 So apart from Glackin there seems to be agreement that the constructivist needs to explain how the judgments that we direct at putative sick or healthy people form a special class of judgments. And that explanation has to show, in addition, why we think the conditions that we single out as diseases with those special judgments are candidates for a particular set of causal explanations. It’s all very well to point out, as Reznek does (p.88) that an etiology only explains a pathology if we have already decided that it is a pathology. This is correct, but it dodges the conceptual question of why we first decide that only some people or conditions are pathological. The naturalist says this: we think some people are worse off because of a special kind of causal process, namely a disturbance of normal physical or psychological function. It is that causal judgment that has conceptual priority, even if, as a matter of timing, the violation of a norm is what is detected first. Note that it does not refute naturalism to point out that the concept of disease is sometimes misapplied, so that we think people are sick but discover that they are not. In such cases (e.g. homosexuality) the explanation for why it happened may be that our values caused the initial judgment, but that does not show that the concept of disease is constructivist, rather than naturalist. No concept is correctly applied every time.