Note: I've decided (again) to try blogging. So yes, this is the first post of the latest attempt. Maybe I'll keep it up, maybe I won't.
This post arises out out of some articles I recently posted on my facebook wall, and various comments that people made about them. Both articles discussed culture-bound syndromes (CBSs). According to wikipedia, a CBS is "is a combination of psychiatric and somatic symptoms that are considered to be a recognizable disease only within a specific society or culture. There are no objective biochemical or structural alterations of body organs or functions, and the disease is not recognized in other cultures." The specific articles argued that PMS and mental illnesses more generally are much more conditioned by the specific influence of "Western" culture than is typically thought. Now, this may or may not be true. Disease causation is complicated, and we shouldn't pretend that we know more than we do. Especially in the case of psychiatric diseases, since we definitely don't know much about the mind works. There are clear cases of CBSs (like the late-nineteenth and early-twentieth century epidemic of hysteria in the West) and clear cases of diseases that don't have any direct cultural causation (e.g. skin cancer). A lot of other things are probably somewhere in the middle.
Interesting as it is, I'm putting the science to the side for the purposes of this discussion. What I'm concerned with is the outraged reaction that several people had to the suggestion that certain maladies are CBSs. This outrage, I think, stems from the imputed suggestion that CBSs aren't "real" diseases. That is, they are "all in the sufferer's head", they could just "snap out of it", they shouldn't receive medication or any other treatment, they shouldn't be able to get time off work, receive government disability benefits, and so on. And I think I know exactly why this imputation seems plausible - in our popular culture and, indeed, to a large extent in medicine, we have the notion that a "real" disease has an exclusively biological cause.
Coincidentally, today I came across an article which tacitly applies a similar sort of dichotomy in a completely different context, namely sexual orientation. Here, the author excoriates the use of the term "sexual preference" because it implies choice. The major point he wants to convey is that this is just scientifically inaccurate - in fact "our brains were tuned to be gay or straight before we were born". You may also recall the controversy that ensued when actress Cynthia Nixon in effect declared that she is gay by choice.
Again, interesting as it is, I'm not going to comment on the science here. What is interesting is the way that biological causation is implicitly being used here as a strategy of legitimisation. It is argued that gay rights are defensible precisely because being gay is biologically innate, just as treatment for a disease is justifiable precisely because it has a specific biological cause. The point I really want to make in this post in that the use of biology in this context is totally bullshit from an ethical point of view, and that this whole strategy is therefore fundamentally misdirected. A particular way of living doesn't become more or less "acceptable" because it is caused biologically caused; and an illness doesn't deserve treatment only if it is caused purely by a biological abnormality.
That said, I get where the outrage comes from in both contexts. The "biological cause only" understanding of disease is so prevalent that cultural explanations have been used to try to invalidate people's suffering and effectively deny them assistance. And LGBT people have long endured the sneer that their behaviour is "unnatural". So I sympathise with the reasons people have for resisting CBS and preference talk. But I think that the real enemy is the prestige assigned to biological causes as legitimating a person's needs and desires.
What would a more sensible view look like? Well, in the LGBT case, it's pretty obvious. Civil rights, including gender-unrestricted marriage rights, are a good thing because they make a lot of people happy and don't significantly hurt anyone else. It doesn't matter why people are different in all kinds of ways, if you believe in ethical liberalism, you should try to accommodate this difference insofar as is possible without unduly harming anyone. Done. No reference to biology is required. Similar, in the disease case, we need to think of why we treat people who have various conditions. The answer also seems obvious - because they're distressed and can't alleviate this distress without help. From an ethical position, this is a fully sufficient reason for helping, irrespective of the exact causal story underlying the distress.
