Announcement I am pleased to announce that my article, "The Meaning of Atheist" appears in the most recent Carnival of the Godless # 47 with a number of other articles that may be of interest to readers.
I have been writing a bit about definitions recently (Is Pluto a 'planet'? Is astronomy 'subjective'? Was the Holcaust 'Wrong'?). I thought that I would fill in some gaps by talking about another in this set of questions: Is homosexuality an 'illness'? This brings up the question, “How do we define ‘illness’?”
Illness as a Value-Laden Term
Illness is a value-laden term. Illness are bad. This is not an accidental relationship. Scientists did not conduct a survey and discover, surprisingly (Gasp! Eureka! Holy Plague, Batman!) that by chance or pure luck illnesses turn out to be bad. Illnesses are bad in the same way that circles are round and in the same way that bachelors are not married. If something is not bad (round, unmarried), then it cannot be an illness (circle, bachelor). Not all bad things are illnesses (round things are circles, unmarried things are bachelors), but all illnesses are bad (circles are round, bachelors are unmarried).
To say that something is bad is to say that there is reason to avoid it. Again, it makes no sense to call something bad where nobody, anywhere, can come up with a reason not to bring it about. In calling AIDS or malaria an 'illness', I am saying that, in general, all else being equal, there exist reasons to avoid having AIDS and malaria. If there were, in general, no reasons to avoid being in a state of having AIDS or malaria, then it would not make any sense to classify these things as 'illnesses.'
'Reason to avoidedness' is such an integral part of the meaning of 'illness' that separating the two would be a significant change in our language. Technically, we could separate them. Language is, after all, an invention that we can change as we please. We can redefine our words so that the word ‘illness’ means ‘green with red spots’ with absolutely no hint at all that green things with red spots are to be avoided. However, in the narrow sense of realistic practicalities it makes no sense to divorce the concept of ‘illness’ from the concept of ‘there are reasons to avoid.’
This is the same issue that I wrote about yesterday with respect to the meaning of ‘wrong.’ severing the connection between 'wrong' and 'reasons to avoid doing.' The two concepts are so tightly connected that even those who assert that we can define wrong as we wish (which we can) do not even think to consider the difficulty in severing the concept of 'wrong' from 'that which there are reasons not to do.' If we do this, winning the lottery may become 'wrong', but this would no longer imply that there are reasons not to do it.
This means that we cannot have a theory of 'illness' without a theory of ‘badness’ – or, more accurately, a theory of value.
This also means that anybody who thought that medicine is a science and hence objective, while a theory of value must necessarily be subjective is stuck in a contradiction, since medicine is concerned primarily with the value of different physical and mental functions.
Other Features of an ‘Illness’ (or ‘Injury’ or ‘Defect’)
There are other limits on what gets classified as an illness. In a strict sense, the term applies to changes in physical or mental functioning (depending on whether we are talking about physical or mental illness). So, an illness is a change in mental or physical functioning that there are reasons to avoid. Homosexuality would be an illness if and only if there are reasons to avoid being in a state of being a homosexual.
As an aside, this method gives us an easy way to distinguish between ‘illness’ and ‘injury.’ These terms were invented back when there were greater limits to what one could identify as the cause of a change in mental or physical functioning. Basically, if the cause of a change in functioning (a bacteria or virus, cancer, aging, muscular degeneration) cannot be seen without the aid of technology, then the change is called an 'illness.' However, if we can readily see the cause of a change in physical functioning (getting trampled by a horse, stabbed with a sword, falling off of a tall building onto a pile of rocks), then the change is called an 'injury.' Still, illnesses and injuries are changes in functioning that people have reason to avoid.
A ‘defect’ differs from an ‘illness’ or ‘injury’ in that it does not represent a change in how the body or mind functions. It is, instead, present from conception. Yet, it is still unusual or abnormal, and it to is something that there are reasons to avoid, if possible.
In all three cases, to determine if something counts as an illness, injury, or defect, we have to look for whether reasons exist to avoid such a state.
Desire Fulfillment and Reasons for Action
Here I am taken back to one proposition that is central to all of my writing. The only “reasons for action” that exist are desires.
Desires are propositional attitudes; that is to say, they can be expressed in the form of an attitude towards a proposition. Specifically, desires can be expressed in the form 'agent desires that P', where P is a proposition and the desire is an attitude that the proposition is to be made or kept true. A state of affairs S fulfills a desire that P if and only if P is true in S. A state of affairs S thwarts a desire that P if and only if P is false in S. People "have a reason" to bring about those states that fulfill their desires and "have a reason" to avoid states that thwart their desires.
On this account, an illness is a change in mental or physical functioning that there are reasons to avoid. The only reasons that exist can be found in the thwarting of desires. So, a state of mental or physical functioning is a state that there is reason to avoid (is an 'illness') if and only if it is a state that tends to thwart (other) desires.
Anybody who calls homosexuality an ‘illness’ who makes reference to some other type of ‘reason not to be a homosexual’ is making a false claim. They are asserting that a ‘reason for action’ exists that is not tied to desire, and no such reason for action exists.
Moral Evil and Reasons for Action
There is one more important point that I need to bring into this discussion. This concerns the importance of moral evaluations in determining whether certain reasons not to have a particular state are relevant to calling that state an illness.
If we stopped with what we had said so far, then 'being a woman,' for example, could be counted as being in a defective state. 'Reasons to avoid' being a woman arise from the fact that women are far more likely to be raped, and there are reasons to avoid being raped. If an illness or injury (or defect) is a state that there is reason to avoid, then this would imply that being a woman is a defect.
In Nazi Germany, there were reasons to avoid being a Jew in that there were reasons to avoid being sent to the concentration camps. Here, too, if we say that an illness or defect is a state that there exist reasons to avoid, then being a Jew in Nazi Germany would be a defect.
These are absurd results that expose an error in this theory of ‘illness’ that I have described so far. That error can be corrected by adding a moral component to the criteria for ‘illness.’
That criteria says that reason to avoid being in a particular state (being a woman, a Jew, or a homosexual) does not qualify that state as being a ‘defect’ if that reason is to avoid the consequences of other peoples’ bigotry.
Allow me to add a moral component to the account of ‘reasons for action’ that I gave above. I have said that desires are the only reasons for action that exist. In this next paragraph I describe the difference between a good and a bad desire.
Desires can be molded through social conditioning such as praise, condemnation, reward, and punishment. Among our 'reasons for action' there are reasons to promote some desires and reasons to demote others. Namely, there are reasons to promote desires that fulfill other desires (e.g., charity, kindness, honesty). The desires being fulfilled give us the reasons for this promotion. Accordingly, there are reasons to demote desires that tend to thwart other desires (e.g., rape, cruelty, dishonesty). The desires that there are thwarted give us reason for these demotions.
Now, we have an account of good and bad desires. These are desires that tend to fulfill or thwart other desires.
The remaining criterion, then, is that the reasons to avoid being in a particular physical or mental state do not count as an illness or defect if those reasons are to avoid the harms inflicted by people with bad desires – with desires that society generally has reason to demote. In these causes, those with bad desires are held responsible for the consequences, not those whose traits make them the victims of people with bad desires.
The reasons that exist to avoid being the victim of a rapist does not make being a woman a defect to be cured. They are reasons that exist for delivering even greater condemnation against those who would be rapists.
The reasons that exist to avoid being the victim of a Nazi does not make being a Jew a defect to be cured. They are reasons that exist for delivering even greater condemnation against those who would be Nazis.
The reasons that exist to avoid being the victim of an anti-homosexual bigot does not make being a homosexual a defect to be cured. They are reasons that exist for delivering even greater condemnation against those who would be anti-homosexual bigots.
If we could cure people of these defects – the rapist, the Nazi, the anti-homosexual bigot – then the world would be a better place.
In a sense, the International Astronomical Union faced limits in defining “planet” just as anybody working on a theory of value or a theory of ‘illness’ faces limits on their options. Whatever definition the IAU came up with; Mercury, Venus, Earth, Mars, Jupiter, Saturn, Uranus, or Neptune had to end up being planets.
Similarly, whatever definition we come up with for ‘wrong’, it has to have something to do with what there is reason not to do; and whatever definition we come up with for ‘illness’ or ‘injury’ or ‘defect’ has to refer to physical and mental states that there are reasons to avoid having.
Language is an invention and, in some sense, we can completely redefine words. However, in a realistic sense, it is of little practical use to invent a whole new language. For all practical purposes, there are limits to what we can select in our definitions.
In value theory, our terms are limited to ‘reasons for action that exist’. Homosexuality is an illness if any only if there are reasons that exist to avoid being a homosexual – reasons other than avoiding the harms that anti-homosexual bigots would inflict. There is nothing inherently desire-thwarting in homosexuality (unlike, for example, drug addiction or schizophrenia). There is no reason to avoid being a homosexual, other than to avoid the harms inflicted by anti-homosexual bigots. Therefore, it is not an illness.