The concept of naturalism and disease

Naturalism defines disease as the absence of health and uses a natural class to determine the normal functioning of a part or process. Thus, anything that deviates from the normal functioning of the natural class can be considered a disease. A naturalist would classify hyperandrogenism as a disease as it complies with Boorse’s four pillars of naturalism. If Caster Semenya is compared to a natural class that constitutes other woman her age who do not suffer from hyperandrogenism, then she deviates from the natural class. Furthermore, when compared to the natural class, Caster Semenya’s endocrine system and the structures that produce androgens are not within “ normal function”. Her excessive androgen levels decrease her chances of reproducing and therefore impair her normal functioning. Since naturalism defines disease as anything that impairs normal functioning, hyperandrogenism is a disease.

Normativism defines disease as anything that causes harm, where ‘ harm’ is defined by society. A normativist would classify hyperandrogenism as a disease. Hyperandrogenism could be considered bad for Caster Semenya due to the host of symptoms that accompanies it – high blood pressure, insulin resistance and heart disease. Furthermore, Caster Semenya can be deemed unfortunate due to symptoms like excess hair growth and infertility – symptoms that society deems unlucky. In addition to this, hyperandrogenism has the potential to be treated medically through hormone therapy. Therefore, hyperandrogenism is considered a disease by normativists.

Hybridism combines the strong points of naturalism and normativism and thus defines disease as anything that is biologically dysfunctional and is deemed harmful. Hybridism would classify hyperandrogenism as a disease as it can be considered both a source of biological dysfunction and as harmful to Caster Semenya. An excessive level of androgen in the female body indicates the abnormal functioning of the endocrine system and its respective organs. Furthermore, these excessive androgen levels pose great risk to Caster Semenya’s overall wellbeing as they can cause high blood pressure, high cholesterol and ovarian and adrenal tumours. Therefore, according to hybridism, hyperandrogenism is a disease.

Naturalism, as a theory, contains many problems. Firstly, the determination of the natural class and the use of this natural class in determining normalcy are problematic as no specific guidelines are given on how to properly determine the normal class. Therefore, a person could be compared to other people of the same age or other people of the same gender or other people of the same cultural background. This problem can be demonstrated by analysing Caster Semenya’s case. When compared to women of the same age who do not suffer from hyperandrogenism, Caster Semenya’s excessive androgen levels deem her biological functioning as abnormal and she is therefore diseased. However, if she was to be compared to women who also suffer from hyperandrogenism or men, her excessive androgen levels would not seem excessive, but rather normal. Thus, she would not be diseased. This illustrates the importance of accurately determining a reference class as how one defines normal functioning is dependent on the reference class you compare someone with. Secondly, Boorse’s model states that disease is the absence of health and is the impairment of normal functioning. This is a vague definition of disease. Furthermore, no distinction between normal and abnormal functioning has been made, only that abnormal functioning is one that differs from the functioning of the natural class. This problem can be illustrated using Caster Semenya’s case where hyperandrogenism is considered a disease because it differs from the normal functioning of women who do not suffer from hyperandrogenism. However, if normal functioning was characterised by high levels of androgens, then Caster Semenya would not be diseased. Therefore, naturalism provides no guidelines on determined a reliable reference class and provides a vague definition of health and normal functioning.

Normativism is problematic as it relies on society’s definition of health. Therefore, the idea of health is subjective and is not universal. This problem can be illustrated by analysing Caster Semenya’s case. If pregnant women or women who were hoping to fall pregnant were asked to determine whether hyperandrogenism is a disease, they would that it is one the grounds that it can result in infertility. However, if bodybuilders or athletes were asked, they would say that it is not a disease as androgens increase muscle mass and can thus improve one’s athletic performance. This illustrates that determining whether or not a condition is a disease is heavily dependent on society’s values and is thus exposed to bias. This is problematic as there is no set definition of health.