Approches naturaliste et normativiste de la santé

Différences entre approche naturaliste et normativiste de la santé

• Naturaliste: Defines health as the absence of physiological disease, focusing on optimal bodily function as dictated by nature. It's a "negative" view, defining health by the absence of an undesirable state.
• Normativiste: Views health as a capacity for action and an overall state of well-being (physical, mental, social). It incorporates societal and human norms and values, including subjective dimensions in defining health. It's a "positive" view, defining health as a desirable state to achieve, involving moral evaluation of a "better life" and societal norms imposed on individuals.

Criticisms of Naturalism

• Reductionism: Reduces health to a purely physical state, neglecting psychological, social and cultural aspects that influence well-being. This approach overlooks the subjective experience of illness and health, and the impact of environmental and social factors.
• Defining "nature": The concept of "nature" is problematic; is it an immutable reality or a social/cultural construct? Naturalism may project social norms onto the body and naturalize inequalities or discrimination.
• Exclusion of people with disabilities: Definition based on statistical norms and biological functions may exclude individuals with disabilities, viewing them as deviations from an arbitrary norm. Some argue that anomaly isn't necessarily pathological and human variability is valuable.
• Ignoring values: Claims to objectivity and science while neglecting values and value judgements. The critics point out that medicine is a social practice with choices influenced by values, societal norms, and ethical considerations.

Criticisms of Normativism

• Relativism and subjectivity: Leads to excessive relativism in health, making the distinction between normal and pathological unclear, and allowing for arbitrary definitions of health. What's healthy for one person may not be for another. This blurs the line between objective state definition (criteria) and subjective value judgement (undesirability).
• Difficulty establishing objective criteria: Defining health in terms of "well-being" or "capacity for action" raises the question of how to objectively and universally measure these concepts. Criteria for well-being vary across cultures, time periods and individuals.
• Risk of inflated health needs: By broadening the definition beyond the absence of disease, it risks an unlimited demand for care and treatments. Everyday problems or discomfort could be deemed health issues, putting strain on health systems.
• Paternalism and social control: Can be used to justify paternalistic interventions and social control. Behaviors deemed "unhealthy" or "deviant" could be stigmatized and subject to coercive measures.

Normativism and Relativism

• Normativism doesn't inherently lead to a purely relativistic view of values. It acknowledges cultural and individual variations but can be grounded in universal values related to disease definitions. It can distinguish between values and facts, employ rationality, recognize evolving norms, and claim the existence of objective and universal criteria for health.

Health Policies: Naturalism vs. Normativism

• Naturalism: Policies concentrate on disease prevention and treatment based on statistical norms. Spending is limited to strictly defined care needs, excluding personal preferences and subjective well-being considerations.
• Normativism: Considers subjective and social dimensions of well-being; includes individual values and preferences in defining health needs. Promotes a holistic view of health, recognizing the interdependence of physical, mental, and social well-being; promotes patient participation in care decisions and policy-making.

Is Old Age a Disease?

• Naturalist perspective: Old age, as a natural biological process, is not inherently a disease, as it isn't a biological malfunction.
• Normative perspective: Old age may be seen as pathological due to potential limitations, suffering, and loss of autonomy, viewed as "evils."

Values in Medical Science

• Example (Homosexuality): Historically, homosexuality was classified as a mental disorder in the DSM, reflecting societal values. Its de-pathologization arose from challenges to these classifications based on a lack of scientific evidence.

Deductive vs. Inductive Reasoning in Medicine

• Deduction: Starts with general principles (universal laws) to reach specific conclusions (e.g., applying general laws to specific patients). If premises are true, conclusions are necessarily true. Explains particular cases.
• Induction: Starts with particular observations to infer general conclusions (e.g., observing symptoms in numerous patients to formulate diagnoses). Conclusions are probable but not necessarily true. Formulates hypotheses from empirical data.

Modern Experimental Medicine: Inductive or Deductive?

• A combination of both. Modern methods follow a hypo-deductive model, combining induction and deduction in a cyclical process, iterative and allowing for testing knowledge and refinement. Induction helps form hypotheses from observations, while deduction is employed in testing hypotheses through experimentation.

Philosophy and Medicine in Antiquity

• Close relationship. Medicine seen as a branch of philosophy, covering fundamental questions on human nature, health, and disease. Philosophical theories influenced medical understanding. Hippocratic humoral theory is rooted in Greek philosophy. Distinct domains, philosophy as broader theoretical inquiry, while medicine is technical art (techne).

Philosophy as Therapy of the Soul

• Philosophical inquiry is related to seeking happiness and wisdom, seen as a remedy to the soul's ailments (ignorance, passions, vices). This contrasts with Platon's view.

Galenic Theory of the Humors

• Four humors (blood, phlegm, black bile, yellow bile) compose the body.
• Each humor is linked to an organ: heart, brain, spleen, liver; to an element: air, water, earth, fire; and a temperament: sanguine, phlegmatic, melancholic, choleric.
• Health is a balanced mixture (krasis or temperament) of humors; illness results from imbalance.

Galien's Medical Concept: Naturalism vs. Normativism

• Primarily naturalism: Health as a natural optimal state, based on the balance of humors. Disease reflects deviation from this state.
• Also contains normative elements: physician's moral qualities, the pursuit of patient well-being signifying values.

Claude Bernard's Definition of Health

• Health as a quantitative deviation from a norm. Health and disease are not fundamentally different but variations in the same biological process. Health is a dynamic equilibrium. Disease results from deviations from a norm/average. Statistically defined norm.

Goldstein's Organism as a Whole

• Holistic view of the organism: interdependency of parts, compensation, plasticity, adaptation. Disease as a form of adaptation to a new situation, resulting in a new norm.

Canguilhem: Anomalous vs. Abnormal

• Anomalous: Variation from a specific type; statistical deviation, not necessarily pathological.
• Abnormal: Deviation from a normative standard; endangering life processes and adaptive capacity; synonymous with pathological.

Canguilhem: Normal vs. Pathological

• Dynamic and relative concepts. Normal is a process of adaptation and norm creation. Disease isn't deviation but an attempt to normalize in new circumstances. Distinction is dependent on context, relative and fluctuating.

Boorse's Criteria for Biological Function

• Survival/Reproduction: Necessary effect on survival/reproduction.
• Species-Typical design: Conformity to established species design, age/sex class.
• Statistical Normality: Normal function within the given reference class.

Boorse's Theory: Naturalism

• Naturalistic because it frames health and disease as natural facts independent of human values; emphasizes verifiable biological criteria and statistical notions of normality. Boorse recognizes deviations, but distinguishes non-negative deviations from pathological deviations and impairment of life quality.

Plato: Body as Tomb of the Soul

• Dualistic view: Soul (immortal, immaterial, belonging to the realm of Ideas) vs. Body (mortal, material, belonging to the physical realm). Body hinders the soul's quest for truth due to passions and desires.

Plato: Passions and the Good

• Passions (sensual pleasures) distract from the contemplation of true, eternal ideas, hindering the soul's ascent to the true Good (knowledge of ideas).

Plato's Cosmological Body

• Body a microcosm reflecting the macrocosm. Headed towards intellect; rest of body connected to passion. Influence on spirituality, body-mind dualism, self-mastery pursuit. Holistic approach.

Aristotelian Potency and Act

• Potency (dynamis): capacity of an entity to become or do something. Act (energeia): realization of that capacity. Movement is a transition from potency to act driven by an already actualized agent (the mover). Realized actuality is a striving towards a natural endpoint/goal.

Aristotle: Hylomorphism

• Composition of material and form. Soul is the form of the human composite, not separate. Soul animates and organizes matter. Different types of souls (vegetative, sensitive, intellectual). Body essential to the soul.

Aristotle's Finalism in Nature

• Teleological view; every natural thing has an inherent purpose or goal (telos). The telos is a natural tendency, not conscious intent. Ergon (function) inherent to being. Natural order in which the goal guides existence.

Christianity and Gendered Bodies

• Reinforced gendered perspectives on bodies by integrating biblical narratives of transgression into broader views on soul-body relations. Augustine interpreted physical pain as part of the Fall, focusing on women as temptation; associated women with body, and men with spirit, reinforcing a hierarchy. Emphasized virginitiy and chastity, considering the body a potential obstacle.

Christian Interpretation of Bodily Pain

• Pain is understood as a consequence of the Fall. It has an expiatory dimension (reminding of humanity's fallen state), while also having a potential for spiritual growth in endurance. Pain serves as an opportunity for purification and spiritual development; a sign from God.

Empiricism in Modern Philosophy

• Emphasis on sensory experience in knowledge creation, rejecting innate ideas. Critique of scholasticism that prioritized deductive reasoning over observation. Development of scientific method tied to experiments, induction, and direct observations.

Vesalius' Critique of Aristotelian and Galenic Science

• Vesalius critiques reliance on ancient texts, particularly Galen, without sufficient direct observation. He stresses the importance of human dissection for accurate knowledge. Galen's errors in human anatomy noted from animal dissection. Calls for a shift towards empiricism and skepticism, using independent observation.

Harvey's Circulation Discovery: Consequences

• Overthrows Galen's theories about blood production. Promotes the experimental method; vivisection employed. Advances physiology and understanding of organs (heart, vessels, blood). Leads to mechanistic view of body as a complex machine governed by physical laws. Advances in treatment and diagnostic capabilities.

Modern Mechanistic Physics vs. Finalism

• Mechanistic physics rejects final causes, explaining natural events by efficient causes (forces/interactions). It focuses on matter and motion. It counters Aristotle's belief in natural "goals" and teleological views. Critiques final causes as anthropomorphic projections, reducing natural phenomena to physical interaction.

Cartesian Dualism

• Human being composed of two distinct substances:
  • Res cogitans (thinking substance: mind/soul): immaterial, indivisible, thinking, conscious.
  • Res extensa (extended substance: body): material, divisible, spatial, governed by physical laws.
  • Interaction problem: how can the immaterial mind affect the material body? Proposed pineal gland as the point of contact.

Descartes: Body as an Automaton

• Mechanistic view of the body: bodies are seen as physical machines.
• Emphasis on extension: material bodies entirely defined by spatial characteristics and are subject to physical laws and movement.
• Explanation through efficient causes alone: rejection of final causes in the physical world.
• Analogies to machines (clocks, fountains): human body functions (digestion, circulation) are explained via physical mechanisms.

Cartesian Dualism in Modern Context

• Not widely accepted now: Cognitive sciences show mental activity tied to brain activity. Psychology and psychiatry demonstrate strong biological influences on behavior. Difficulty explaining mind-body interaction and critics from materialism and monism.

Monism: Body-Mind Relation

• Monist view: mind and body are aspects of the same reality; mind not a separate entity but an emergence or aspect of physical processes.
• Supported by advances in cognitive sciences connecting mental activity to brain function. Emphasis on causality and mechanistic views.

Neuroscience and Determinism

• Neuroscience, adhering to a deterministic perspective, seeks to explain mental phenomena through physical/biological causes.
• Neuroscience supports eliminationism, where mental concepts are illusions and purely physiological.
• Use of scientific methods (brain imaging), mechanistic view of the body. Complexity and environmental influence temper determinism.

Freud: Discovery of the Unconscious as a "Wound"

• Discovering the unconscious challenges the human self-image; reveals fragility of conscious control and complexity of the psyche.

Freud: Conscious and Unconscious

• Three parts: id (unconscious), ego (partially conscious), superego (representing social norms, partially conscious).
• Unconscious influences the conscious through repressed contents, unfulfilled desires, and conflicts. Manifestation through dreams, slips, or symptoms.
• Body is a mirror reflecting unconscious conflicts. Repressed material expresses through physical symptoms, mirroring the soul's conflict.

Physical vs. Psychological Causation of Illness

• Physical: Biological causes (viruses, genetics, trauma). Emphasized in modern medicine.
• Psychological: Influence of mind/emotions on the body. Freud's psychoanalysis illustrates how internal conflicts can manifest as physical ailments. Canguilhem emphasizes the subjective experience of the body and its adaptation/norm-creation.

Ce quiz explore les différences entre l'approche naturaliste et l'approche normativiste de la santé. Il aborde des sujets critiques tels que la définition de la santé, les enjeux liés à l'exclusion et l'influence des normes sociales. Participez pour renforcer votre compréhension des perspectives sur la santé et leur impact sur les politiques de santé.