What is healthy? What is normal?

Question 1

Discuss different definitions (and examples) of what is “healthy” and “unhealthy.”

Answer 1

WHO: “Health is astate of complete physical, mental and social well-beingand not merely the absence of disease or infirmity.”

• Very demanding
• uninformative or circular;

Naturalism

Naturalism: Loosely speaking, a person is healthy if and only if their body parts function in a way that is normal

A person is unhealthy if their body parts function abnormally

• Naturalism states that health and disease is an objective matter; health and disease are value-independent (Boorse, 1977) - biostatistic theory of health and disease

problem:

• What is normal for some groups is abnormal for others; elite athletes vs the general population
• How do we choose the groups that determine what is ‘normal’?
• This is the reference class problem (Kingma, 2007)
• classification of homosexuality; DSM-I in 1952: “sociopathic personality disturbance”. Removed from the DSM 1987
• Doesn’t what is ‘normal’ change over time?
• Is it healthy or normal to reduce calorie consumption?
• Is it healthy or normal to take statins
• Concepts of normal changes over time

Naturalism and exhaustion

• Lian and Bondevik (2015) look at ways exhaustion has been understood across history.
• Long‐term exhaustion became transformed from a somatic ailment bred by modern civilization, to a self‐inflicted psychiatric condition.
• Sociologists now think that what counts as normal depends on a cultural, social and moral standard. As a result, they think that health in turn is shaped by cultural. social and moral norms - It is contextual

Question 2

Discuss the differences between definitions of normative,normal, and abnormal.

Answer 2

Normativism

Normativism: Loosely speaking, a person is healthy if and only if their body functions in a way considered valuable by society.

• A person is unhealthy if their body is functioning in some way considered harmful by society (Cooper, 2002).
• Health and disease may be a subjective matter;
• Health and disease are value-dependent (or normative)
• Perhaps depending on social factors

Problem with Normativism

Drapetomania;

• Can disease be solely value-dependent?
• Shouldnt diseases also have some natural basis?

(Stegenga, 2018, pp.29-34)

“From our contemporary perspective, we think that it is wrong to call drapetomania a disease. We believe that drapetomania was not a disease then and is not a disease now. But if you are a normativist, you cannot say that those American doctors were wrong to call drapetomania a disease. All you can say is that we have different values from those nineteenth century doctors” (Ereshefsky, 2009, p. 224).

• Normativism cannot say it wasn’t not a disease as it matched with the then society norm

In the Hmong: person with epilepsy are viewed with pride, “portends a heightened capacity for achieving an elevated level of spirituality (Khalil et al. 2021)

Lay Conceptions

• draw upon naturalist or normativist ideas
• Are my symptoms the sign of some abnormal functioning? (depends upon their lay conception of normality)

Lay epidemilogy

“Lay epidemiology” is a term used to describe the processes by which laypeople understand and interpret their health and health risks.

But should we care what people believe?

1. .People do not always believe health messages that are issued from public health bodies. 2. People have cultural or individual values that can undermine health messages

Moorley et al’s (2016) African-Caribbean women’s lay beliefs identified alternative explanations - witchcraft and curses,

Question 3

Discuss how social factors influence definitions of health andnormality.

Answer 3

Lay epidemilogy

“Lay epidemiology” is a term used to describe the processes by which laypeople understand and interpret their health and health risks.

But should we care what people believe?

1. .People do not always believe health messages that are issued from public health bodies. 2. People have cultural or individual values that can undermine health messages

Moorley et al’s (2016) African-Caribbean women’s lay beliefs identified alternative explanations - witchcraft and curses,

‘lay beliefs such as witchcraft can co-exist amicably alongside modern medicine, as long as they do not hinder access to medication, treatment or risk factor management of stroke’.
Lay beliefs can inform an individual’s capacity to self-care and manage their own health