Nature of the Universe: 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.
For syllabus, assignments, readings, announcements, and other material please see the course page on TCU Online.
Philosophy/medicine in the media
- 30 January, 2016 – The podcast Criminal (In)justice posted an episode (Ep. 35) about mental healthcare in American prisons.
- 23 December, 2016 – The New York Times recently published a feature on recent studies showing that people of color have difficulties enrolling in clinical cancer trials, resulting in worse health outcomes.
- A new 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.
- 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 recently 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
- In connection with our discussion last week 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.”
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.
- 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 fatique syndrome, and a dispute between researchers and patients.
- Texas recently created a genome registry 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 (Week 9).
- 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?” (Be aware that the rest of the episode involves a frank description of animal sex practices, some of which are rather unsavory.)
- If you want to hear more about domesticated foxes, you can check out Radiolab’s story “New Nice.”
- 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.
- 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.