A Philosophical Approach to the Social Construction of Disease

These two readings from Ludwik Fleck and Jeremy Simon develop a philosophical approach to the topic of social construction of disease. Ludwik Fleck aims to establish how empirical facts, (in the field of medicine) originate and what this actually means (Fleck, xviii). In his first chapter, he exercises this point by focusing on how the concept of syphilis originated and evolved into what we know it as today. The disease can be traced back to the 15th century during a period of war and a myriad of skin diseases. At this particular time in history the disease was known to carry a religious and astrological stigma (sin and fate). This is because explanations in a society must be “stylized in conformity with the prevailing thought style” (Fleck, 2). In order for an explanation to evolve or develop, the society’s attitudes must change. This means that empirical observations are not the prevailing force in altering a thought style. Fleck then further outlines how syphilis evolves by providing details on how it was treated and the underlying stigma following it for various centuries. Interestingly enough, throughout its entire history, there was never a ‘heroic’ experiment or that one significant discovery that changed the direction of the concept (Fleck, 10). Those particular exceptional results would often be attributed to “either an accident or an error” (Fleck, 10). This is also why providing an accurate historical account of a disease is particularly challenging. He provides us with an interesting analogy that demonstrates this difficulty. Imagine trying to write down “the natural course of an excited conversation among several persons all speaking simultaneously clamouring … to make themselves heard” (Fleck, 15). These conversations must also adhere to the prevailing thought style, thus many discoveries have to be removed in order to maintain this consensus. This idea is foreshadowing the notion of thought collectives which he discusses in his second chapter. He then establishes the modern concept of syphilis through the discovery of its causative agent. He concludes this chapter, however, by maintaining that the concept of syphilis is incomplete and likely always will be. This is because the conversation for syphilis will always continue and therefore additional related theories will evolve (Fleck, 19). As we gain new knowledge and discoveries, new problems will arise and the concept will continuously develop.

In his second chapter, titled Epistemological Conclusions from the Established History of a Concept, Fleck focuses on the importance of history. In order for a concept to develop, it must originate from somewhere. Therefore, to thoroughly understand the concept of syphilis, we must study its history. This is because the disease does not magically appear from one theory or experiment, it is after consecutive theories and experiments that the concept emerges (Fleck, 22). This is precisely why the importance of history cannot be understated. Fleck then describes the notion of proto-ideas and why they are relevant for science (Fleck, 23). They are important because it is through these proto-ideas that scientific proofs were able to exist. Whether or not this proto-idea is right is irrelevant, as its main purpose was to inspire the theory into fruition.  In the third section of this chapter, Fleck brings to attention the idea of closed systems. These closed systems include the current mode of thinking, which consists of the specific details about a concept. Once this has been established, any dissenting theories or opinions are strongly resisted. This means that ‘discoveries’ are to be considered errors; “to recognize a certain relation, many other relations must be understated, denied or overlooked” (Fleck, 30). Discoveries come from outside of the closed system and so in order for these new ideas to become assimilated, changes to the current system must be made accordingly. From this idea of closed systems, Fleck directs us towards thought collectives. He identifies a thought collective as a, “community of persons mutually exchanging ideas or maintaining intellectual interaction” (Fleck, 39). Therefore, there are  three factors that compose our cognition: the individual, the collective and objective reality (Fleck, 40).  The individual is inadvertently tied to the collective and so his or her objective reality is influenced as such. Additionally, each idea stemming from one individual “originates from notions belonging to the collective” (Fleck, 41). This means that we are necessarily tied to history because any discovery is a product of the thought collective. Fleck’s underlying point is that these thought collectives provide scientists with a special environment in which they would not have produced these ideas without the collective.

Jeremy Simon takes a different approach in his article Constructive Realism and Medicine, where he attempts to show “how abstract models can provide an account of the ontology of diseases” (Simon, 353). He starts off by differentiating science and medicine, in that medicine is in fact more than a science as it incorporates the disease as well as the patient, and has a significant ethical side as well. With respect to medical ontology, there are two camps: the realists and the anti-realists. The realists maintain that diseases objectively exist while the anti-realists argue that they are constructed (Simon, 355). Simon wants to find a middle ground between these two camps and attempts to take the strengths of each camp to develop a constructive realism. He utilizes Giere’s project and outlines his theory in this section (Simon, 356). The main idea of the theory is that scientists utilize particular models in order to represent the real world (or in this case, disease). Thus, constructive realism, “accepts that the real world has a modal, or causal, structure, and that for a model to be acceptable, its modal structure must reflect the real-world’s modal structure” (Simon, 357). In order to develop this notion, Simon applies constructive realism to the concept of Cystic Fibrosis. He does this by analyzing how this disease is presented in medical textbooks (Simon, 358). He then concludes that Cystic Fibrosis is an abstract entity, it merely has volumes of various descriptions and characterizations. This means that diseases are the models, and the purpose of the textbooks is to advise doctors how to treat our conditions and symptoms. He, therefore, concludes that disease(s) “is an abstract entity that specifies the structure of part of an otherwise unspecified human organism” (Simon, 362). These models are used to predict our behaviour as well as represent our conditions. If I had Cystic Fibrosis, it would be represented by this model –and because of what doctors know about human physiology, they are able to predict my behaviour by referring to the model. This means that all diseases fall under a particular model, which is an alternate position from Fleck who maintains that diseases fall under a particular thought style or collective.

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