In a recent article in Neuroethics, Owen Flanagan (2016) argues that the debate about whether addiction is a disease is “much ado about nothing” because what matters isn’t what we call it, but what it is, i.e., an “unquestionably destructive” condition. I am not planning to focus on Flanagan’s main point, which is that addiction isn’t real and that the term designates a number of different disorders. What I will focus on is his claim that ‘disease’ is a folk term. Additionally, I will tackle Flanagan’s distinction between words we use to designate a phenomenon and that phenomenon’s nature. He uses this distinction to diminish disputes about terms--for example whether we call something a ‘disease,’ a ‘disorder,’ or a ‘problem’--as mere semantics.
It is not always clear how certain words are identified as folk terms, but one way to do that is to concentrate on words employed in everyday parlance. Lewis (1972) proposes a way to circumscribe the boundaries of folk psychology by collecting all the platitudes that feature mental terms, such as ‘pain,’ ‘belief,’ ‘desire,’ etc. These platitudes include things we say to predict and explain each other’s behavior. For example, “Maria is crying because she is in pain” or “Fred opened the fridge because he thinks that the cake is in there.” Folk-psychological platitudes also include classifications of particular psychological states, e.g., arachnophobia, as a type of mental state, say fear.
The collected platitudes specify the role psychological states play in mediating between our environment and our behavior, and, in this way, form a theory about those states. Additionally, the functional roles specified by the platitudes implicitly define the terms employed by our folk psychology. Thus, a term is a folk term when it is featured in a theory specified by our everyday parlance. A similar methodology could be employed to define other purportedly folk terms, including ‘disease,’ ‘malady,’ or ‘disorder.’ If one sticks with Lewis’s approach, however, the meaning of a term is not separate from the nature of the phenomenon it designates, because the term ‘disease,’ for example, is functionally defined by what a disease does. Think of all the ways in which we speak about disease in everyday life: we refer to how it affects behavior, or quality of life, or the way in which one’s having a disease impacts loved ones. Based on this approach, the meaning of a word is not independent from the theory within which it is embedded, and disputes about which words to use are debates about the most accurate way to characterize a phenomenon.
In addition, our everyday parlance changes over time and has been steadily influenced by science, which undermines the characterization of certain theories and terms as folk terms and theories. A reason to suspect that our notion of disease has been influenced by science is that it is colloquially used to designate conditions with a biological etiology. Healthcare professionals will often categorize certain psychological or psychiatric conditions, including addiction, as a disease, in order to alleviate the stigma associated with having a condition without an identified biological origin. Psychological conditions are sometimes blamed on weakness of the will in ways that biological conditions are not, and claiming that depression or addiction are diseases is to take advantage of the connotation that a disease is a biological condition.