An A–Z of medical philosophy

OK, every tribe likes to reserve some language for its own use and polish up a few long words to keep the barbarians at bay. Philosophers are no different, but not as bad as medics. ‘Ontology’ is the study of what types or categories of things might reasonably be thought to exist in the world itself as opposed to just our imagined ways of thinking about things.

Talking about planks of wood and body tissue is easy — they seem to exist in the world as it is in itself — we can cut them, we can measure them, we notice when they go wrong. But what about ‘right’ or ‘wrong’? Are they real categories in the world? They are certainly not real categories in the world of matter but neither is the experience of seeing the colour red — it exists within our mind only but is no less real for that. Might right and wrong be real categories in the human world, which is part of the whole world, or do we just invent them as we talk?

Similarly neuroscientists accept the reality of neurons but many will want to dispute whether there is really such a thing as ‘mind’ other than as a way of talking about certain apparent experiences that are generated by those neurons.

And what about diseases? Lung cancer would have a good claim to be a thing in the world itself, a different thing from normal lung tissue. But we talk about hypertension in the same way as we talk about lung cancer, talking it into being a disease rather than a risk factor when in the world itself all we see is a continuous distribution curve of blood pressure measurements. Similarly, is personality disorder a separate category like schizophrenia, with a pathology to be found in the world itself, or is it simply a way of talking about personal characteristics at one end of a normal distribution curve?

Why might this matter? As doctors we usually use a biomedical model. We tend to see problems within a disease model. We have a habit of thinking of categories such as personality disorder or hypertension as separate entities that are abnormal, as if they were diseases. We therefore automatically feel they need fixing rather than seeing them as normal variation that might sometimes cause problems or pose risks.

If we take enough measurements then all of us are going to be more than one or even two standard deviations from the norm on some of them. We need to be a bit more careful about labelling normal variation as disease unless we want to medicalise the whole world. This is not to argue that some risk factors may not be significant enough to require treatment but it does emphasise the need to make a persuasive case rather than just lazily label something as a disease thus justifying automatic treatment.

Ontology does not help to solve this problem. However, it does remind us to think through issues more clearly. It alerts us to where doctors might be making medical problems rather than solving them.

• © British Journal of General Practice 2014