Medical Explanations

There are several types of explanations (Ladyman, 2002). A historical explanation provides the antecedent events responsible for a past event. For example, one nation may cite previous grievances for invading another country. A psychological explanation accounts for organismic behavior. For example, a person may exhibit violent behavior because of being abused earlier as a child. An astrological explanation relies on the alignment of stars and constellations to account for an event or action. For example, a person may exhibit specific behavior patterns because of their astrological sign. A theological explanation invokes divine action. For example, a person may suffer from a disease because the divine is punishing that person for a trespass or sin. A teleological explanation invokes purpose to account for an event. According to Aristotle, for example, fire rises because its natural location is up or away from the center of the earth.

In this chapter various explanatory schemes are examined, especially in terms of scientific and medical knowledge. Beginning with covering law explanation that dominated philosophical understanding of explanation for decades, the discussion turns to explanatory schemes proposed to resolve the problems associated with the covering law model. The first and most powerful explanatory scheme is causal explanation, especially Paul Thagard’s causal network instantiation scheme for explaining disease. Kenneth Schaffner champions a “six component” explanatory scheme for the biomedical model that incorporates many of the preceding explanatory schemes, especially the causal mechanistic approach. Inference to the best explanation and functional explanation also represent two important explanatory schemes that are relevant for the natural sciences.2 And, these explanatory schemes are utilized in the biomedical model to varying degrees of success to account for medical phenomena. Finally, although humanistic or humane practitioners appreciate the power of these explanatory schemes they often utilize a narrative explanatory scheme that includes the patient’s personal knowledge, especially in terms of the patient’s illness story.