The pharmaceuticalisation of life? A fictional case report of insomnia with a thought experiment

Background The safety of sleeping pills has increased dramatically during the last 100 years, from barbiturates to bensodiazepines to modern day so-called Z-drugs. Methods The circumstances of prescribing sleeping pills in the early 20th century are illustrated by summarizing the main storyline of a novel by Swedish writer Vilhelm Moberg. This is followed by a thought experiment and a theoretical discussion. Results In his 1937 novel Sömnlös (Swedish for sleepless) Vilhelm Moberg portrayed existential and relational distress in relation to insomnia. In a thought experiment, past progresses in sleeping pills safety are projected into the future. Thereby, it is claimed that important issues in the area of philosophy of medicine come to the fore. This leads to a theoretical discussion about broader questions concerning the role of the physician, the goals of medicine (as described by Lennart Nordenfelt), the concept of pharmaceuticalisation (as described notably by sociologist of sleep Simon J. Williams and co-workers), and health enhancement (c.f. Carl Elliott and the alleged wish to be better than well). Conclusion Insomnia is a prism through which important philosophical and sociological questions related to the practice of medicine can be asked.

Introduction

Philosophers have been writing about the practice of medicine for some time, but relatively little has been written about the practice of clinical diagnosis or the issues of evidence, ethics, and justice involved in this process. This introduction sets the stage for the philosophical analysis that takes place in the rest of the book, which combines methods of current philosophy of science and philosophy of medicine to address both issues in diagnostic reasoning and diagnostic testing in the clinical setting.

Anti-essentialism, modal relativity, and alternative material-origin counterfactuals

In ordinary language, in the medical sciences, and in the overlap between them, we frequently make claims which imply that we might have had different gametic origins from the ones we actually have. Such statements seem intuitively true and coherent. But they counterfactually ascribe different DNA to their referents and therefore contradict material-origin essentialism, which Kripke and his followers argue is intuitively obvious. In this paper I argue, using examples from ordinary language and from philosophy of medicine and bioethics, that statements which attribute alternative material origins to their referents are useful, common in political and medical reasoning, and in many cases best interpreted literally. So we must replace the doctrine of material-origin essentialism with one that can make sense of ordinary discourse and the language of the medical sciences. I propose an anti-essentialist account of such counterfactuals according to which individuals’ modal properties are relative to a given inquiry.