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The term “mental health” is everywhere, from government agendas, to educational reforms, to daily discourse. This is for good reason—hundreds of millions of people suffer from significant mental health concerns with a diagnosable mental disorder, let alone the fact that nearly all individuals have struggled with their mental health. The importance of mental health is uncontroversial, but the same cannot be said about its nature. Every practice related to mental health—which involves some of the most vulnerable people in the world—is committed to a conceptualization of mental health regardless of whether that practice is cognizant of this fact. Therefore, it is imperative to develop better answers to the questions of “what is mental health and why?” because conceptualizations of mental health systematically guide research, intervention, policy, and even how individuals strive to live their lives. I argue that the answer to the question of “what is mental health?” is that mental health is a causal nexus of positive facts. That is, mental health is to be identified with a cluster of positive facts that regularly co-occur such as resilience, hedonistic mental states like joy, high cognitive functioning like concentration, and productivity. The answer to the question “why is mental health what it is?” is that the positive facts regularly appear together due to the causal relations between them, rather than arbitrarily. For instance, resilience causes high cognitive functioning, which in turn causes resilience, which causes productivity, which causes high cognitive functioning and joy, and so forth. This explains why mental health is what it is because the causal relations between positive facts “glue” them together, causing them to regularly co-occur, thereby making them a stable category of existence that factors into epistemic practices such as induction and prediction. However, given the state of our knowledge, further empirical evidence is needed to elucidate the exact positive facts that constitute the mental health causal nexus and thus answer what mental health is. I provide a novel methodology—the anchoring analysis—that involves studying the mechanisms of causal interactions between potential positive facts to determine which are the most causally important and thus should be considered constitutive facts of mental health. Elucidating the homeostatic mechanism of the kind mental health is a daunting task; however, we only complicate matters for ourselves if we simplify the complexity of mental health. / Thesis / Candidate in Philosophy

This study is a contribution to the bioethical debate about new and possibly emerging reproductive technologies. Its point of departure is the intuition, which many people seem to share, that using such technologies to select non-disease traits – like sex and emotional stability - in yet unborn children is morally problematic, at least more so than using the technologies to avoid giving birth to children with severe genetic diseases, or attempting to shape the non-disease traits of already existing children by environmental means, like education. The study employs philosophical analysis for the purpose of making this intuition intelligible and judging whether it is justified. Different ways in which the moral problems posed by reproductive technologies are often framed in bioethical debates are criticised as inadequate for this task. In particular, it is argued that the intuition cannot fully be made sense of in terms of harm to the children that such technologies help create. The study attempts to elaborate an alternative to that broadly consequentialist approach, by drawing on Martin Heidegger’s philosophy of technology, Hans Jonas’s ethics, and Aristotle’s practical philosophy, as it has been received and developed in the hermeneutical tradition. It is suggested that reproductive choices, unlike decisions for already born children, are characterised by a peculiar one-sidedness: the future child appears to the parents as something wholly theirs to decide about, not as a concrete other with whom they must interact in a responsive and attuned way. This is problematic because it means that such choices cannot call upon the particularised moral understanding only gained in interpersonal encounters. In particular, it makes them easily shaped by various tendencies, to which parents are always susceptible, to relate to children in instrumentalising ways, and at risk of reinforcing such tendencies. However, this does not mean that all uses of reproductive technologies are equally troubling. When selecting against severe disease the parents can rely on a widely shared illness experience to escape the dangers that one-sidedness involves. It is concluded that the intuition under discussion, thus explicated and in some ways qualified, makes sense morally. / Avhandlingen är ett bidrag till den bioetiska debatten om olika reproduktionstekniker som antingen nyligen blivit tillgängliga eller som kan komma att utvecklas i framtiden. Utgångspunkten är en intuition som många verkar dela, nämligen att användningen av sådana tekniker i syfte att välja icke-sjukdomsegenskaper – som kön och känslomässig stabilitet – hos framtida barn, är mer moraliskt problematiskt än både att forma sådana egenskaper hos redan existerande barn genom exempelvis utbildning och att använda teknikerna för att undvika att barn föds med svåra sjukdomar. Studien är ett försök att genom filosofisk analys begripliggöra denna intuition och avgöra om den är berättigad. Olika sätt på vilka man i den bioetiska debatten ofta gestaltar de moraliska problem som reproduktionstekniker ger upphov till kritiseras som otillräckliga för denna uppgift. I synnerhet framhålls att intuitionen inte helt kan förstås som en oro över att de barn som sådana tekniker sätter till världen kan komma till skada. Med avsikt att utveckla ett alternativ till detta konsekvensorienterade synsätt söker sig författaren till Martin Heideggers teknikfilosofi, Hans Jonas etik och Aristoteles praktiska filosofi, som den tolkats och utvecklats i den hermeneutiska traditionen. Med hjälp av dessa teorier betonas hur reproduktiva val, till skillnad från beslut gällande redan existerande barn, kännetecknas av en slags ensidighet. Det framtida barnet framstår för föräldrarna som föremål för beslut som är odelat deras, snarare än som en konkret andre som de måste interagera med på ett lyhört, noga avpassat sätt. Detta är problematiskt eftersom det innebär att sådana val inte kan ledsagas av det slags partikulära moraliska förståelse som bara uppnås i möten mellan människor. I synnerhet innebär det att valen lätt formas av, och i sin tur riskerar att underblåsa, olika för föräldraskapet karaktäristiska tendenser som ständigt riskerar förmå föräldrar att förhålla sig till sina barn på ett instrumentaliserande sätt. Men detta betyder inte att alla användningar av reproduktionstekniker är lika problematiska. Val som syftar till att undvika svåra sjukdomar kan undgå de faror som ensidigheten öppnar för genom att åberopa en gemensam mänsklig sjukdomserfarenhet. Avhandlingens slutsats är att intuitionen som diskuteras är berättigad, med vissa reservationer, om den förstås på detta sätt.

Alors qu’il n’existe pas de définition consensuelle du concept de maladie génétique, ce concept s’est progressivement élargi pour désigner des maladies communes, non héréditaires, non mendéliennes et polygéniques, aboutissant à une généticisation des maladies. Pour résoudre ce paradoxe de la génétique médicale contemporaine, les philosophes réfutent généralement cette généticisation comme une extension génocentriste abusive du concept de maladie génétique et cherchent à redéfinir un concept plus strict de maladie génétique. Nous montrons que cette stratégie échoue et proposons au contraire d’abandonner le concept de maladie génétique et de supposer que la généticisation révèle l’élaboration d’une explication du rôle commun des gènes dans toutes les maladies, que nous appelons une « théorie génétique de la maladie ». Nous définissons les conditions de possibilité et les critères nécessaires d’une théorie génétique a minima et aboutissons à un spectre des théories génétiques possibles. Nous proposons alors de tester si la généticisation des maladies révèle plutôt une théorie génétique des maladies, c’est-à-dire un ensemble de théories génétiques spécifiques à chaque classe de maladie, ou une théorie génétique de la maladie, reposant sur une définition générale de la maladie qui unifie le rôle commun des gènes dans toutes les maladies. Pour ce faire, nous analysons deux exemples de théories génétiques contemporaines : la théorie génétique des maladies infectieuses et la théorie génétique de la médecine des réseaux. Nous concluons à la coexistence nécessaire de plusieurs formes de théories génétiques dans la littérature biomédicale contemporaine. / While there is no consensual definition of the concept of genetic disease, this concept has gradually extended to designate common, non-hereditary, non-Mendelian, polygenic diseases, leading to the geneticization of diseases. In order to solve this paradox of the contemporary medical genetics, philosophers usually discard geneticization as an inappropriate genocentrist extension of the concept of genetic disease and attempt to define a stricter concept of genetic disease. We demonstrate the failure of this strategy and argue on the contrary that we should give up the concept of genetic disease and understand geneticization as the elaboration of an explanation of the common role of genes in diseases, what we call “a genetic theory of disease”. We define the conditions of possibility and the necessary criteria for a genetic theory a minima and end up with describing the spectrum of potential genetic theories. We then suggest to test whether geneticization of diseases reveals rather a genetic theory of diseases, that is, a set of genetic theories specific to each class of disease, or a genetic theory of disease, that is, a general definition of disease unifying the common role of genes in disease explanations. In order to do so, we analyse two examples of contemporary genetic theories: the genetic theory of infectious diseases and the genetic theory of network medicine. We conclude that several forms of genetic theories coexist in the contemporary biomedical literature and that this coexistence is necessary.

This thesis examines philosophical controversies surrounding the evaluation of medical treatments, with a focus on the evidential roles of randomised trials and mechanisms in Evidence-Based Medicine. Current 'best practice' usually involves excluding non-randomised trial evidence from systematic reviews in cases where randomised trials are available for inclusion in the reviews. The first paper challenges this practice and evaluates whether adding of evidence from non-randomised trials might improve the quality and precision of some systematic reviews. The second paper compares the alleged methodological benefits of randomised trials over observational studies for investigating treatment benefits. It suggests that claims about the superiority of well-conducted randomised controlled trials over well-conducted observational studies are justified, especially when results from the two methods are contradictory. The third paper argues that postulating the unpredictability paradox in systematic reviews when no detectable empirical differences can be found requires further justification. The fourth paper examines the problem of absence causation in the context of explaining causal mechanisms and argues that a recent solution (Barros 2013) is incomplete and requires further justification. Solving the problem by describing absences as causes of 'mechanism failure' fails to take into account the effects of absences that lead to vacillating levels of mechanism functionality (i.e. differences in effectiveness or efficiency). The fifth paper criticises literature that has emphasised functioning versus 'broken' or 'non-functioning' mechanisms emphasising that many diseases result from increased or decreased mechanism function, rather than complete loss of function. Mechanistic explanations must account for differences in the effectiveness of performed functions, yet current philosophical mechanistic explanations do not achieve this. The last paper argues that the standard of evidence embodied in the ICE theory of technological function (i.e. testimonial evidence and evidence of mechanisms) is too permissive for evaluating whether the proposed functions of medical technologies have been adequately assessed and correctly ascribed. It argues that high-quality evidence from clinical studies is necessary to justify functional ascriptions to health care technologies. / <p>QC 20150312</p>

Suicide holds an ambivalent position in contemporary social and cultural contexts. It questions what it means to live and die, yet provides no clear-cut answers about death or dying, life or living. This thesis explores some of the ways suicide has been understood and represented, to demonstrate that knowing suicide is dependent not only on what suicide means, but also on how meanings of suicide become part of knowledge. Knowing suicide is not a matter of responding to it as self-evident, transparent, neutral and obvious, but rather is implicated in social processes and norms central to how knowledge gains intelligibility. Guided by poststructuralist, postmodernist, feminist and postfeminist philosophies, the thesis takes up gender and gendering as its central focus, to interrogate how knowledge about suicide becomes knowledge. Critically examining a wide variety of textual sources, it argues that suicide is principally rendered as a masculine, and even a masculinist, practice. Knowing suicide today is anchored in suicidology - the study of suicide - and maintained by institutional sites of practice including sociology, law, medicine, psy-knowledge and newsprint media, each of which is analysed here. Suicide as masculine and masculinist practice is invoked through multiple, often-contradictory and inextricably linked readings of gender, even while claiming homogeneity. Its gendered foundations can however be made to appear gender-neutral, even when actually gender-saturated. The twin gender movements of neutrality and repleteness are in fact crucial to the knowing of suicide. The thesis establishes that knowing suicide can never occur outside discourse. Even more importantly, how suicide enters discourse cannot be thought outside gender. The body matters to the production of deeply problematic understandings of agency, intent and violence, on which the production of suicide as masculine and masculinist depends. It becomes clear that such dependence rests not only on gender, but also on race and sexuality, as conditions of its knowing. The thesis suggests that further attention be given to the production and maintenance of highly reductive and limiting homogenous truth claims in suicide - truth claims that validate and privilege some interpretations of suicide, at the expense of rendering others less legitimate and serious. If the processes and practices of interpreting suicide become a site of permanent debate, they are more likely to challenge the ways in which masculinist ways of knowing render, and limit, the intelligibility of suicide.

Les médecins cherchent à résoudre les problèmes de santé posés par des individus. Une solution individualisée tient compte de la singularité du patient concerné. L'individualisation des pratiques est-elle possible et souhaitable? Le cas échéant, selon quelles modalités peut-elle ou doit-elle être réalisée'? La première partie de la thèse vise à montrer: que la question se pose depuis les premières théories de la décision médicale (Hippocrate) ; qu'elle s'est posée de façon aiguë au début du XIX" siècle, avec l'apparition des études statistiques; et que l'observation médicale et son évolution concrétisent la façon dont la documentation des cas et leur individualisation interagissent. La deuxième partie reprend la question dans le contexte contemporain, à travers la naissance de l'"evidence-based medicine", ses critiques et son évolution. La troisième partie montre que l'articulation du raisonnement par règles et du raisonnement par cas modélise de façon opérationnelle une démarche raisonnée d'individualisation des décisions médicales. Ce modèle simple permet de rendre compte du mouvement d'aller-retour entre deux conceptions de l'individualisation et d'en proposer une version équilibrée, mise à l'épreuve dans les domaines de l'évaluation des pratiques et de la littérature médicale. / Physicians try to solve health problems of individual patients. Customized solutions take into account the uniqueness of the patient. Is the individualization of medical decisions possible and desirable'? If so, how can I tor should it be performed? The first part of the thesis shows: that the question arises since the first conceptualizations of medical reasoning (Hippocrates); that is was much debated in the early nineteenth century, when statistical studies were first performed to guide medical decisions; and that the medical observation and its evolution materialize how case documentation and management interact. The second part addresses the issue in the current context, from the birth of evidence-based medicine, its cri tics and its evolution. The third part shows that linking rule-based and case-based reasoning adequately pictures the process of customizing medical decisions. This simple model can account for the movement between two kinds of customization and leads to a balanced approach, tested in the field of practice evaluation and medical literature.

La médicalisation de la naissance, par l’extension des possibles qu’elle occasionne, confronte à de nouveaux choix. Ces décisions, autrefois prises par les médecins, se réfèrent désormais au « projet » des parents. Non plus simple réponse à une proposition du corps médical comme peut l’être le consentement, le projet fait du patient le sujet décisionnaire, à l’origine comme à la fin : le projet est donc le critère qui guide les pratiques, la nouvelle instance de décision. Là où la médicalisation, accusée de « déshumaniser » la naissance, pouvait apparaître comme un instrument d’assujettissement et de désubjectivation au service d’une société industrielle pour Illich ou d’une biopolitique pour Foucault, une résistance à cette gouvernementalité aurait vu le jour sous la forme du projet. Garante de l'autonomie et de choix singuliers, la référence au projet aurait ainsi une valeur émancipatrice, relèverait d’un nouveau mode de subjectivation. Pourtant, cette catégorie s'insérant dans une nouvelle forme d’organisation sociale à laquelle Boltanski donne le nom de « cité par projets », elle apparaît dès lors comme un rouage de cette cité, elle-même inséparable du nouveau cadre que constitue le néolibéralisme. Penser la naissance en terme de projet, c’est alors étendre le néolibéralisme jusque dans la naissance. Car celle-ci marque le début de la vie humaine ; laquelle est précisément associée, dans la gouvernementalité néolibérale, au nouveau capital à entretenir. Et si auparavant le début de la vie humaine représentait un domaine d'impuissance, la médicalisation a modifié cette donnée : la médecine s'est emparée de ce premier temps de la vie, et dorénavant, on peut agir dans le champ de la naissance. La médicalisation de la naissance, via le projet, a ainsi permis l’extension du néolibéralisme à l'ensemble de l'existence. La catégorie de projet, loin de constituer une véritable alternative, est au contraire soluble dans le néolibéralisme contemporain et la nouvelle forme de gouvernementalité qui le caractérise. La naissance peut-elle alors résister au néolibéralisme? Plus que d’envisager de libérer la catégorie de projet de son sens néolibéral, c’est du côté d’une pensée voire d’une philosophie de la naissance qu’une voie sera esquissée. C’est dans l’attention à la naissance comme totalité vécue, comme expérience incarnée et non comme support de projet, qu’une résistance peut voir le jour. Contre le volontarisme néolibéral du projet nous suggérerons l’incarnation philosophique de la naissance. / The medicalization of birth by extending the realm of the possible, confronts with new choices. These decisions, formerly taken by doctors, now refer to the project of the parents. No more a mere answer to the offer from the medical corps as the consent can be, the project gets the patient into a decision making subject, at the beginning like at the end: then the project is the criterion that guides practices, the new decision making authority. Where the medicalization, accused of “dehumanizing” birth, could appear as an instrument of subjugation and desubjectivation in the service of an industrial society for Illich or of biopolitics for Foucault, a a resistance to this governmentality has emerged in the form of the project. Guarantor of autonomy and singular choices, the reference to the project would then have a liberating value, would constitute a new mode of subjectivation. However, this category getting into a new form of social organization which Boltanski gives the name of “projective city” thus appears to be a cog of this city, itself inseparable from the new framework that neoliberalism consist in. Thinking the birth in terms of project means expanding neoliberalism up to birth. For this marks the start of human life; which precisely embodies, in the framework of neoliberalism, the new capital to look after. And if the start of this human life formerly stood for an area of helplessness, medicalization changed this fact: medicine captured this first time of life, and from now on we can act in the field of birth. Hence the medicalization of birth, via the project, has enabled the expansion of neoliberalism to the whole of the existence. The project category, far from offering a real alternative, is on the contrary soluble in the contemporary neoliberalism and the new form of governmentality that characterizes it. Can birth then resist neoliberalism? Rather than planning to release the project category of its neo-liberal meaning, we might find a way around a thought, even a philosophy of the birth. A resistance can emerge from the attention to birth as a lived whole, as an embodied experience, and not as the support of a project. Against the neo-liberal voluntarism of the project we shall suggest the philosophical incarnation of birth.

Cette thèse est consacrée à l'étude de la genèse de l'œuvre canguilhemienne la plus ambitieuse, l' « Essai sur quelques problèmes concernant le normal el le pathologique ». Le premier chapitre, Esprit, présente la philosophie canguilhemienne de jeunesse, très marquée par l'approche réflexive d'Alain, comme un mélange de rationalisme cartésien et kantien fortement teinté de spiritualisme duquel l'expérience de la guerre et la décision d'entreprendre les études médicales éloignent peu à peu Canguilhem. Le deuxième chapitre, Vie, montre que la pratique de la Résistance et de la médecine, ainsi qu'une réinterprétation du vitalisme bergsonien attirent l'attention de l'auteur vers la vie. Elle hérite de ces pouvoirs que la philosophie réflexive conférait à l'esprit, lequel, s'émancipant d'un rationalisme exorbitant, réintègre ses fonctions sensibles et affectives. Dans cette perspective anthropologique, nous présentons la notion canguilhemienne de normativité biologique. Le troisième chapitre, Homme, l'interprète comme une réponse à la notion de normalité comtienne confiant sur une psychologie non naturaliste, que Canguilhem apprend en suivant le cours « Psychologie pathologique » de Lagache, et s'appuyant sur la Wertphilosophie allemande et l'axiologie dupréelienne, desquelles il s'occupe dans son propre cours « Les normes et le normal ». Le détour canguilhemien à travers les sciences de la vie nous apparaît comme un exercice métaphysique visant à regagner la sensibilité à une subjectivité transcendantale. Cette réflexion sur la maladie se révèle être une médiation sur le mal, entendu non pas comme un être inexistant ou méchant mais comme un nom de la dialectique évolutive humaine. / This thesis aims to analyze the genesis of Georges Canguilhem's most ambitious work, the “Essais sur quelques problèmes concernant le normal et le pathologique”. The first chapter, Esprit, presents Canguilhem's juvenile philosophy, heavily influenced by Alain's reflexive approach, as a spiritualistic mixture of Cartesian and Kantian Rationalism from which the experience of war and the decision to study medicine progressively drive Canguilhem away. The second chapter, Vie, shows how the practice of Resistance and medicine, together with a reinterpretation of Bergson's vitalism, draw the author's attention towards life. Life inherits the powers that reflexive philosophy assigned to the spirit while the spirit, divesting an exorbitant Rationalism, reintegrates its sensible and affective functions. Under this anthropological point of view, Canguilhem's notion of biological normativity is presented. The third chapter, Homme, considers it as an answer Lo Comte's notion of normality, based on a non-naturalistic psychology, which Canguilhem learns attending Lagache's course “Psychologie pathologique”, as well as on German Wertphilosophie and Dupréel's Axiologie, which the author deals with in his course “Les normes et le normal”. Canguilhem's detour via life sciences appears as a Metaphysical exercise intending to regain sensitivity to transcendental subjectivity. This reflection on disease reveals itself to be a meditation on evil, considered not as a non-existent or malevolent being but as a form of human evolutionary dialectic.

<p>My thesis examines how eugenicist and psychologist Robert M. Yerkes’ experimental intelligence research helped to situate the non-human primate as the ideal research subject for human betterment research in the twentieth century U.S. Yerkes believed that the primate was the ideal research subject to address questions of human betterment and social welfare, specifically best to create methods of evaluating the imagined threat of intellectual disability. While Yerkes has been studied extensively in the history of psychology, primatology, and eugenics, rarely have his separate contributions to these fields been placed in conversation with one another. Placing the primate at the center of Yerkes’ work allows for all three fields to engage with one another in a new perspective. By analyzing Yerkes’ publications about the Multiple-Choice Experiment within the context of the American eugenics’ movement, we can see how the primate came to hold a central position in U.S. scientific research, the advancement of human welfare and betterment, and as a means of defining what it means to be human. This story offers a glimpse into this longer process of how the primate came to occupy this position, but even a glimpse offers historians of the American eugenics’ movement new questions. What was the role of the non-human animal in the formulation of American eugenic theories? How have we historically used the natural world in our attempts to separate ourselves from it? And can we truly reconcile a history with eugenics if we continue to ignore the role of animals within it, they who today exist unquestionably within the status of the sub-human?</p>