Abstract
This chapter explores the epistemology of disease, with emphasis on the ways in which concepts of disease reflect how we know1. It considers discussions in epistemology about the extent to which reason provides access to knowledge. The focus here is on methods of knowing, on how we know, on the explanans, in contrast with the previous chapter’s attention to what is known, on the explanandum 2. This chapter argues that knowing disease requires a representative realist method.
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Chapter Endnotes
The term “know” (Gr. gignas ken,to know) means to perceive with clarity, to understand clearly, or to be sure orwell-informed.
One is reminded of Marjorie Grene’s book, The Knower and the Known (1974).
This division is in many ways artificial. In his Lectures on the History of Philosophy (1955), Hegel rejects a distinction between rationalist and empiricist approaches. I am indebted to Fred Bender, Department of Philosophy, University of Colorado, for our discussions on this and related matters.
For more on the relation between faith and reason in Roman Catholic thought, see Cutter (2002e)
Here, deduction is the faculty by which subsequent truths are known with necessity from intuited truths, or from intuited truths taken together with other deduced truths (Audi, 1995, pp. 183–184).
For Hoffmann, pathology is an aspect of physiology and all of its laws (Garrison, 1929, p. 314).
Asclepiades ofBithynia (124 B.C.) establishes Greek medicine on respectable footing in Rome. Asclepiades opposed the Hippocratic idea that morbid conditions are due to a disturbance of the humors of the body (humoralism). He attributes disease to constricted or relaxed conditions of its solid particles (solidism). This is the so-called doctrine of the strictum et laxum, which was derived from the atomic theory of Democritus (Garrison, 1929, p. 106 ).
This analysis draws from Albert et al.( 1988, pp. 118–125), with the following exception. It interprets “significant” causal accounts in two ways: first, to refer to jointly sufficient causal accounts and second to refer to those accounts in which a factor is chosen as significant in order to achieve a certain goal. Though these two are not incompatible, they are distinct epistemologies. Where the first involves rationalist commitments, the second involves empiricist ones.
The “nomological” in the name means that the explanation contains a law or laws. The “deductive” refers to the relationship between the law and the initial conditions and the event to be explained.
Here I am indisagreement with Wulff et al., who states that “[t]he justification of realism on the ontological level requires rationalism on the epistemological level” (1986, p. 15). It does not, as this discussion illustrates.
An empiricist account of disease employs to some extent an inductive approach to knowing or diagnosing disease. Here induction refers to an inference to a generalization from its instances. Here distinct kinds of inductions may be distinguished. Strict or explicative induction is assertion concerning all the entities of a collection on the basis of examination of each and every one of them. The conclusion sums up but does not go beyond the facts. Ordinarily, however, induction is used to mean ampliative inference as distinguished from explicative. Ampliative induction is the sort of inference that attempts to reach a conclusion concerning all the members of a class from observation of only some ofthem. Conclusions inductive in this sense are onlyprobable, in greater or less degree according to the precautions taken in selecting the evidence for them (Audi, 1995, pp. 368–369 ).
James coins the term “radical empiricism.” See Pragmatism and The Meaning of Truth (1978).
This is a complex relation. To begin with, skepticism is the position that knowledge is to be doubted. Some interpret this position to mean that the individual cannot be sure of his or her knowledge claims. Solopsists hold that all that the knower can be sure of are the claims that the individual makes. If all one can be sure of are the knowledge claims that one makes, then one might question the possibility of any meaning or knowledge that spans beyond the self. If there is no such meaning or knowledge, a nihilist position results.
Not solely, for it is misleading and dogmatic to attribute science strictly to empirical methodology.
Syllogistic reasoning is a valid or invalid argument in which a conclusion connecting two terms is deduced from two premises connecting those terms to a third term, called the middle term. The subject of the conclusion is called the minor term, and is connected to the middle term in the minor premise. The predicate of the conclusion, the major term, is connected to the middle term in the major premise, and is conventionally written first. In “All men are mortal, all Greeks are men, so all Greeks are mortal,” “men” is the middle term, “Greeks” the minor term, and “mortal” the major term.
Three main criticisms are made of syllogisms. First, as an argument, they beg the question because the conclusion is already contained in the premises. Second, it is unclear whether the allowed kinds of propositions entail the actual existence of things (called the problem of existential import) (e.g., “all unicorns are black”). Third, syllogisms are very limited in scope, and in particular ignore the logic of relations by using “be” as its only verb.
A causal relationship is a function of what is sensed, as Hume illustrates. Hume holds that meaningful ideas are analyzable in terms of the sensory impressions from which they are derived. The meaning of the term is exhausted by those features of experience with which the term is in every case associated; that is, meaning is constituted by a set of features, which lead us to say that an item is an X instead of a Y or Z. Armed with this method of proceeding, Hume isolates three empirical relations: contiguity, succession, and constant conjunction. He proclaims them the essential elements of the idea of causation. In considering the action of billard balls, he observed: “In the considering of motion communicated from one ball to another, we could find nothing but contiguity, priority in the cause, and constant conjunction” (Hume, 1938 [1740], p. 22). Additionally, he cites an apparently non-empirical element, necessary connection. “But besides these circumstances, ‘tis commonly suppos’d, that there is a necessary connection betwixt the cause and effect…” (Hume, 1938 [1740], p. 22). Hume’s theory of causation largely consists of a close analysis of contiguity, succession, constant conjunction, and necessary connection. Special attention is given to constant conjunction and necessary connection, the latter of which Hume thinks to be subjective (or a “habit” of the mind) (Beauchamp and Rosenberg, 1981 ).
Falsification plays an important role in empiricist thinking (Popper, 1959, 1965).
Mathematics and logic for Mill (System of Logic,1874) are empirical endeavors. Theorems in geometry, for instance, are deduced from premises that are real propositions, inductively deduced.
This is not to suggest that there is a single method. Rather, there are variations, as this discussion illustrates.
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Cutter, M.A.G. (2003). Knowing Disease. In: Reframing Disease Contextually. Philosophy and Medicine, vol 81. Springer, Dordrecht. https://doi.org/10.1007/978-94-017-0155-6_4
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