Is health a “social construct”?

Oy, the kids are at it again, and it just gets worse and worse. In fact, this one is so bad that I can barely bear to write about it. Yes, it’s from the ultimate Hierarchical Oppression site, Everyday Feminism, always a way to gauge the Regressive Left Zeitgeist. Since the site loves listicles, this is one of them: “5 social theories that prove health is constructed,”   by Melissa A. Fabello, who describes herself on her website as “a feminist writer and speaker who covers issues related to body politics and beauty culture.”

Read the title of her piece again and see if you can guess what the piece is about. Yep, you’re probably right: health is not in any sense “objective”, but a social construct that is sold to us by various Organizations of Power like doctors and Big Pharma. In reality, she implies there are many ways to be healthy. Being sick is one of them.

Now Sam Harris makes the case, in The Moral Landscape, that we can have objective morality—i.e., those actions that promote well being; and he makes his case by pointing to something that he thinks is indubitably objective: health. Health is a kind of well-being, he says, and few of us doubt what it means to be healthy, want to be healthy, or judge someone healthier than someone else.  While I disagree with Sam’s general argument on the objectivity of morality, it’s hard to argue with this example.

Unless, that is, you’re Melissa A. Fabello, who, besotted by postmodernism, thinks that “health” is a very complex topic, and, in fact, a socially constructed concept. This is one example of where the Left has gone badly wrong on science.

Well, in one sense the concept of being “healthy” is a social construct since it’s a concept constructed by humans, but if you have the flu, or measles, or a flesh-eating bacterial infection, it’s also a meaningful concept, because you want to be cured, feel better and not to have your nose eaten away. With the exceptions of people who suffer from Munchausen Syndrome and like being ill, doctors and medicine exist for a reason: people want to be healthy and feel good, and they prefer not to be sick. People of all races and genders go to doctors when they have “socially constructed” illnesses.

Not so fast, says Fabello, and lists five “social theories” that support the notion that “being healthy” is purely subjective. All quotes are indented (emphases are Fabello’s); my take is flush left.

  • Healthism.

Healthism (Crawford, 1980) describes a political ideology wherein a biomedical understanding of health is given social power and individuals are held responsible for their ability to uphold their own health.That is, it’s our cultural belief that meeting the standards of a one-size-fits-all version of health should be a priority for everyone – and that those who don’t meet that criteria can and should be oppressed as punishment.It is, basically, the idea that health is valuable – not just individually, but socially. . .

I get it. It makes sense that we would be evolutionarily drawn to the idea of good health and longevity. But prioritizing health (and especially making it a moral issue) still creates a hierarchy wherein some people are deemed more worthy than others – and that’s an oppressive way to think about our bodies.

Health, sure enough, is arguably a physical experience of biological beings. But our moral obligation to health is something that we, ourselves, created.

She’s talking about “ableism” here—the discrimination against those who are ill or disabled—and that is wrong. But we do have an obligation to health—perhaps not our own, but that of our family and friends, and society as a whole. Why else would Everyday Feminism write article after article about how increase the well being of the disabled, or “heal from toxic whiteness” (that’s a paid course they offer). If nothing else, it’s clear they feel we all have an obligation to mental health.

  • Social model of disability

Here she claims that society has a responsibility to ease restrictions for disabled or ill people.  To some extent she’s right. A disabled person isn’t usually disabled by their own choice.  And we should do what we can to help them and give them access to the same opportunites that others have.  But isn’t the notion of “disability” a real one, then, and not a social construct? And if disabled people are disadvantaged, that shows that there is an alternative condition, not involving accommodating the disability, that would render them not disadvantaged, like not being paralyzed.

  • Biopsychosocial model. 

The biopsychosocial model (Engel, 1977) was created in response to the biomedical lens – the latter of which assumes that all disease and disorder has an organic cause, and therefore, an organic solution, within the body. Using a biopsychosocial lens means recognizing that biology, psychology, and sociocultural factors all play a role in how we develop and are treated for illness.

It’s a way more holistic (and honest) way of looking at health.

Western Medicine hyper-medicalizes health – which seems sensible at first. But only because we’ve been socialized to believe that our bodies should operate like machinery and that with a little fine-tuning from doctors, we can live long and healthy lives.

But no. Our health isn’t only determined by what’s going on in our physical bodies (more on that next), so we need to think more broadly about it. Not because medicine isn’t legitimate – but because it’s limited.

Of course there are psychological and sociocultural factors that cause illness and disability, but this still manifests itself organically. Doctors may not be able to help you, and are limited in that sense, but you won’t get helped by anything that doesn’t have some effect on the molecular makeup of your being, whether it be your body or your brain. If all Fabello is saying here is that not all diseases are purely caused by mutations or microbes, then that’s completely trivial. As is her next “model”:

  • Social determinants of health. 

What if I told you that the genes with which you were born and the health behaviors in which you choose to engage only account for 25% of your health experience? What if these two factors that we spend so much time and money on understanding and fixing are only a quarter of the problem?

You can learn more from the World Health Organization and the Centers for Disease Control and Prevention, but here’s the gist: There are five factors that determine (un)health: genes, behavior, social environment, physical environment, and access to health services. And guess which are the ones that have the biggest influence. YupThe last three – also known as the social determinants of health.

And think about it: What affects our social environment (who we interact with), physical environment (where we live), and access to health services (how available healthcare is to us)? Our intersecting social locations.

But if health is a social construct, how can you even talk about what determines health or “unhealth”. There must be a way to measure it, and surely those measurements are in the two links they give. The emphasis on “intersection” in the last sentence gives away the real point of this article:

Our race affects our level of health. Our class affects our level of health. Our gender, size, sexual orientation or identity, documentation status, and ability affect our level of health.

The more oppressed a person is by intersecting systems, the more likely their health is to suffer.

Tell me again that biology is simple.

The whole article boils down to that second sentence, which is “the more oppressed somebody is, the sicker they are.” That may well be true. But again, how does that make health a “social construct”? How can your “health” suffer if it’s a social construct? Can’t you just declare yourself healthy, as a transgender person can declare themselves a member of another gender (gender, too, is a social construct)?

Finally, we get to the conspiracy theories:

  • Medical Industrial Complex.

The medical industrial complex (Ehrenreich & Ehrenreich, 1969) is a term used to criticize health as a for-profit industry and how the driving force of money creates an unbalanced, unjust system.

How can we trust anti-“obesity” research findings when the studies are funded by the weight-loss industry? How can we have faith in medical practitioners offering us prescriptions when they’re sponsored by pharmaceutical companies? How can we believe that we really are sick when disease is invented just so that a solution can be sold to us?

When our (lack of) health puts money into big businesses, we need to question the systems telling us that we’re unhealthy.

And when our level of health determines how we’re treated in society, we need to question the validity of “health” as a concept.

Now there’s no doubt that there’s cronyism, biased reporting by the pharmaceutical industry in drug tests, and so on, but not all drugs are useless. And really, are medical practitioners “sponsored by pharmaceutical companies”? Some of them get perks from those companies, or have their research sponsored by them, but #NotAllDoctors!

In the end, this is a profoundly confused article, which, it seems to me, both admits health is real and quantifiable but then argues it’s a social construct. It can’t be both. The whole problem is summed up in the last sentence:

And when our level of health determines how we’re treated in society, we need to question the validity of “health” as a concept.

Seriously? How does that work? Just because society may discriminate wrongly on the basis of something, doesn’t mean that that “thing” is somehow invalid.  People are also discriminated against on the basis of ethnicity and gender, but does that mean that “gender” and “ethnicity” are invalid concepts? They may be criteria that aren’t morally or socially relevant, but they’re still real things.

And with that Fabiello displays her profound anti-science views, dismissing something as real if it can be a cause of bigotry. That’s exactly what Heather Heying was talking about this morning, and it’s exactly how the Regressive Left approaches studies of differences in behavior and preferences of different groups, or of evolutionary psychology as a whole. Because they could in principle be used to promote bigotry, they can’t tell us real things.

I have a feeling I’ve just wasted half an hour. . .

83 Comments

  1. GBJames
    Posted October 3, 2017 at 11:10 am | Permalink

    sub

  2. Harrison
    Posted October 3, 2017 at 11:15 am | Permalink

    I’ll remember the “we have no objective moral obligation to health” thing next time I come across a story about some negligent theist parents who let their children die from preventable or treatable illness.

    • Posted October 3, 2017 at 11:54 am | Permalink

      Also, this person should be asked what health insurance is for under this understanding, and if it is a tragedy that many Americans are uninsured/underinsured?

  3. Harrison
    Posted October 3, 2017 at 11:20 am | Permalink

    There’s a paranoia among Fat Acceptance advocates that doctors are in league with Big Diet and Big Exercise. But when your doctor advises you to lose weight for your health, they’re not writing prescriptions for Bowflex or Skinny Magic. Medical diet plans focus on cutting things like salt and sugar, and simple calorie counting. It’s absurd thinking that conflates this with the diet pill or exercise gimmick industries.

    • Posted October 3, 2017 at 1:05 pm | Permalink

      This argument comes from the Fat Acceptance/Health at Every Size movement. It’s their way to deny the consequences of obesity, especially morbid obesity. Type 2 diabetes is not bad if pretend that health aint nothing but a number.

  4. Posted October 3, 2017 at 11:21 am | Permalink

    Not a wasted half an hour…I don’t have the knowledge or skills to comment further but by reading your ‘wasted 30 minutes’ I may have learnt something…at least thought about something…so thank you.

  5. Jeff Rankin
    Posted October 3, 2017 at 11:26 am | Permalink

    Just another vector through which one can claim oppression and victim status. Like the other vectors, the goal isn’t justice, it’s power.

    With a * studies degree, you can’t gain power through hard work, because there’s no work per se, power can only be gained through victimhood – the greater the number of vectors/intersections, the greater the status.

    A bit of a tangent, but I’m reminded of the conversation between Jordan Peterson and Camille Paglia that was just published – specifically the pomoists rejection of competence.

    • Posted October 3, 2017 at 11:33 am | Permalink

      Is there a transcript available for the Paglia/Peterson conversation?

      • Jeff Rankin
        Posted October 3, 2017 at 11:37 am | Permalink

        Not that I know of, but it would be great were someone to make one. Great conversation, and I’m only 45 minutes in. Here’s the link, apologies in advance if it gets embedded:

        • Jeff Rankin
          Posted October 3, 2017 at 11:38 am | Permalink

          Yeah sorry for the embed.

  6. BobTerrace
    Posted October 3, 2017 at 11:28 am | Permalink

    What is wrong with those people? Should I not pick up my antibiotic from the military/industrial/medical complex (CVS drugstore) and succumb to the Streptococcus because it is a social construct?

    How can anyone have any respect for people who talk like that?

  7. Ken Phelps
    Posted October 3, 2017 at 11:29 am | Permalink

    “How can your “health” suffer if it’s a social construct? Can’t you just declare yourself healthy, as a transgender person can declare themselves a member of another gender (gender, too, is a social construct)?”

    Well of course there’s no answer to that. I’d merely hoped that you wouldn’t raise that particular objection, but I can see that you’re more than a match for me. /python

  8. Posted October 3, 2017 at 11:29 am | Permalink

    Next to tweets, listicles epitomize the debasement of discourse going on today.

  9. Bill Shipley
    Posted October 3, 2017 at 11:35 am | Permalink

    This argument arises because the author doesn’t really understand the concept of “measurement”. Consider the concept of “temperature”. If we ask different people to feel different objects and assign a number (purely subjectively relative to themselves) that represents how “hot” or “cold” the object feels, then we will find a large degree of agreement in terms of the ranking of these senses across different people. This shows that there is some generalizable property (temperature) that is experienced in the same qualitative way by people. This is the most basic meaning of temperature. We would find the same thing if we then asked people to rank their “health” in different scenerios (terminal stage cancer, cronic pain, flu, splinter in finger…).

    We could then search for measuring instruments (mercury thermometers, themocouples, thermistors…) that are maximally correlated with these sensorial rankings of “temperature”. This provides us with more reliable and repeatable ways of quantifying our sensorial experiences. We then operationally define “temperature” of an object as “the height of a column of mercury in a vacuum” when surrounded by the object, and assign measurement units to it (degrees C or F). Finally, we might identify the underlying physical cause of this (the average kinetic energy of atoms or molecules composing the object) and re-define “temprature” this way, with new units (degrees Kelvin).

    In the case of “health”, we are still at the sensorial stage of a definition, but it is still objective and repeatable. We don’t have the equivalent of a thermometer that we can stick in a person’s mouth and measure his/her “health” cause the notion of “health” is multidimensional and involved many different causes. This does not mean that health is purely “subjective” and determined by some powerful clique. On the contrary, it is determined collectively by the fact that virtually everyone would independently agree on how to rank degrees of “health” given different scenerios.

    • Posted October 3, 2017 at 11:56 am | Permalink

      Or: health is a vector quantity, not a scalar.

      • Posted October 3, 2017 at 7:29 pm | Permalink

        Scalars. Vectors. Don’t you know math is a social construct? 1+1=2 is merely an assertion by a white male cisgendered logic supremacist.

  10. GM
    Posted October 3, 2017 at 11:39 am | Permalink

    There is a quite objective definition of disease/disorder/etc. — it is those physical or mental conditions that decrease your inclusive fitness relative to what it would be were you not to have them.

    To deny that this is an objective definition is to deny that differential reproductive success is a real thing.

    I can easily envisioning them going that route one day though — and not just denying it is a natural fact of life, but trying to actively make it so that it is not the case…

  11. DrBrydon
    Posted October 3, 2017 at 11:43 am | Permalink

    Oh, that must be where the term Social Disease comes from….

  12. Posted October 3, 2017 at 11:49 am | Permalink

    The article does seem profoundly confused, but I don’t think equating “social construct” with “purely subjective” helps criticism here.

    • Posted October 3, 2017 at 11:51 am | Permalink

      In what ways are they NOT equivalent?

      • Posted October 3, 2017 at 12:41 pm | Permalink

        Look, officer, as this law is a social construct, it must be in your head.

    • Posted October 3, 2017 at 11:57 am | Permalink

      Well, the extreme postmoderns (if they were logically consistent) effectively conclude the world is “in you”, so …

  13. Carey Haug
    Posted October 3, 2017 at 11:54 am | Permalink

    I had heard that Everyday Feminism was going bankrupt- in the financial sense. It’s already bankrupt intellectually.

  14. Icarus
    Posted October 3, 2017 at 12:08 pm | Permalink

    Have you finished reading the biography of Freud by Frederick Crews ? What is your final synopsis , Professor Ceiling Cat ? Thanks in advance .

    • Posted October 3, 2017 at 8:08 pm | Permalink

      2/3 through; I had to interrupt my reading to read another book I’m reviewing. But it’s very, very good, and an engaging read. The reviews by Freudians have unfairly damned it, but that’s to be expected. Like all Crews’s work on Freud, it’s meticulously researched and even the critics can’t fault that, so they just accuse Fred of “Freud bashing.”

      Definitely worth reading, as were his two previous books on Freud (one an edited collection).

      • Posted October 4, 2017 at 11:26 am | Permalink

        It will be very interesting to see where in the realm of disciplines the Freudians will be found to “address” Crews’ latest. I’d hazard a guess that in the English language press they will all be, like Crews himself, in literature and language areas. *Maybe* an anthropologist, or “Film Studies”, which could use it from what I understand. (I recommended one of Crews’ earlier essays to a friend studying that. No word on how it went over.)

      • Icarus
        Posted October 7, 2017 at 6:12 pm | Permalink

        I’m looking forward to reading it . Thank you. I also enjoyed this interview with the author :

  15. peterandes
    Posted October 3, 2017 at 12:09 pm | Permalink

    I think you put things perfectly when you say: “Well, in one sense the concept of being “healthy” is a social construct since it’s a concept constructed by humans, but if you have the flu, or measles, or a flesh-eating bacterial infection, it’s also a meaningful concept, because you want to be cured, feel better and not to have your nose eaten away.”

    But then you say: “But if health is a social construct, how can you even talk about what determines health or “unhealth”.” and “this is a profoundly confused article, which, it seems to me, both admits health is real and quantifiable but then argues it’s a social construct. It can’t be both.” These sentences seem to suggest that when something is merely a social construct, it is worthlessly subjective.

    I thought your initial take on the matter was the right one to have–social constructs can be meaningful and useful and are none the worse for being social constructs. You go on to suggest that social constructs aren’t measurable, but aren’t things we might think are socially constructed, like money, measurable? I think the more useful way to think about social construction is in your first sentence I quote above.

    I would agree with your conclusion, but for reasons you probably wouldn’t endorse. I want to say: of course health is a social construct–what isn’t? What things, from mountains to giraffes to health and gender aren’t picked out and shaped by and for the purposes of human linguistic and social practices? Of course, at that point, if everything is a social construct, then so is the very notion of a “social construct”. And we can ask, so, did we discover that everything is a social construct, or did we socially construct this realization? (And what about this distinction itself? The same question applies.)

    After a certain point, it becomes beside the point. We realize that the found/made distinction doesn’t actually help us much when it comes to deciding what we should do, since we can’t well see ourselves as having found that everything is made. Maybe instead of trying to sort out the found from the made we could see what notion of health best suited the practices that we believe will better human life, and go with that.

    One can perfectly well agree that health is a social construct if one wants to, while not seeing how this gloss on it matters very much for our current practices that treat it is something everyone should roughly be able to agree on, since almost no one wants to suffer from illness. It’s also worth noting that the test of a social construct would not seem to be whether someone can make declarations that alter it–after all, if anything is worth calling a social construct, it is money, and one cannot simply declare any piece of paper to be a dollar bill. The same goes for marriage, another thing commonly thought to be socially constructed. Not just anyone can declare any two people to be married.

    • GBJames
      Posted October 3, 2017 at 12:21 pm | Permalink

      One can, in fact, make those declarations… that any scrap of paper is a dollar, that any arbitrary two people are married, etc. What matters in those situations is whether anyone else goes along with the declarations.

      This isn’t the same with health. If I’ve got a case of pneumonia going on I’m sick, whether I’m conscious of it or not (I may be bedridden in a coma) or whether I’ve been diagnosed or not (I’ve come down with pneumonia and haven’t left my live-alone home).

      These two sorts of things don’t seem at all the same. The only thing socially constructed about my pneumonia are the social rules for how we treat sick people, wether I’m allowed to seek treatment, and so forth.

      • peterandes
        Posted October 3, 2017 at 12:30 pm | Permalink

        I think the crucial element you highlight is agreement–what matters is that we get people to agree that something is money or that something is pneumonia. Prior to any agreement on the matter, prior to any understanding of what counts as either, there’s no way to pick out money or pneumonia as reflecting anything different from anything around them. Once you’ve got the linguistic practices in place that pick them out, then you can say they existed even if no one knew about them (easier to imagine in the case of pneumonia, since our understanding of pneumonia is that it might still be around in animals if there were no humans, but it’s hard to imagine how there could be money without humans–perhaps practices that look like the use of currency in other primates count?). On this view, the point would be that, whether we think something would be around without humans or not, it would only be through established linguistic practices that pick out the thing in question that we can make sense of it as being different from anything else.

        • GBJames
          Posted October 3, 2017 at 12:43 pm | Permalink

          No. It isn’t the same… money and sickness (pneumonia). We have to agree about money. But if the right (wrong) microorganisms are playing hop-scotch in my lungs I’m sick, whether or not you and I agree on it. Some things exist out there in the world whether or not we witness them. Health (or ill-health) is a function of reality, not something we invent between us.

          • peterandes
            Posted October 3, 2017 at 1:03 pm | Permalink

            I guess I just see our agreement on what counts as pneumonia coming before there’s something called pneumonia “out there”. I don’t see how it’s any different from anything else until we’ve differentiated it. Once we have a scientific vocabulary in place to talk about pneumonia because it is so unpleasant to have the wrong microorganisms in your lungs, then it’s here to stay. Once we’ve differentiated it in our linguistic practices, then I agree that it’s out there whether we like it or not. But I think our ways of talking about pneumonia, our linguistic practices, are not already “out there” before they come about.

            I don’t think we’re matching up our linguistic practices with something like the “language of nature”. I don’t think nature speaks a language. Only we do. So I see our ways of talking as descriptions of the world based on our needs and interests (like not getting sick). I don’t see how things laid out by the descriptions of our linguistic practices could be around before linguistic practices, since linguistic practices pick them out because we find them salient. The world is outside of our control, but our ways of describing the world come from us and it is within our linguistic practices that we come to our descriptions, not by finding a way the world is apart from our descriptions of it. Our descriptions have to be there to break up the world at all.

            Of course, I would not say this way of seeing things is the right one–the one that gets the world right. I would rather suggest that it’s useful in allowing us to pick up and put down vocabularies that serve us–rather than those that are supposed to serve the world–since by its own lights we can’t make much sense of getting the world right before our linguistic practices are on the scene.

            • GBJames
              Posted October 3, 2017 at 1:14 pm | Permalink

              Humans don’t need to exist for disease to exist. Disease is an attribute of life processes. No people are required to create it. No language is required. Nothing that existed before language required language to exist. In the beginning it was not the word.

              • peterandes
                Posted October 3, 2017 at 1:30 pm | Permalink

                I’ve really appreciated this exchange. I fear I’m fast losing my ability to say anything different or interesting about my own position. At the risk of being tiresomely repetitive:

                I would just ask, what picks out what a “life process” is? I can’t see anything that would do so but language users. I don’t think reality knows or cares what a life process or a disease is, because I don’t think reality knows or cares about anything. Without anyone to know or care how a “life process” differs from any other part of reality, I’m not sure I can make much sense of there being life processes without language users interested in such things. I think the world exists before we come to describe it, but without a way to describe it we can’t make use of any descriptions like “life processes” or “disease” to differentiate these things. I just see our descriptions of the world picking out the things we then understand to exist independently of us.

              • GBJames
                Posted October 3, 2017 at 2:12 pm | Permalink

                The things we “call” disease exist out there whether we identify them or not. Whether or not anyone “knows about” them is irrelevant to their existence. The universe didn’t pop into existence when some people got together and agreed about it.

                It comes down to recognizing models of things with the things themselves. A model of some disease process is a “socially constructed thing” because people worked together to construct it. But the model is a model of something. That thing is “out there” in reality. If humans vanish from the face of the earth, dogs (or whatever animals are still around) will still get sick.

              • peterandes
                Posted October 3, 2017 at 4:48 pm | Permalink

                You raise some really interesting points. I think the issue in question is whether the standards which we use to decide how well a model “fits” reality are internal to that model or not. People like me don’t see how they could be anything but. Once you’ve got a model working, with an idea of what it means for the model to represent reality better and better, then you can say it gets at something that is out there. But which model you pick up will depend on what interests you and what you need out of it.

                I just don’t see how we could say that one model represents reality better than another, when the model itself lays out what counts as criteria for more accurate representation. Once you pick up the model, you’re off to the races. But which models do we pick up? That just seems like a matter of which models are convenient to our practices.

                We’re going to be very interested in models that tell us how to stop feeling awful from illness or send rockets into space. But do these models represent reality? All we can do is see what our own model tells us. But we’ve picked that model over others because it suits our purposes to do so, not because it is more accurate, since prior to picking it we had no way to see which models were more accurate.

                This is pretty much the debate between Thomas Kuhn and his critics like John Searle. One might think no scientists take Kuhn’s views very seriously, but his influence on the debate over scientific realism reaches farther than one might think. In their book The Grand Design, Stephen Hawking and Leonard Mlodinow espouse something they call “model-dependent realism”. They write, “But there may be different ways in which one could model the same physical situation, with each employing different fundamental elements and concepts. If two such physical theories or models accurately predict the same events, one cannot be said to be more real than the other; rather, we are free to use whichever model is most convenient” (p. 7). That seems pretty Kuhnian to me. (Of course, Hawking and Mlodinow go on to say that we can call whatever our models tell us “have a quality of reality and absolute truth” (p. 7) which doesn’t make much sense to me, but then they don’t want to be seen as entirely giving up the game.) And that already assumes that we’re interested in prediction, and that we have some model of it we already subscribe to, as what we want out of the models we pick up. Sorry to be so long-winded, I’m really interested in this stuff.

              • GBJames
                Posted October 4, 2017 at 8:01 am | Permalink

                “…I just don’t see how we could say that one model represents reality better than another…”

                This is the postmodernist’s self-negation, pure and simple. If it were true there would be no reason to take it seriously. And there are endless examples that show it is false.

              • peterandes
                Posted October 4, 2017 at 4:02 pm | Permalink

                I think it would be if I were defending my view as the right way to view reality, since part of what my view entails is that it doesn’t make sense to say that there is a right way to talk of reality independent of a vocabulary that describes it and tells us what the standards for rightness are. If I were saying, “I’ve got the right way to talk about reality, it’s that there’s no right way to talk about reality!” then that wouldn’t make much sense.

                But as I say in my first post, I’m trying to cast doubt on the usefulness of the found/made and real/social construct distinctions. I’m not saying that I’ve found that everything is made, since then I would have found something that was not made. Rather, I’m suggesting that an allegiance to scientific realism and to a way the world really is apart from our descriptions of it doesn’t make a lot of sense. And once we see that it doesn’t make a lot of sense, we shouldn’t say that we’ve found out that it’s not true to reality, since that would mean we were still allied to thinking about the way the world really is. We should say, well, maybe we should try finding some way of talking that does make sense. Maybe we should forget about trying to sort the found from the made since that effort seems pointless.

                I think we can get along a lot better without the found/made distinction or the real/social construct distinction (How is a social construct “unreal” anyway? It’s not physical? How do we come by our understanding of physical? What would something be if not physical, and if there is such a something, how is it unreal, if it’s still something and not nothing?). We might get along better without these distinctions by focusing on a notion of health that works to help us make human lives better, not offered as “how health really is” but as health as it works best for us so that we can improve human lives.

          • Posted October 4, 2017 at 11:28 am | Permalink

            Here’s an example from pure science.

            We decide that there is a significant pattern to be captured in the periodic law. Once the pattern is conceptualized (i.e., focused on) it is not up to *us* to decide that calcium is more like barium (chemically) than either is like hydrogen or xenon.

        • Heather Hastie
          Posted October 3, 2017 at 12:43 pm | Permalink

          All money is, is a medium of exchange (moe). As societies we happen to have agreed on particular ones for ease in transacting business -currency. However, if you remember what it’s purpose actually is, there’s no problem seeing it the way you describe, including in the animal kingdom. A male Bower Bird’s moe is his bower, the mate he attracts moe is her ability to provide offspring.

          • GBJames
            Posted October 3, 2017 at 1:01 pm | Permalink

            True, that. And when you think of it, ant hills and many other non-human things are socially constructed.

            You may be making me change my perspective a bit. My sickness might be socially constructed after all. But only to the extent that pneumonia is socially constructed by micro-organisms working together to make me sick.

            • peterandes
              Posted October 3, 2017 at 1:09 pm | Permalink

              Interesting thought. I guess the question is then what counts as a society, and whether micro-organisms can be thought to have one.

            • Heather Hastie
              Posted October 3, 2017 at 1:27 pm | Permalink

              I don’t think health is a social construct in the way the writer of the article describes. I’m with Jerry as far as that’s concerned. I was just adding to the discussion re money.

              We need a medium of exchange because our society is too complex to operate like a baby sitting club. Health has objective measurements. For me, the important thing is people shouldn’t be discriminated against because of their health status.

              Society as a whole should provide care, and every developed country does that except the US. That obviously doesn’t mean we can’t have physical, mental, or psychological requirements for certain jobs. If health is a social construct, Trump is fit to serve as president.

              • GBJames
                Posted October 3, 2017 at 1:56 pm | Permalink

                Trump isn’t fit regardless!

        • Posted October 3, 2017 at 2:00 pm | Permalink

          Pneumonia exists outside of representations. Money doesn’t.

          Money isn’t paper or coins or digits on magnetic tape, it exists as shared representations in the mind’s of human beings.

          There is no money prior to representation. A currency will devalue as people lose confidence in it.

          • peterandes
            Posted October 3, 2017 at 4:17 pm | Permalink

            I agree. I would just say that to make the distinction between the stuff that wouldn’t be here if humans didn’t exist and the stuff that would seems to already require linguistic practices in place that pick out these different sorts of things. Once we have linguistic practices that characterize pneumonia the way we do, it exists independently of those practices, since that’s part of our characterization of it. But if no one has yet bothered to develop a characterization of pneumonia, I don’t know to whom it’s going to matter whether it’s worth adopting a description of something we call “pneumonia” and whether it should be characterized, as you put it, as outside of representations, or not.

            • infiniteimprobabilit
              Posted October 3, 2017 at 7:17 pm | Permalink

              Pneumonia is a physical thing, regardless of whether it’s diagnosed or we have a name for it. It most certainly existed long before it was known as ‘pneumonia’. The social concept of what pneumonia is, is a different issue – obviously it couldn’t be discussed until it was named. ‘Gravity’ would be an even better example of that.

              A better example of a socially constructed disease might be some psychological complaints or disorders, some of which seem to appear or disappear according to fashion and depend entirely on what society considers to be within the bounds of ‘normal’ behaviour.

              cr

              • Posted October 4, 2017 at 11:31 am | Permalink

                Psychological conditions have a more “proximate” social component (as befits the brain as the primary interface between the social and the biological) and so it is understandable that dysfunction is relative to the social system that the behaviours take place in.

                However, this shows the ambiguity between the various notions of “social construction”. Clearly people did not *invent* “amok” or “amae”, but these are nevertheless social in the sense they deal with behaviours that would be different or differently (dys)functional elsewhere.

                It also doesn’t follow that there are no social dysfunctional universals, either.

    • eric
      Posted October 3, 2017 at 7:36 pm | Permalink

      What things, from mountains to giraffes to health and gender aren’t picked out and shaped by and for the purposes of human linguistic and social practices?

      Somehow I think the mountains would still be there no matter what language we spoke, or even if we spoke none. And the same is true for yersinia pestis.

      After a certain point, it becomes beside the point. We realize that the found/made distinction doesn’t actually help us much when it comes to deciding what we should do…

      But this distinction does help us decide what we should do. Because the measles virus is not socially constructed, we should vaccinate against it. Because culture-bound syndromes are socially constructed, we must treat them via sociology and psychology. If you try and vaccinate against fan death or kuru, you will fail to produce anything more than a placebo response. And OTOH if you try and talk people out of thinking they have measles, you will also fail to achieve cures higher than the placebo rate.

      It is, somewhat ironically, because there are social constructive aspects to how we perceive health that it becomes so important to be able to tell the difference. With these two factors both influence our health, it becomes critically important that we address causes of illness with the appropriate and effective cures. Pretending there is no social aspect fails to apply the most effective cure to some illnesses. Pretending there is no objective physical aspect fails to apply the most effective cures to others (and, because I don’t want to propagate any sort of false equivalence, let’s remember that the latter causes far more untimely deaths than the former).

      • peterandes
        Posted October 3, 2017 at 7:58 pm | Permalink

        I think once we have a linguistic practice that picks out mountains as being around before humans then we can say that they would be there even if we hadn’t existed. It’s hard to imagine, however, how what we call a “mountain” would be differentiated from its surroundings if there really were no language users to take an interest in it.

        I would want to see the found/made distinction replaced by the more useful/less useful distinction. Treat the things that respond to therapy with therapy, and the things that respond to medicine with medicine. Go with the practices that are most useful, most effective, for your purposes.

        I don’t think there’s any need to try to settle how anything could avoid being socially constructed in some sense in order to go with what works. Different treatments work on different things, and you don’t have to have a theory of natural and social kinds worked out to deliver treatments in psychology or medicine.

  16. Posted October 3, 2017 at 12:18 pm | Permalink

    I can only facepalm this time, it is impossible to write a response to something that is-not-even-wrong wrong.

  17. Posted October 3, 2017 at 12:20 pm | Permalink

    I wonder of Fabello would dispute that a few days ago Tom Petty was rather unhealthy and his health has deteriorated substantially since then!

  18. Posted October 3, 2017 at 12:26 pm | Permalink

    A lot of this is really an extension of fat-acceptance.

    There are health problems associated with obesity and there is also social stigma, and in order to combat the latter fat-activists have to deny the former.

    And the same logic lies behind intersex conditions where it can be used to deny that chromosomal or developmental abnormalities are simply part of a sexual spectrum.

    There’s some truth to the social model of disability: reasonable adjustments can be made to the workplace or public spaces that make them more disability-friendly. Coverage of sports for disabled athletes has eveolved from the patronising ‘Aw, bless!’ school of reporting to something which inspires genuine awe. But we have to recognise that not being able to walk is not equivalent to not being able to swim and that some mental disorders should disqualify people from running a country.

  19. Posted October 3, 2017 at 12:29 pm | Permalink

    Meh. I am still going to watch what I eat and go to the gym, go running, hiking, etc. I feel better at 200 lbs. than at my old 320 lbs.

    • Jeff Rankin
      Posted October 3, 2017 at 12:56 pm | Permalink

      Another sad victim of healthism.

  20. Heather Hastie
    Posted October 3, 2017 at 12:31 pm | Permalink

    This article is just plain stupid, and I’m glad you took the time to take it apart Jerry.

    Further, from the pov of someone living in a country with decent healthcare for all, the writer would be better off focusing on that lack in the US.

    One of the things governments in countries like mine do is focus on those causal factors she mentions to improve the health of all. For example, making sure all properties are properly insulated to ensure everyone has warm, dry, living conditions. Funding smoking cessation programmes. Funding cancer screening. Funding nurses in schools. Free immunizations. Etc etc etc.

    Many are less direct, like teaching about good diet by the examples used in all subjects in the curriculum. I get told by 6 yo nieces how many calories and how much sugar is in my soft drinks (soda). This sort of thing equalizes social conditions, to put it into words she would understand. It also reduces health costs for the government long term – prevention is cheaper than cure, as well as better.

  21. J. Quinton
    Posted October 3, 2017 at 12:37 pm | Permalink

    If health is a social construct, then I suppose death is a social construct too.

    Congratulations PoMos: You’ve just recreated religion.

    Here’s the reductio ad absurdum QED, though. The concept of a “social construct” is also a social construct.

    *head explodes*

    • phoffman56
      Posted October 3, 2017 at 1:43 pm | Permalink

      Glad I checked the word “death”. Or I would have written that, having got worse and worse with the social construct known as brain cancer, the poor bugger suffered the social construct of dying.

    • Posted October 3, 2017 at 1:43 pm | Permalink

      Death is a social construct to the extent that if you have signed a DNR death will be called before someone who hasn’t got a DNR, as in that case the doctors will continue to attempt resuscitation. Those attempts will also last longer if you are rich.

      Also, a missing spouse can be declared legally dead after a number of years.

    • BobTerrace
      Posted October 3, 2017 at 2:05 pm | Permalink

      *head explodes*

      Take two aspirin and call me in the morning.

    • Posted October 4, 2017 at 11:33 am | Permalink

      That’s exactly what happened (so to speak) to Bloor when he tried to apply the “Edinburgh school” stuff to itself. He found it very difficult to be “self reflexive”, as these pomo sociologists called it. This of course hasn’t stopped them, but …

  22. Posted October 3, 2017 at 1:31 pm | Permalink

    Something for Fabello to think about:

    And when our level of wokeness determines how we’re treated in society, we need to question the validity of “woke” as a concept.

  23. J.Baldwin
    Posted October 3, 2017 at 1:35 pm | Permalink

    There are reasonable approaches to the empirical facts of constructed realities (i.e. non-pomo approaches). John Seale’s “The Construction of Social Reality” is an excellent book on the subject.

    • Posted October 3, 2017 at 1:51 pm | Permalink

      As is Searle’s The Making of the Social World. Some things exist because we agree to their existence. Marriage, money, law. If people stop believing in them they cease to exist. We can also extend the meaning of institutions like marriage beyond their original meaning so long as we agree to do so – and, in recent years, most of the West has.

      Searle is careful to distinguish between between brute facts and social facts. Everest will continue to have snow on its peak even if we call the mountain ‘Mr Peaky’ and snow ‘angel dandruff’, or, indeed, if humans were entirely oblivious of its existence.

      • GBJames
        Posted October 3, 2017 at 2:19 pm | Permalink

        I’m curious whether Searle includes dieties on his list. I would assume so. But… ?

        • Posted October 4, 2017 at 11:34 am | Permalink

          I doubt it. Social items exist – they just don’t exist independently of humans (or other social animals). Gods are not like that.

          • GBJames
            Posted October 4, 2017 at 12:45 pm | Permalink

            So there really is a Huitzilopochtli?

  24. JonLynnHarvey
    Posted October 3, 2017 at 1:53 pm | Permalink

    I suppose that a quarter-truth in what she is saying lies in the fact that some disabilities bring with them enhanced capabilities in other areas.

    Blind people often have far more acute hearing than average. Some autistics don’t want therapy and like many features of their condition, and want to see it as simply a different way of being.

    However, Hippocrates is (among other things) famous for rejecting the notion that epilepsy either has spiritual causes OR that it is desirable.

    • Posted October 3, 2017 at 2:57 pm | Permalink

      Yes, but these minimal benefits, to hear a little better, do not outweigh the disadvantages caused by the fact that you have no vision

      Are there any species of mammals (except the naked mole rats and moles), which are known to have survived in an environment above ground?

      Blind people can only survive because they live in a society where they are helped for a lifetime.

      • JonLynnHarvey
        Posted October 3, 2017 at 4:57 pm | Permalink

        Entirely agreed.

        (I assume you mean blind mammals.)

        • Posted October 3, 2017 at 5:03 pm | Permalink

          Yes of course I referred to blind mammals, thanks for the hint.

  25. Steve Pollard
    Posted October 3, 2017 at 2:54 pm | Permalink

    I agree that this article is wrong-headed and misleading. Yet the notion of “disease” as an unhelpful social construct is sometimes not wrong. I am thinking in particular of the pronouncements of the American Psychiatric Association, as set out in its Diagnostic Manual of Mental Disorders, which manages to define many vagaries of human behaviour as illnesses that require treatment. This medicalisation of normal ranges of behaviour is deeply flawed, not least in distracting attention from conditions that really are issues that can be clinically helped.

    • infiniteimprobabilit
      Posted October 3, 2017 at 7:30 pm | Permalink

      Mental disorders are a different sort of thing from physical disorders (though obviously the two can co-exist in many cases).

      I do most certainly agree that, at the ‘milder’ end of the scale, many ‘disorders’ are socially created as a consequence of the social view of what is within the bounds of ‘normal’ behaviour.

      Physical disorders, on the other hand, are real and surely not a ‘social construct’.

      cr

      • Posted October 3, 2017 at 7:51 pm | Permalink

        Do you seriously believe that social constructs such as laws and professional qualifications are not “real”?

  26. Posted October 3, 2017 at 3:39 pm | Permalink

    Is there anything in the world that does not always have a negative side and therefore has the potential to be the starting point for bigotry?

    It seems that the meticulousness with which the potential of a possible discrimination is investigated rather serves the moral sense of self-esteem rather than the superficial theme on which the indignation is based

    Humans are no hunters anymore of big deer, but they are moral hunters now.

  27. Richard Sanderson
    Posted October 3, 2017 at 3:40 pm | Permalink

    Remember when the likes of Mercola and other pushers of woo would come out with stuff like this, and skeptics such as PZ Myers would criticise them?

    Boy, is that a long time ago. PZ would no doubt be defending his regressive left, post-modernist comrades, these days.

    Everyday Feminism is pretty much a hate site, and a bastion of woo and nonsense. No wonder so many former “skeptics” turned SJWs feel at home there.

  28. eric
    Posted October 3, 2017 at 7:40 pm | Permalink

    I’m curious to know if she has kids, and if so, if she had them vaccinated.

    Actually I guess I’m curious to know if she’s pro- or anti-vax regardless of whether she has kids. It seems to me that such postmodernism would logically lead to an anti-vaxxer stance.

    • Posted October 4, 2017 at 11:36 am | Permalink

      Pomo is often used by woo-peddlers to attempt to insulate their views from criticism, so it wouldn’t surprise me if your prediction is correct.

  29. Wayne Y Hoskisson
    Posted October 3, 2017 at 11:13 pm | Permalink

    Fabello does not ever define “health” which makes it easy talk vaguely and with seeming meaning about health. She notes “The concept of health has always been complicated.” But then writes as though no one actually thinks this is true. The WHO definition is as close to an agreed upon definition as there is, “Complete physical, mental, and social well-being, not just the absence of disease.” This yields vagaries that are not easy to define such as “social well-being.”

    Fabello makes huge leaps of logic or illogic such as, “Understanding that health is more complicated than the institution of Western Medicine wants you to believe doesn’t make you a conspiracy theorist; it makes you a critical thinker.” Western medicine is not an institution that wants anything, it is a body of knowledge that works better than any other at maintaining health. Her example is the opposite of a critical thinker, it is the thinking of one blinded by dogma.

    When I was going to college total hip replacement was new and mostly successful. Prior to then severe osteoarthritis of the hip meant you would be confined to crutches, wheelchairs, and bed and remain in demoralizing pain. Forty plus years later it is not just a social construct that I can walk without pain with a new hip.

    Language is a social construct and it is useful to the extent that it can actually describe something in the world as well as the thoughts and fancies of our minds.

    I love reading Wittgenstein. Mostly it is a quirk. He wrote, “Philosophy is a battle against the bewitchment of our intelligence by means of language.” Post modernism seems to me very much a bewitchment of language. It is as though if you can say it or write it then it must mean something.

    • Posted October 4, 2017 at 4:55 am | Permalink

      The confused Fabello text doesn’t help anyone to understand anything. I’m particularly sad about the crime of dragging the concept of “social construct” into mud.

      It’s simply socially irresponsible to oppose vaccinations, if you have the insane notion of social constructs as something “purely subjective”.

      Health, according to WHO, is “Complete physical, mental, and social well-being, not just the absence of disease.”

      Health is a social construct.

      Yersinia pestis evolved through natural selection and genetic drift. But Black Death is a social construct. It might never have happened, if 14th century Europe had consisted of 150-member tribes living hundreds of kilometres apart.

  30. Posted October 4, 2017 at 12:06 pm | Permalink

    Yep, you wasted your time, so I will return the favor. There is that dictum … still true … to never argue with a pig as onlookers will not understand and it only irritates the pig. (Don’t know who said that first.)

    I am really tired of people who have not done their homework. You know the kind, theists who claim that atheists eat babies and what not. I always ask them to show me their files. Surely a simple Google search will list hundreds of these newsworthy events. But, of course, they didn’t do their homework, they just made that up (or repeated it from someone else who did).

    I, for one, would like to see what the success rate for “social theories” is. Given that they are notoriously hard to disprove and that very, very few people are even trying, most of these just drift off into obscurity because “there is no there there.” There is no utility. They make no predictions, they guide no research, etc. They lack … substance.

    • GBJames
      Posted October 4, 2017 at 12:49 pm | Permalink

      According to Google, George Bernard Shaw said “I learned long ago, never to wrestle with a pig. You get dirty, and besides, the pig likes it.”


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