Mechanisms, patho-mechanisms, and the explanation of disease in scientifically based clinical medicine

Abstract

In scientifically based medicine, explanations of normal and deviating organismic properties or events commonly have recourse to the notions of normoand patho-mechanisms. I will argue-contrary to the shortcut view of most adherents of mechanistic philosophy-that there is a necessarily long but feasible passageway from normo- to patho-mechanisms and will plead for objectivism of the concept of individual diseases on the basis of the concept of a complex mechanistic base supplemented with a general function-analytical account of explanation. This study also considers some of the most prominent ontologies of disease entities, i.e. disease as process or as incapacity. Further, objective criteria are presented which delimit the range of items belonging to a base. These are preparatory steps to carve out the concepts of directionality or connectivity of mechanistic bases which turn out to be the most proximate notions of order in systems combining inciting and inhibitory causal relations. However, a knowledge of the laws of living matter is declined. These findings suggest that mechanistic bases are akin to causal bases and that explanation in medicine is supported by these objectifying concepts. Finally, by introducing a notion of difference among various organismic states, as long as they refer to the same mechanistic base, this contrastive component imbues the underlying mechanistic framework with the distinguishing notions of normo- and patho-mechanisms.