How we think about health and why it matters
Prisms for thinking about health
A blog post (a longread) from Lead Educator Dr Beth Mackintosh for Mental Health Awareness Month
At CATALYST we work with students aged 10–17 to sharpen the analytical tools that underpin all good thinking — not just at school, but in life.
A particular area of focus, when developing thinking skills and tools, is the fostering of conceptual analysis and engagement. You can learn more about philosophical skills and conceptual analysis in one of our previous blogs: Thinking about Philosophy and Philosophers is great, but what do Philosophers actually do and why does it matter? — CATALYST by Winchester College
Health concepts and why they matter
Certain concepts and phrases, such as the person, freedom, justice and ‘respect for the right of the individual’, are seen as central to working through our ethical and political dilemmas; they are often waved around as if some sort of talisman to ward off any unethical behaviour. However, we need to be alert to how many terms and concepts can become dangerously familiar, and they could have been, and indeed are, very different in alternate cultures and communities. We have many budding young medics social scientists, interested in issues healthcare, join us on our Horizons — CATALYST courses, and through our modules in Science, AI, Economics and Philosophy, culminating in their capstone projects, explore ideas about health, disease, wellbeing, illness, sickness and disorders.
We like to think our conceptions of health, and connected health concepts listed above, are clear and well understood, but of course their meanings are far more slippery that we often come to realise or like to admit. Mary Midgley famously talked about the need for ‘Philosophical Plumbing,’ and outlines how the practises of philosophy and plumbing are analogous. Concepts and ideas, like pipes in a building, are not always immediately visible and are often underexplored; these concepts are all around us, supplying us with necessary structures for everyday life. If these structures are not interrogated and reflected upon, they can cause us trouble and do damage, and so to further Midgley’s plumbing analogy, we must commit to getting the water flowing again by making sure our concepts serve us.
More here: https://blog.apaonline.org/2025/05/29/mary-midgley-and-the-necessity-of-philosophy/
Philosophical Plumbing
Our health concepts have powerful implications, because any aspect of health care is a practical outworking (either explicitly or implicitly) of our understandings of ‘health’ and related concepts. Likewise, the term ‘mental health’ has been conceptualised in multiple ways over time by a variety of thinkers from varying fields of expertise and there is much discussion about whether narrowing the definition would help or hinder mental health interventions.
Good health – could we overreach?
Given our CATALYST modules are an intersection of Science, AI, Economics and Philosophy and ethics, we are keen to explore various kinds of technological modification of human characteristics and functioning, for example, genetic modification, and neurotechnologies. Eric Jeungst defines human enhancements as: ‘interventions designed to improve human form or functioning beyond what is necessary to sustain or restore good health.’ These interventions could refer to and include a range of technological practices including genetic selection, genetic modification, pharmaceuticals, brain implants and even non-technological enhancements such as the commonly-referred-to ‘hyper-parenting’ (as explored by Michael Sandel and bell hooks). Sandel thinks there is an important philosophical and ethical distinction to be made between a therapy and an enhancement, as therapies are interventions designed to restore good health. Sandel has been criticised by the likes of Julian Savulescu as holding on to an outdated stance of what is ‘natural’ and ‘natural functioning’ in his work and to holding back progress. Sandel, however, claims the march of medical technology, in a highly-competitive instrumentalist setting, has created an arms race that has the potential to redefine our understanding of health and health concepts. Listen to Sandel on this theme here: The Perfect Human Being Series E13 - Michael Sandel on the values of being a human being
Thinking about value and benefit
Norman Daniels and Christopher Boorse have been critical this therapy-enhancement distinction and of the concept of ‘normal’ or ‘natural function.’ Daniels does also stress that our values shape how we define both disease and health and so we have questions about what values should be doing the shaping. John Harris offers a utilitarian response (although Harris is not committed to one theory of morality, his work has a predominant focus on the importance of ‘benefit’) which claims that the distinction is not coherent, significant or useful: ‘it…does not draw either a morally significant or an explanatorily significant distinction and so fails utterly to be useful.’ You can learn about a famous thought experiment from John Harris to get you to think about the value of life here: Harris: The Death Lottery
Health and disease can therefore operate within normative frameworks, from a utilitarian account akin to the ideas of Harris, to the work of Christopher Megone, building on an Aristotelian account on what it is to function or flourish.
Heather Widdows and Iain Law have made the case for the capabilities approach to health and disease. The capabilities approach emerged as a reaction against utilitarian agendas (and algorithmic tools dominating the discourse) and is associated with the work of Martha Nussbaum, drawing on the ideas of Aristotle and feminism and Amartya Sen, influenced by the work of John Rawls and liberalism. The capabilities approach provides an evaluative framework for assessing well-being and social arrangements – what does the individual require to be able to function within their social and cultural setting? The approach, claim Widdows and Law, would avoid narrow definitions of health, health in this context is understood as a capability, and would think about ‘functioning’ in the context of both individual and group context. This is an approach, they argue, that allows for a flexibility and the ability to capture how context transforms our understanding of our interrelated ideas about illness, sickness and disease etc. Read their case here:
One way in which CATALYST explores conceptions of health and other concepts is to make use of the philosopher and Director of PLATO (Philosophy Learning and Teaching Organization) Jana Mohr Lone’s ‘prisms for thinking’ method. This is a tool I have used throughout my 20 years of teaching and lecturing. You consider a dilemma, or in this case a concept, via a prism or question. For example:
‘How do we consider this concept (in this case health) from a utilitarian (benefit/consequentialist) perspective or prism?
“What course(s) of action will best sustain and nurture caring relationships?” (A Care Ethics Prism) Learn more about care ethics here: What Is Care Ethics and Why Does It Matter? | Oxford Law Blogs
The Egoist prism asks: “What course(s) of action will most effectively ensure that my short and long-term goals are reached?” Is health to be understood within the context of goals? Perhaps ‘vital goals’ and health as an ability to realise ‘vital goals’ as espoused by Lennart Nordenfelt?
Of course an academic specialist will help flesh out and clarify the real intricacies of each ‘prism’ or framework, or to ascertain what prism is at the heart of a particular text or argument under review. This allows a powerful way to peer in at the dilemma or concept under review and to consider a range of alternative lenses or ‘windows’ that might offer crucial insights, when considering questions relating to health, wellbeing, disease or disorder.
The watery metaphor - the aquarium - as a way to look and consider our world and our challenges
Midgley spoke of philosophical plumbing needed to interrogate concepts, but she was also known for her famous metaphor of the aquarium where she said that a range of epistemic windows (or prisms) is needed to peer in at ‘the view’ that is the aquarium in order really see what is going on. Just focussing on the coral, the fish or the water leaves us with an impoverished understanding of the reality or phenomenon we seek to understand. Interestingly, despite regularly drawing on this metaphor she also used it at the very end of her last book, What is Philosophy For? – a book she published at 99 years old. She was reflecting at this point on how we might appropriately think about mental health and was keen to impress upon the reader that this will require many windows and tools, used at different times, to have a robust understanding and to serve our real-life communities.
‘(Mental health) has two interdependent aspects – the impersonal medical angle and the person’s own viewpoint. We try to balance these fairly. We try to balance these fairly. But this is hard, both because of particular details and because of our general bias for or against some wider aspects of science of humanity. Treating the two sides together involves looking in at the whole scene – as we might do at an aquarium…separate windows which reveal different views.’
Mary Midgley, What is Philosophy For, page 194-5.
Our concepts (of the mind and mental health) seek to serve us well, but they can also fail us, and the implications will be treacherous and painful for those who must live by such conceptualisations – concepts which are far from lofty in the case of health, disease, illness, wellbeing or disorder.
Care in context
Two must-read blogs that demonstrate the practical implications of getting our health concepts wrong and why we must do this crucial thinking work can be found below:
The EPIC Research Project| Epistemic Injustice in Healthcare
Blog | Neurodivergent Girls Club
I am also now reading Cancer Ward by Aleksandr Solzhenitsyn (recommended to me by one my awesome students at the University of Winchester) as we have been thinking about what it is we are seeking to preserve, and control, when thinking about our health concepts: Cancer Ward by Aleksandr Solzhenitsyn, Alexander Dolberg | Waterstones
There are only a few spaces left on our Horizons Summer Course for students aged 14-17!
Apply now — CATALYST by Winchester College | Learn How to Think (Really Think)
