penalty in Texas and standards for intellectual disability. In the process they discuss the difference between medical and legal standards, social influences on standards, and the DSM.
Mental healthcare
The podcast Criminal (In)justice posted an episode (Ep. 35) about mental healthcare in American prisons.
A 2016 study by Tara Bishop et al. in Health Affairs reports that major depression is often not treated according to best practices, unlike chronic somatic illnesses. See reports by NPR and the Huffington Post.
WNYC’s On the Media broadcast a story at the intersection of medicine, psychiatry, disability, and law (and Texas). They discuss an upcoming Supreme Court case concerning the death penalty in Texas and standards for intellectual disability. In the process they discuss the difference between medical and legal standards, social influences on standards, and the DSM.
Prejudice in medical science
The New York Times published a feature on recent studies showing that people of color have difficulties enrolling in clinical cancer trials, resulting in worse health outcomes.
Annie Minoff and Elah Feder at Undiscovered discuss the fact that African Americans don’t tend to participate in clinical trials, and examine the causes and consequences. A good listen.
Wendy Zuckerman tells a story about American eugenics and the history of the word “moron” at her podcast Science Vs. Well worth checking out.
The Irish podcast Our Sexual History has a 15-minute episode about the history of the Tuskegee syphilis experiments.
Radiolab has a 25-minute segment on the story of Henrietta Lacks. The segment is part of a longer episode about famous tumors, and the other segments are interesting as well (though not related to scientific racism).
Other topics
A study in Nature debunks the “Patient Zero” myth, according to which a French-Canadian flight attendant named Gaëtan Dugas was thought to have brought HIV to the U.S. in the early 1980s. New analyses of viral genomes (and closer attention to the original study) reveal that the virus had been in the U.S. for many years beforehand, and that a notation error had misled experts into thinking Dugas played a greater causal role in spreading the epidemic. See also discussions in Scientific American and at On the Media.
Based on this image, which is based on this article.