According to the general theory of value on which desirism is built, all value exists as a relationship between states of affairs (objects of evaluation) and desires.
A desire is a propositional attitude. A “desire that P” gives a person a motivating reason to bring about states of affairs in which the proposition “P” is true. All value-laden claims are claims about what people have a reason to realize or to avoid. Consequently, all value-laden terms capable of being true describe a relationship between the object of evaluation and some set of desires that answers the following four questions: • What is this term used to evaluate?
- What desires are relevant in making this evaluation?
- Does the object of evaluation objectively satisfy or dissatisfy the relevant desires?
- Does the object of evaluation objectively satisfy or dissatisfy desires directly or indirectly or both?
- Here, I wish to apply this general theory to the concepts of “illness” and “injury”.
Nothing counts as an illness or an injury unless it is bad in some sense. In other words, they are necessarily things that people have reason to avoid. This fact is built into the very meaning of the terms. The general theory of value on which desirism is built handles these concepts as follows:
(1) What are the objects of evaluation for this term?
Ultimately, they are used to evaluate changes in physical and mental functioning – or deviations from the norm with respect to physical and mental functioning - depending on whether we are talking about physical or mental illness or injury.
More specifically, an injury is a change or deviation in physical or mental functioning that is brought about by a macro cause - a cause that can be seen. Whereas an illness is a change or deviation in physical and mental functioning brought about by a micro cause – a cause that is invisible such as a bacteria or a genetic disorder. Consequently, if a person gets trampled by a horse that breaks the person’s leg, the person has been injured. If the person gets bitten by a mosquito and gets malaria, then that person has gotten sick – has acquired an illness.
(2) What desires are relevant in evaluating these objects of evaluation?
There is a tendency to evaluate changes or deviations in physical and mental functioning relative to the desires the people commonly have. Consequently, a person may be considered sick if he acquires some change in mental functioning that people generally have reason to avoid. However, it is generally difficult to maintain a lot of the implications that come from an illness or an injury claim by sticking to this definition. Under this definition, a person can be injured or sick and have actually no reason to get better. This is the case when the person’s own desires differ from those that people generally have. When we say that a person is sick or injured, we generally mean that the person herself has a reason to avoid or to get out of that state (even if that person does not realize it).
Consequently, it makes more sense to say that illness and injury evaluate changes in physical and mental functioning relative to the desires of the agent. They are changes in functioning, whether by a macro cause or a micro cause, that the agent herself has reason to avoid. This is the only way to support the implication that the person in question has a reason to avoid the illness or injury. We could use a term that defines illness or injury according to what most people want. However, if we went this route, we would not be able to tell from the mere fact that a person has gotten sick or being injured that something bad (something that he had reason to avoid) had happened to him.
(3) Are the relevant desires objectively satisfied or dissatisfied by the object of evaluation?
It is built into the very definition of the terms “illness” or “injury” that whatever they are, they tend to thwart the desires of the people who have them. Thus, the people who have them have a reason to get themselves out of that state (whether they are able to or not). It is in this sense that illnesses and injuries are necessarily bad.
(4) Are the relevant desires objectively satisfied or dissatisfied directly or indirectly by the object of evaluation?
In the case of an illness or injury, it does not matter whether the change or deviation in physical or mental functioning objectively dissatisfies desires directly or indirectly. Both types of relationships are relevant.
An illness or injury might be thwart desires directly simply by being uncomfortable. A throbbing pain or a persistent cough can simply be unpleasant, and directly give those who have it a reason to want to be rid of it.
Or, an illness or injury might thwart desires indirectly. Blindness and deafness make it the case that the agent has no access to potentially useful information. An amputated arm will make it difficult to perform any number of tasks – thus thwarting desires that one would have otherwise been able to fulfill. The concepts of “illness” and “injury” do not care about whether the thwarting of desires is direct or indirectly, only that the object of evaluation is responsible for thwarting (or preventing the objective satisfaction of) desires.
Application: Is homosexual desire a mental illness?
Using this model, we can then answer questions such as whether homosexuality is an illness.
Somebody who believes in the existence of intrinsic values or of reasons for action that exist independent of desires might wrongly conclude that homosexuality is an illness. However, these conclusions are grounded on false premises. The only values that exist are desires – they provide the only reasons for action in the universe (that we know of).
Homosexual desire has the same tendency to thwart other desires as heterosexual desire. Perhaps less, given that heterosexual desire creates a risk of unwanted pregnancies that rarely comes from satisfying homosexual desires. However, we clearly cannot say the same thing about incestuous desires or sexual desires involving children – both of which tend to thwart a great many desires.
Since we can know the relationship between homosexual desires and other desires as a matter of fact, we can know whether homosexuality is an illness as a matter of fact. We can also know whether people generally have many and strong reasons to promote or inhibit homosexual desire as a matter of fact – or if they think; they do – a fact about which people can be and many are in fact mistaken.