A Myth in Creation

In this blogpost I am collecting some of my recent tweets on the topic of attribution of “disease” or “disorder” in medicine and psychiatry, and whether legitimacy of medicine depends on that. I have edited the tweets for clarity. (Also see the post Beyond Definitional Disagreements  for additional background.) Suffering, impairment, harm, neurobiological and psychological differences, these exist independent of anyone’s wishes, but whether we see them through the concept of “disease” is a different issue that can be validly debated without committing a philosophical or scientific error. ( link ) There are indeed truths out there, but “disease” is not among those truths. What does exist is suffering, impairment, harm, and various sorts of neurobiological and psychological differences, etc., but our conceptualizations of these phenomena do not constitute fundamental truths. ( link ) While characterization of distress/incapacity as “disease” is coherent and historically respectable

Something I posted on twitter First Law of Ambiguity: What happens in vagueness stays in vagueness, unless acted upon by a clarifying force. "What happens in vagueness stays in vagueness" is a common enough phrase that it even appears on some t-shirts. It is also a play on the "What happens in Vegas stays in Vegas". So I can't take credit for this particular phrase. But as I came across it a few days ago, my mind immediately made a link to Newton's first law of motion, resulting in my specific version articulated above. Allen Frances proposed in response to my tweet the Second Law Of Ambiguity : Often there is no clarifying force and we must learn to live vagueness. In response to that, Dariusz Galasiński proposed the Third Law of Ambiguity :  Ambiguity is hard to spot, certainty prevails. Even when spotted the desire to reject it and replace it with certainty prevails.

This blog post is derived from a twitter thread , in response to this blog by Mark Ruffalo . I’ve been thinking a lot about how to navigate debates where participants strongly disagree on definitions of concepts such as “disease” and “pathology.” These concepts don’t have a single, privileged definition, so if we are confronted with two internally consistent definitions it seems rather futile in my opinion to insist that one definition must be abandoned in favor of the other. In this scenario, on one hand we have a biological essentialist notion of disease as a demonstrable neurobiological abnormality or lesion, on the other hand we have a notion based on distress and impairment, defended by Ruffalo & Pies. Mark Ruffalo does a good job showing that the prospect of symptoms being “meaningful” does not pose a threat to the internal consistency of the notion of disease as severe distress and impairment. However, the authors of Understanding Psychosis don’t deny that psychosis can be