The point of departure for this article is a review of the discussion between Twaddle and Nordenfelt on the concepts of disease, illness, and sickness, and the objective is to investigate the fruitfulness of these concepts. It is argued that disease, illness, and sickness represent different perspectives on human ailment and that they can be applied to analyze both epistemic and normative challenges to modern medicine. In particular the analysis reveals epistemic and normative differences between the concepts. Furthermore, the article (...) demonstrates, against Nordenfelt's claim, that the concepts of disease, illness, and sickness can exist without a general theory of health. Additionally, the complexity of different perspectives on human ailment also explains why it is so difficult to give strict definitions of basic concepts within modern health care. (shrink)

The article uses a producer-consumer theory from philosophy of mind and language to analyse the meaning of basic health concepts like disease, illness and sickness. The core idea of the producer-consumer perspective is that a person who has an incomplete understanding of a term can associate it with the same concept as a linguistic expert, if both of them are willing to defer to the same contextual or general norms of meaning. Using “disease” as an example, the article argues that (...) the producer-consumer theory implies that if patients were normally willing to defer to a standard expert concept of disease, it would be reasonable to assume that the concept of disease is this concept. However, it is empirically well documented that many patients are not willing to defer to health workers’ understanding of lay health concepts like “disease”. This means that the overall conceptual analysis of disease and other lay health concepts should be pluralistic—the concepts belong within what Wittgenstein calls different language-games. This conceptual pluralism is inconsistent with assumptions many theorists have made when attempting to develop general definitions of basic concepts of ill health. Furthermore, the pluralistic analysis has striking implications for how conceptions of meaning should be accepted as sound; participants in health discourses are entitled to use basic health terms like “health” and “illness” in accordance with their own language-games, and health workers should therefore acknowledge a diversity of meaning in patient communication. Nevertheless, health professionals can often secure a communicative platform of shared concepts by understanding patients’ language games, and by achieving contextual aims of agreement about meaning. (shrink)

One of the most pervasive messages in modern advertising, both public and private, is that good health is something to strive for. Thus, the condition of our bodies and how the medical fraternity can impact on us is never far from our thoughts. Central to this interaction between doctor, patient, and society is a core group of terms that frame our discussions of sickness and health. Of particular interest to philosophers of medicine, the way we use and recognise the differences (...) between these terms has implications for how we decode the medical encounter. In this essay, three terms, disease, illness, and symptoms will be analysed to develop an argument for the continued separation and appreciation of them as distinct, although imbricated, concepts crucial to the performance of modern medicine. (shrink)

The concepts of disease, illness and sickness capture fundamentally different aspects of phenomena related to human ailments and healthcare. The philosophy and theory of medicine are making manifold efforts to capture the essence and normative implications of these concepts. In parallel, socio-empirical studies on patients’ understanding of their situation have yielded a comprehensive body of knowledge regarding subjective perspectives on health-related statuses. Although both scientific fields provide varied valuable insights, they have not been strongly linked to each other. Therefore, the (...) article aims to scrutinise the normative-ethical implications of patient perspectives in building a bridge to the empirical ethics debates. Three potential fields of tension between the illness and the disease perspective are presented. Consequently, findings from empirical research examining patient perspectives on illness are displayed and the practical implications and associated ethical issues which arise are discussed. This leads to the conclusion that an explicit and elaborate empirical-ethical methodology is needed to deal appropriately with the complex interaction between patients’ views and the medico-professional view of disease. Kon’s four-stage model of normative-empirical collaboration is then applied against the background of empirical data on patient perceptions. Starting from this exemplary approach, the article suggests employing empirical-ethical frameworks for further research on the conceptual and normative issues, as they help to integrate perspectives from the philosophy of medicine with socio-empirical research. The combination of theoretical and empirical perspectives suggested contributes to a more nuanced discussion of the normative impact of patients’ actual understanding of illness. Further empirical research in this area would profit from explicitly considering potential ethical issues to avoid naturalistic fallacies or crypto-normative conclusions that may compromise healthcare practice. Vice versa, medico-theoretical debates could be enriched by integrating subjective views of those people who are immediately affected. (shrink)

Between Sickness and Health is about illness rather than disease, and recovery rather than cure. The book argues that illness is an experience, represented by the feeling that 'I am not myself'. From the book's phenomenological point of view, feelings of illness cannot be 'unreal' or 'fake', whatever their biological basis, nor need they be categorised as 'physical', 'psychosomatic' or 'psychiatric'. The book challenges the disease-centred ethos of medicine and medical education. It demonstrates that a clearer conception of illness, as (...) distinct from disease, is therapeutic. The feeling that 'I am once again myself' can return, in some degree, whatever state the body is in. Resilience becomes more available when it is seen as a set of personal skills that can be developed, rather than as an inborn trait. Possibilities of wellness are enhanced by recognising that medical and other therapies can either support or impede recovery, as can human relationships and the socio-political environment. The book's many clinical examples are drawn from the author's broad experience as a neurologist, rehabilitation physician and systemic family therapist. Between Sickness and Health will be useful for students, practitioners and academics, and also for anyone who has been or might one day be ill. (shrink)

Written in a jargon-free way, Body Matters provides a clear and accessible phenomenological critique of core assumptions in mainstream biomedicine and explores ways in which health and illness are experienced and interpreted differently in various socio-historical situations. By drawing on the disciplines of literature, cultural anthropology, sociology, medical history, and philosophy, the authors attempt to dismantle common presuppositions we have about human afflictions and examine how the methods of phenomenology open up new ways to interpret the body and to re-envision (...) therapy. (shrink)

_The first part called the Preamble tackles: (a) the issues of silence and speech, and life and disease; (b) whether we need to know some or all of the truth, and how are exact science and philosophical reason related; (c) the phenomenon of Why, How, and What; (d) how are mind and brain related; (e) what is robust eclecticism, empirical/scientific enquiry, replicability/refutability, and the role of diagnosis and medical model in psychiatry; (f) bioethics and the four principles of beneficence, non-malfeasance, (...) autonomy, and justice; (g) the four concepts of disease, illness, sickness, and disorder; how confusion is confounded by these concepts but clarity is imperative if we want to make sense out of them; and how psychiatry is an interim medical discipline. The second part called The Issues deals with: (a) the concepts of nature and nurture; the biological and the psychosocial; and psychiatric disease and brain pathophysiology; (b) biology, Freud and the reinvention of psychiatry; (c) critics of psychiatry, mind-body problem and paradigm shifts in psychiatry; (d) the biological, the psychoanalytic, the psychosocial and the cognitive; (e) the issues of clarity, reductionism, and integration; (f) what are the fool-proof criteria, which are false leads, and what is the need for questioning assumptions in psychiatry. The third part is called Psychiatric Disorder, Psychiatric Ethics, and Psychiatry Connected Disciplines. It includes topics like (a) psychiatric disorder, mental health, and mental phenomena; (b) issues in psychiatric ethics; (c) social psychiatry, liaison psychiatry, psychosomatic medicine, forensic psychiatry, and neuropsychiatry. The fourth part is called Antipsychiatry, Blunting Creativity, etc. It includes topics like (a) antipsychiatry revisited; (b) basic arguments of antipsychiatry, Szasz, etc.; (c) psychiatric classification and value judgment; (d) conformity, labeling, and blunting creativity. The fifth part is called The Role of Philosophy, Religion, and Spirituality in Psychiatry. It includes topics like (a) relevance of philosophy to psychiatry; (b) psychiatry, religion, spirituality, and culture; (c) ancient Indian concepts and contemporary psychiatry; (d) Indian holism and Western reductionism; (e) science, humanism, and the nomothetic-idiographic orientation. The last part, called Final Goal, talks of the need for a grand unified theory. The whole discussion is put in the form of refutable points._. (shrink)

This chapter relates the problem of demarcating the pathological from the non-pathological in psychiatry to the general problem of defining ‘disease’ in the philosophy of medicine. Section 2 revisits three prominent debates in medical nosology: naturalism versus normativism, the three dimensions of illness, sickness, and disease, and the demarcation problem. Sections 3–5 reformulate the demarcation problem in terms of semantic vagueness. ‘Disease’ exhibits vagueness of degree by drawing no sharp line in a continuum and is combinatorially vague because there are (...) several criteria for the term’s use that might fall apart. Combinatorial vagueness explains why the other two debates appear hopeless: Should we construe ‘disease’ in a naturalistic or in a normative way? Neither answer is satisfactory. How should we balance the three dimensions of pathology? We do not have to, because illness, sickness and disease (narrowly conceived) are non-competing criteria for the application of the cluster term ‘disease’. (shrink)

Hilary Putnam’s influential analysis of the ‘division of linguistic labour’ has a striking application in the area of doctor–patient interaction: patients typically think of themselves as consumers of technical medical terms in the sense that they normally defer to health professionals’ explanations of meaning. It is at the same time well documented that patients tend to think they are entitled to understand lay health terms like ‘sickness’ and ‘illness’ in ways that do not necessarily correspond to health professionals’ understanding. Drawing (...) on recent philosophical theories of concept possession, the article argues that this disparity between medical and lay vocabulary implies that it is, in an important range of cases, easier for doctors to create a communicative platform of shared concepts by using and explaining special medical expressions than by using common lay expressions. This conclusion is contrasted with the view that doctors and patients typically understand each other when they use lay vocabulary. Obviously, use of expressions like ‘sickness’ or ‘illness’ does not necessarily lead to poor communication, but it is important that doctors have an awareness of how patients interpret such terms. (shrink)

A number of studies show that when doctors become ill, there is often ambiguity in the division of roles and responsibilities in the medical encounter. Yet little is known about how the dilemma of the sick doctor has changed over time. This article explores the experience of illness among physicians by applying an historical, narratological approach to three doctor’s narratives about personal cases of cardiac disease: Max Pinner’s from the 1940s, Robert Seaver’s from the 1980s, and John Mulligan’s from 2015. (...) Drawing on Erving Goffman’s principles of social interaction, I argue that part of the challenge in the analysed narratives is because when doctors seek medical attention for themselves, the ensuing medical ‘drama’ suffers. I compare the three narratives to argue that the experience of becoming a patient while simultaneously remaining a doctor is a challenge that has changed over time. In Pinner’s narrative, the patient identity is both undesirable and inaccessible; in Seaver’s, role ambivalence between doctor and patient is the most salient feature; for Mulligan, his personal rather than professional experience of illness is the overarching theme of the narrative. Finally, I suggest that an awareness of how the medical drama often changes when doctors are patients might prove beneficial both for the doctor-patients and providers of medical care. (shrink)

Ausgehend von Kleinmans Differenzierung des Krankheitsbegriffs in disease, illness und sickness und der Unterscheidung von Krankheit und Behinderung durch die Weltgesundheitsorganisation wird am Beispiel von Aufmerksamkeitsstörungen untersucht, welche Zusammenhänge zwischen den beiden Konzeptionen, Krankheit und Behinderung, bestehen. Hierbei wird gefragt, ob und wie Kleinmans Differenzierung des Krankheitsbegriffs auf den Behinderungsbegriff übertragen werden kann und wie eine Modifizierung produktiv für das Verständnis konkreter Syndrome genutzt werden kann. Während die WHO seit 1980 Behinderung von Krankheit auch per Klassifikation unterscheidet, ist der Bereich (...) chronischer Erkrankungen und psychischer sowie kognitiver Syndrome nicht eindeutig verortet. Dies zeigt sich u. a. daran, dass Intelligenzminderungen und Aufmerksamkeitsstörungen (als spezielle Form hyperkinetischer Störungen) sowohl medizinisch mit der ICD-10 (als Krankheitsklassifikation) diagnostiziert als auch mit der Behinderungsklassifikation der WHO, der Internationalen Klassifikation von Funktionsfähigkeit, Behinderung und Gesundheit (ICF), klassifiziert werden können. Im Gegensatz zur ICD lassen sich die Syndrome mit der ICF differenziert kategorisieren, dadurch dass einzelne Körperfunktionen oder Aktivitäten sowie die individuelle Umwelt beurteilt werden. Aufmerksamkeitsschwierigkeiten sowie verschiedene kognitive Fähigkeiten können interdisziplinär beurteilt werden, indem sowohl ihre physischen und psychischen als auch ihre individuellen und gesellschaftlichen Komponenten berücksichtigt werden. Die fachliche und die persönliche Perspektive auf die Syndrome sollten miteinander korreliert werden. Eine klare konzeptionelle Unterscheidung von Krankheit und Behinderung ist nicht möglich. (shrink)

“Iatrophilosophy” is defined as the translational discipline between medicine and philosophy that has a double objective, theoretical and practical. It is presented a model of practical iatrophilosophy applied to chronic pain associated with depression and stress—depresalgia—, that expands Phenomenologic, Hermeneutic, Dynamic Psychotherapy (PHD) to the general medical field. It starts from the general model of the medical triad - disease, illness, and sickness- and, in the horizon of Ortega's anthropology, five nuclear metaphors are proposed: greed of the body, anguish of (...) circumstance, personal tear, personal knots, and personal expropriation. These are related to the neurobiological mechanisms of central sensitization, allostasis, and alteration of the hypothalamic-pituitary-adrenal axis. A personal recovery process based on therapeutic concord is proposed. The analysis of chronic pain and other complex health problems can benefit from philosophical methodologies such as clinical hermeneutics. (shrink)

Philosophers of medicine have formulated different accounts of the concept of disease. Which concept of disease one assumes has implications for what conditions count as diseases and, by extension, who may be regarded as having a disease and for who may be accorded the social privileges and personal responsibilities associated with being sick. In this article, we consider an ideal diagnostic test for coronavirus disease 2019 infection with respect to four groups of people—positive and asymptomatic; positive and symptomatic; negative; and (...) untested—and show how different concepts of disease impact on the disease and sickness judgements for these groups. The suggestion is that sickness judgements and social measures akin to those experienced during the current COVID-19 outbreak presuppose a concept of disease containing social harm as a component. We indicate the problems that arise when adopting this kind of disease concept beyond a state of emergency. (shrink)

Intensive care units provide focused, aggressive medical intervention to critically ill patients. Physicians responsible for ICU triage must decide which patients are sick enough to require this level of care and which can be managed on the general wards. While some patients are too well for the ICU, intensivists increasingly rely on another category, “too sick to benefit,” when denying ICU admission, even if beds are readily available. Recent studies indicate that between 19 and 37 percent of patients refused ICU (...) admission were declined because they were thought too sick to benefit from it, suggesting that physician use of this category is common in ICU triage.The idea of being too sick to benefit may seem paradoxical given that ICUs exist to treat the sickest of the sick. There is, however, increasing awareness that some diseases progress despite maximal intervention. Although there have been systematic attempts to define these diseases—most notably during the medical futility debates of the 1980s and early 1990s—there is little evidence about which conditions make a patient too sick to benefit from ICU admission. In the absence of a clear understanding of which diseases progress despite maximal care, ICU triage under the category “too sick to benefit” is currently done on a case‐by‐case basis. Contemporary decisions about who is too sick to benefit thus raise a number of ethical issues about what constitutes standard of care, the role of health care providers' judgments of quality of life in triage, and the just allocation of resources.Addressing these ethical concerns requires us to better define the population of critically ill adults who are too sick to benefit—a conceptual and empirical project. In this article, I recommend employing a diagnostic concept from the neonatal literature: namely, a lethal disease. (shrink)

Not only trauma, mourning and disease, but also disability has been recognised in the Book of Job in which the body plays an exceptional role. The protagonist is suffering physically, psychically and spiritually. Although the word, חלה [be sick, ill], never occurs in the book, his body is portrayed negatively being afflicted by some unknown illness, which would probably exclude him from the community described in Leviticus 13–14. While חָרֵשׁ [be silent] occurs several times in the book, it never has (...) the alternative meaning of deaf. Yet, his explicit empathy and sacrificial charity לַעִוֵּר [for the blind] and לַפִּסֵּחַ [for the lame] in 29:15 resonate with his own plight and undermine the possible discriminatory restrictions of like disabled in Leviticus 21:18. In this way, the Book of Job has a transgressive and yet liberating subtext, subverting the idealised body of his status quo. This subtle and veiled critique by the protagonist and therefore the book can be interpreted from a psychoanalytic perspective on physical disability and illness, where the symptoms and alleged imperfections of the body quietly cry out against social and cultural injustice of which they are the projections and mirrors when the context has silenced a concern for the body because of a lack of compassion as it is in the situation of Job. Contribution: The intersection and cross-fertilisation of Biblical Studies, Disability Studies and psychoanalytic theory as interdisciplinary approach widens the horizons and deepens the insight of all three research fields, hopefully for the benefit of those who suffer from their bodies, their psyches and their societies. (shrink)

In At the Will of the Body , Arthur Frank told the story of his own illnesses, heart attack and cancer. That book ended by describing the existence of a "remission society," whose members all live with some form of illness or disability. The Wounded Storyteller is their collective portrait. Ill people are more than victims of disease or patients of medicine they are wounded storytellers. People tell stories to make sense of their suffering when they turn their diseases into (...) stories, they find healing. Drawing on the work of authors such as Oliver Sacks, Anatole Broyard, Norman Cousins, and Audre Lorde, as well as from people he met during the years he spent among different illness groups, Frank recounts a stirring collection of illness stories, ranging from the well-known--Gilda Radner's battle with ovarian cancer--to the private testimonials of people with cancer, chronic fatigue syndrome, and disabilties. Their stories are more than accounts of personal suffering: they abound with moral choices and point to a social ethic. Frank identifies three basic narratives of illness in restitution, chaos, and quest. Restitution narratives anticipate getting well again and give prominence to the technology of cure. In chaos narratives, illness seems to stretch on forever, with no respite or redeeming insights. Quest narratives are about finding that insight as illness is transformed into a means for the ill person to become someone new. (shrink)

Due to the confinement imposed by the COVID-19 pandemic situation, companies adopted remote work more than ever. The rapid rise of remote work also affected local life and many employers introduced or extended their telework activities because of the associated advantages. However, despite the evident positive benefits, some employees were pressured to work remotely while ill. This evidence brought new challenges to the presenteeism literature. This article investigates how individual, economic/societal, and organizational/sectorial/supervisory-related variables can moderate the role of a contagious (...) disease, such as the COVID-19, in explaining presenteeism behavior. Moreover, the current research presents a multi-level conceptual model to describe how a new construct of remote-work presenteeism behavior mediates the relationship between different post pandemic health conditions and future cumulative negative consequences. The authors suggested that the widespread pervasive adoption of remote work because of COVID-19 has important implications for the presenteeism literature and opens avenues for further research. (shrink)

A Christian bioethic needs to place the medical approach to sickness, suffering, and death within the context of redemption and the renewal of humanity in the image of God. This can be done by accounting for the way in which the disruptions of the human life-world that attend the illness experience manifest the structure of the problem of evil and point toward an answer that transcends the individual and the medical community. Further, the disease-oriented approach to medicine, when understood in (...) the context of the analogia entis, can be taken as an analogy for a deeper spiritual healing, and can thus become a vehicle through which one can minister to the disruptions of a patient's life-world. An appreciation of the analogical structure of healing provides the basis for a Christian ethic of care. (shrink)

David Thomasma called for the development of a medical ethics based squarely on the philosophy of medicine. He recognized, however, that widespread anti-essentialism presented a significant barrier to such an approach. The aim of this article is to introduce a theory that challenges these anti-essentialist objections. The notion of natural kinds presents a modest form of essentialism that can serve as the basis for a foundationalist philosophy of medicine. The notion of a natural kind is neither static nor reductionistic. Disease (...) can be understood as making necessary reference to living natural kinds without invoking the claim that diseases themselves are natural kinds. The idea that natural kinds have a natural disposition to flourish as the kinds of things that they are provides a telos to which to tether the notion of disease – an objective telos that is broader than mere survival and narrower than subjective choice. It is argued that while nosology is descriptive and may have therapeutic implications, disease classification is fundamentally explanatory. Sickness and illness, while referring to the same state of affairs, can be distinguished from disease phenomenologically. Scientific and diagnostic fallibility in making judgments about diseases do not diminish the objectivity of this notion of disease. Diseases are things, not kinds. Injury is a concept parallel to disease that also makes necessary reference to living natural kinds. These ideas provide a new possibility for the development of a philosophy of medicine with implications for medical ethics. (shrink)

Many worry about the over-medicalisation of mental illness, and some even argue that we should abandon the term mental illness altogether. Yet, this is a commonly used term in popular discourse, in policy making, and in research. In this paper I argue that if we distinguish between disease, illness, and sickness (where illness refers to the first-personal, subjective experience of the sufferer), then the concept of mental illness is a useful way of understanding a type of human experience, inasmuch as (...) the term is (i) apt or accurate, (ii) a useful hermeneutical resource for interpreting and communicating experience, and (iii) can be a good way for at least some of us to establish a liveable personal identity within our culture. (shrink)

Cherie Moraga’s play, Heroes and Saints, and Helena Maria Viramontes’ novel, Under the Feet of Jesus, offer readers perspectives on the lives of migrant farm workers in California that challenge the moral imagination and conscience. Both focus on health hazards of pesticides and on the often prohibitive difficulty of getting health care for those who fall ill as a result of exposure. This paper offers a reflection on the direct political and moral appeal these works present to readers who may (...) not see or acknowledge the sacrifices sustained by those whose undercompensated labors are an integral part of our food systems. (shrink)

Because it focuses primarily on the sick body (disease), medicine ignores many of the concerns and needs of sick people. By listening to the stories of patients in the clinic, on the Internet, and in published book form, health care providers could gain a better understanding of the impact of disease on the person (illness), what it means to patients over and above their physical symptoms and what they might require over and above surgery or chemotherapy. Only by familiarizing themselves (...) with the entire emotional landscape of illness, which includes fear, anger, shame, guilt, and above all loneliness, can the healthy—medicine as well as society in general—hope to heal in a comprehensive manner. (shrink)

The recent increased prevalence of diseases related to unhealthy lifestyles raises difficulties for healthcare insurance systems traditionally based on the principles of risk-management, solidarity, and selective altruism: since these diseases are, to some extent, predictable and avoidable, patients seem to bear some responsibility for their condition and may not deserve full access to social medical services. Here, we investigate with objective criteria to what extent it is warranted to hold patients responsible for their illness and to sanction them accordingly. We (...) ground our analysis on a series of minimal conditions for ‘practical’ and for ‘moral’ responsibility attribution. By applying these criteria consistently, we highlight that individual responsibility applies to risk-taking life choices rather than stigmatized sickness. We explain that responsibility is a matter of degree, that it varies across life-history, and can be affected by factors beyond the patients’ grasp. We point out that scientific knowledge about the effect of these factors generates responsibilities for other parties such as public health agencies and private industry. The upshot of our analysis is that health policies targeting the ‘liable’ undeserving sick are mostly unwarranted, and tend to increase unequal treatment of already vulnerable groups: the unlucky sick. (shrink)

The experience of illness is a universal and substantial part of human existence. Like death, illness raises important philosophical issues. But unlike death, illness, and in particular the experience of being ill, has received little philosophical attention. In Phenomenology of Illness Havi Carel argues that the experience of illness has been wrongly neglected by philosophers and provides a distinctively philosophical account of illness. Using phenomenology, Carel explores how illness modifies the ill person's body, values, and world. The aim of Phenomenology (...) of Illness is twofold: to contribute to the understanding of illness through the use of philosophy and to demonstrate the importance of illness for philosophy. Phenomenology of Illness develops a phenomenological framework for illness and a systematic understanding of illness as a philosophical tool. (shrink)

Eros and Illness explores the place of desire in illness. We urgently need such an exploration because illness is no longer simply a natural feature of the human condition. Most people fall ill, but illness now falls under the supervision of biomedicine, a science-based, state-regulated system dominated by the new molecular gaze. The use of a person's distinctive genetic data to guide treatment and to forestall disease--called "personalized medicine"-- reflects how the molecular gaze can produce valuable advances in biomedical healthcare. (...) What does this indispensable super-vision, however, tend to overlook? Eros and Illness proposes that biomedicine ignores, in clinical practice and in bench science, the powerful role of desire in illness. Desire, always double-edged, requires attention because it can do both great harm and great good. Patients, caregivers, family members, and physicians, as they recognize the role of desire, gain access to a power that can make the passage through illness much less onerous and far more healing: truly "personalized. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Philosophy, Psychiatry, & Psychology 10.3 (2003) 225-226 [Access article in PDF] Travelers in the Land of Sickness Eric J. Cassell THE PROBLEM OF knowing another person and the world in which that person lives, particularly someone with major mental illness, is addressed in this interesting and rich essay. The number of different metaphors and concepts Potter employs to describe the task of crossing into and then understanding the thoughts, (...) emotions, symptoms, constraints, context, and perspectives of another testifies to the difficulties involved.Yet, as I read the essay, it was not clear what the clinician world traveler, moral tourist, empathizer (and other categories) is supposed to do on the journey to another person. Why do we reach out to the sick person? What is it that we want to know or do that makes this trip necessary? Potter is primarily concerned with mental illness—the examples she cites are patients with schizophrenia—while my experience has in the main been with persons with physical illness, but for the moment, the differences are less important than the central lesson. The illness that the patient presents—the experience of the symptoms, the impairments, disability, and disruptions of the emotional and social existence that happen because of the disease result from an amalgam of the disease process with the specific nature of the sick person. There is no disease in pure form; there is no disease in abstract for clinicians. There is only this sick person. She correctly quotes me, because of all this, as pointing out the importance of integrating knowledge of this particular patient with the abstract knowledge of disease to understand the illness as it is expressed in this person. All to form a basis for the treatment of the patient and especially to help relieve suffering because suffering is always personal, particular, and individual. (It is important in thinking about this topic to remember that most serious diseases, psychiatric and otherwise, are chronic and take place over significant lived time. The acute schizophrenic symptoms or the acute infectious diseases, as dramatic as they are, distract attention from the importance of the place of the sick person.)In physical disease, our long (and continuing) history of separating human beings from nature and the body, and the importance medicine places on objectivity and the objective, have made the inevitable personalization of the disease and symptoms virtually invisible. After ages of explaining psychiatric diseases as the alienation of the person, and a long psychoanalytic period of finding their origins in the person, in the last 30 years these diseases have become increasingly objectified. The place of the person has been diminished as psychiatry has entered the DSM, neurotransmitter, and effective psychotropic drug era. For both physical and mental disease, however, and whatever the current ideology, the nature of person is crucial in determining the onset, diagnosis, course, treatment, and outcome of each illness. It is in order to have an impact on these crucial aspects of sickness that clinicians must come to know their patients to the degree possible. [End Page 225]But there is something more. Nancy Potter quotes a woman with schizophrenia as saying, "All that was my former self has crumbled and fallen together and a creature has emerged of whom I know nothing. She is a stranger to me... She is not real—she is not I... She is I—and because I still have myself on my hands, even if I am a maniac, I must deal with me somehow." (Potter, 2003, p. 215)Must she deal with this crazy self alone? Is that not what her doctors and caregivers are for? But how can they take care of her, protect her, keep what is left intact, and sustain her until she is (hopefully) better without knowing who she is? She makes clear in those few phrases that inside her there is a person with a past, a family, a world, a culture, a role(s) in life, relationships, a body, dreams for the future, things she does, and all the other things that make up a person. It is in... (shrink)

Within philosophy of medicine it has been a widespread view that there are important theoretical and practical reasons for clarifying the nature of basic health concepts like disease, illness and sickness. Many theorists have attempted to give definitions that can function as general standards, but as more and more definitions have been rejected as inadequate, pessimism about the possibility of formulating plausible definitions has become increasingly widespread. However, the belief that no definitions will succeed since no definitions have succeeded is (...) an inductive objection, open to realist responses. The article argues that an influential argument from philosophy of language constitutes a more fundamental objection. I use disease as an example and show that this argument implies that if a common understanding of disease can be analysed into a definition, then this is a non-trivial definition. But any non-trivial analysis must be viciously circular: the analysis must presuppose that disease can be defined, but this is what the analysis is supposed to yield as a result. This means, the article concludes, that disease and other controversial health concepts do not have analyses grounded in a common language. Stipulative and contextual definitions can have local significance, but the normative roles of such definitions are at the same time limited. (shrink)

If James has a latent tuberculosis infection , he is at risk of developing active tuberculosis disease but he is not yet sick. LTBI is a liminal space between health and illness. Diagnosed with LTBI, James could be conceptualised as having a liminal body. Treatments for LTBI are available, but why would a person seek treatment for a disease he does not yet have? One thing is definite: James needs to be educated about the symptoms and severity of active tuberculosis (...) disease. (shrink)

Chronic kidney failure is a serious somatic disease. Addressing the issue of living with a chronic disease means fully considering the patients’ entourage, their families, and those close to them, especially their children and spouses.Objectives: The present paper focuses on the couple’s psychological experience when one of them suffers from a chronic disease, in this instance kidney disease. In particular, how is the spouse affected by the treatment provided? The aim is not only to see how care for sick people (...) can be improved, but also, more specifically, how relatives and especially partners can receive attention.Methodology: A qualitative approach is not only adopted, being based on the psychotherapeutic follow-up of the partners of patients with chronic kidney disease, but also of the patients themselves, addressing the matter of their life as a couple. Three couples were considered, and two case studies are presented here. The issues that cut across these different situations are examined.Results and Discussion: Some couples show considerable resourcefulness. However, over the years, that capacity for adaptation and inventiveness can also be interrupted by the periods of greater suffering and even despair, especially when the somatic pathology becomes chronic. Many spouses talk about how living with a sick partner weighs down on them, causing severe fatigue. Some aspects of the illness can also become traumatic. The disease regularly disrupts the daily life of the couple and the family. This leads to a reworking of family relations. Each couple has its own history with the condition. As it emerges, it can disrupt the bonds of filiation, especially when the illness is hereditary. Making psychological care more accessible to the partners involved constitutes a major challenge for our hospital care systems. (shrink)

Environmental influences on the experiences of people with Parkinson’s diseaseThis study elucidates environmental influences on lived illness experiences. For two consecutive years, persons with Parkinson’s disease (PD) participated in 1 week of daily walking in the Swedish mountains. Daily, low‐intensive walking that is free of intense effort or time pressures associated with group interaction characterized the week. Participants were interviewed 3 months after the mountain stay regarding experiences in the mountains, daily living, and how their experience in the mountains influenced (...) their daily living after returning home. A phenomenological method was used for data analysis. Results point to the close connection between mind, body, and environment. The connection becomes highlighted when people are afflicted with sickness, such as PD, which causes impaired control of body language, impaired voluntary mobility, and lowered energy levels. The results also show how a social context in an environment with suitable physical challenges led to a change in individuals’ perceptions of the manageability of their experienced sicknesses. These results provide a deepened understanding of how individuals with PD experience illness, its influences on daily life, and how a suitable environment opens opportunities for managing daily issues. (shrink)

A multifactorial and growing crisis of health care systems in the developed world has affected medicine. In order to provide rational responses, some central concepts of the past, such as the definitions of health and disease, need to be updated. For this purpose physicians should initiate a new debate. As a point of departure the following definitions are proposed: Health is a dynamic state of wellbeing characterized by a physical, mental and social potential, which satisfies the demands of a life (...) commensurate with age, culture, and personal responsibility. If the potential is insufficient to satisfy these demands the state is disease. This term includes sickness, illness, ill health, and malady. The described potential is divided into a biologically given and a personally acquired partial potential. Their proportions vary throughout the life cycle. The proposed definitions render it empirically possible to diagnose persons as healthy or diseased and to apportion some of the responsibility for their state of health to individuals themselves. Treatment strategies should always consider three therapeutic routes: improvements of the biologically given and of the personally acquired partial potentials and adaptations of the demands of life. These consequences favourably contrast with those resulting from the WHO-definition of health. (shrink)

Narratives of the experience of pulmonary tuberculosis are relatively rare in the Irish context. A scourge of the early twentieth century, TB was as much a social as a physically debilitating disease that rendered sufferers silent about their experience. Thus, the personal diaries and letters of Irish poet, Seán Ó Ríordáin, are rare. This article presents translations of his personal papers in a historico-medical context to chronicle Ó Ríordáin’s experience of a life marred by respiratory disease. Familiar to generations of (...) schoolchildren are his imaginative poems, whose lively metre punctuated the Irish language curriculum from primary through to secondary schooling; for most they leave an indelible mark. Such buoyant poems however belie the reality of his existence, lived in the shadow of chronic illness, and punctuated with despair over his condition and anxiety about the periods of extended sick leave his illness necessitated. Although despair dominated his diaries and he routinely begged God, Mary, the Saints and the devil for death, they were also the locus where his creativity developed. In his diaries, caricatures of friends and sketches of everyday things nestle among the first lines of some of his most influential poems and quotes from distinguished philosophers and writers. Evocative and tragic, his diaries offer a unique prism to the experience of respiratory disease in Ireland. (shrink)

Definition of the problemStaff and patients in institutions of organized health care experience and express a variety of adverse conditions of these organizations. Within a theoretical framework of institutional pathology we can explain some of these “miserable conditions” as effects of the activities of organizations belonging to the political system (health policy) and to the economic system (health economy). Clinical ethics committees (CECs) cannot effectively handle such adversities or even address them properly. Standard organizational ethics can address them but cannot (...) handle them effectively.ArgumentsI propose to strengthen organizational ethics by a theory of institutional pathology. Basic nosological distinctions such as disease, illness and sickness, whose primary reference is to biological organisms and persons, can be analogically extended to socially constituted entities (e.g. hospitals) in terms of functional deficiency, miserable conditions, and need for reform of such entities. A very promising focus for analysis are organizational disorders of responsibility allocation. This group of institutional pathological disorders engenders, amongst other kinds of miserable conditions, specifically morally relevant miserable conditions.ConclusionThe institutional pathology paradigm, oriented to concrete institutions and organizations, can help “clinical” organizational ethics to considerably expand, in theoretical ethics as well as in ethically guided practice e.g. for members of CECs and organizational ethics advisors, the capacities for observing, evaluating and, if necessary, amending disturbed relations of responsibility. (shrink)

The present study investigated the lasting effects of sickness presenteeism on well-being and innovative job performance in the demanding Chinese work context compounded with the precarities of the post-pandemic business environment. Adopting the conservation of resources theory perspective, especially its proposition of compensation of resources, we incorporated social resources at work as joint moderators in the presenteeism–outcomes relationship. We employed a panel design in which all variables were measured twice with 6 months in between. Data were obtained from 323 Chinese (...) employees working in diverse industries in Taiwan. We found that after controlling for the baseline level of well-being, presenteeism did not have a lasting effect on employees' exhaustion. However, presenteeism did have a negative lasting effect on employees' innovative behavior 6 months later. Moreover, we found a significant three-way interaction of presenteeism, supervisory support, and collegial support on employees' innovative job performance, after controlling for the baseline level of performance. Specifically, when working under illness, employees displayed the best innovative performance with high levels of both supervisory and collegial support, the worst performance with both support being low, and the intermediate when any one of the support being high. This can be taken as the preliminary evidence to support the COR proposition of resource caravans, showing that supervisory support and collegial support compensated for each other as critical resources in alleviating the impact of working under sickness on employees' innovative performance. Theoretical implications of the findings are discussed, taking into account the macro-cultural context of the East Asian Confucian societies. We also reflected on the managerial implications of the lasting damages of sickness presenteeism and benefits of mobilizing social resources on employees' well-being and performance. (shrink)

People confront their doctors with three modes of unhealth - disease, illness and sickness. Each is discussed, and the question is asked and answered as to why in this situation people wish to become patients.

The main task of a critical theory of medicine should be to develop a perspectival, context-fair, and multidimensional science of actions which integrates both diversity and heterogeneity within medicine without eliminating either one. Such a theory should employ diversity in the following areas: (1) in systems, subsystems, and professions, because different medical professions embody different health-care subsystems, thereby influencing the way manpower is utilized, (2) in actors, (e.g., patients, health-care experts, and society), processes, and situations, because each actor potentially conceptualizes (...) health, illness, and desired outcomes differently; and (3) in models of medicine (i.e., as an object science versus an action science). Situational influences modify concepts and explanatory models; even the particular terms, such as illness, disease, and sickness, are not necessarily concordant with each other. (shrink)

Mental disorders have been suggested to differ from somatic diseases because they lack an organic correlate. We show that this argument is both empirically wrong and theoretically irrelevant, because diseases are defined by functional impairments and not biological variation. Due to human diversity, a multitude of functions can be defined, and any selection of medically relevant functional impairments is necessarily value-based. We suggest that such values include individual survival and living in a shared world with others, and that their definition (...) requires public debate and a critical reflection by Philosophical Anthropology. However, the presence of functional impairments that are generally relevant for human life and survival only fulfils the so-called disease criterion, which is necessary but not sufficient to diagnose a clinically relevant malady. This would only be justified if such functional impairments cause individual harm, either because they are accompanied by suffering (the illness criterion) or because they interfere with basic activities of daily living such as personal hygiene and food intake (the sickness criterion of a clinically relevant malady). We apply this theory to mental disorders, conclude that only a fraction of such “disorders” currently listed in international classifications of diseases are clinically relevant mental maladies, suggest focusing on the needs of persons with such maladies and recommend avoiding “pathologization” of human diversity. (shrink)

The categories of health and disease/illness are conceptualized from the perspective of the philosophy of medicine. Philosophical contradictions are revealed, which, fueling the debate between naturalism and normativism, prevent biomedicine from developing a single satisfactory understanding of these categories. The theoretical and practical consequences of such biomedicine features as pathocentrism, identification of health with complete well-being, dichotomy of health and disease in the absence of a clear criterion for their differentiation are analyzed. The role of humanistic approaches to the medicine (...) rehumanization is investigated with a focus on their balanced view of health and disease/illness, attentive to the fundamental vulnerability of human nature. (shrink)

Disease and illness are terms that are often used interchangeably by physicians and the lay public. But not all usage permits this. For instance, diseases are referred to in terms of entities with etiologies; illnesses are not. We also speak of illness as being the effect or symptom of a disease, but not the converse. In what follows, disease and illness will be treated as distinct concepts. a.

This paper aims at explicating the role of the connections and interactions between health, well being and beauty. The primary goal of all medical approaches, including the classic biomedical and humanistic or humane approaches, is to restore or create health, whereby medical approaches that include prevention go beyond the mere restoration of health to include the preservation of health. Equating well-being and thus health with a largely self-determined and joyful life, then not only does a healthy life become a beautiful (...) life, a beautiful life also becomes a healthy life! By bringing Beauty into the health discourse, we are entering the field of aesthetics in general and social aesthetics in particular. As the beautiful is not just a decorative element of life but a genuine source of human strength, it gives us the strength and power we need to implement and achieve all that we then experience as “well-being” and that is called a healthy life. Therefore a further development of a human-based medicine is needed, a medicine that focuses not on a disease construct but which places a human being as a whole, with all his potential and limitations at the heart of diagnostic and therapeutic efforts. The noblest therapeutic goal of this kind of medicine can only be the restoration or preservation of a comprehensive state of health in the sense of complete physical, mental and social well-being, in the sense of opening up the possibility for a mostly autonomous and joyful life. (shrink)

From a twenty-first century partnership between bioethics and neuroscience, the modern field of neuroethics is emerging, and technologies enabling functional neuroimaging with unprecedented sensitivity have brought new ethical, social and legal issues to the forefront. Some issues, akin to those surrounding modern genetics, raise critical questions regarding prediction of disease, privacy and identity. However, with new and still-evolving insights into our neurobiology and previously unquantifiable features of profoundly personal behaviors such as social attitude, value and moral agency, the difficulty of (...) carefully and properly interpreting the relationship between brain findings and our own self-concept is unprecedented. Therefore, while the ethics of genetics provides a legitimate starting point - even a backbone - for tackling ethical issues in neuroimaging, they do not suffice. Drawing on recent neuroimaging findings and their plausible real-world applications, we argue that interpretation of neuroimaging data is a key epistemological and ethical challenge. This challenge is two-fold. First, at the scientific level, the sheer complexity of neuroscience research poses challenges for integration of knowledge and meaningful interpretation of data. Second, at the social and cultural level, we find that interpretations of imaging studies are bound by cultural and anthropological frameworks. In particular, the introduction of concepts of self and personhood in neuroimaging illustrates the interaction of interpretation levels and is a major reason why ethical reflection on genetics will only partially help settle neuroethical issues. Indeed, ethical interpretation of such findings will necessitate not only traditional bioethical input but also a wider perspective on the construction of scientific knowledge. (shrink)

We are never illness or disease, but, rather, always their sum in the world of day-to-day experience. Disease and illness are not closed systems, but mutually constitutive and continuously interacting worlds. In the patient’s case it is always experience as well. Pain, sickness and death help make that particular experienced identity unavoidable, and at some level ultimately inaccessible to medicine’s changing understanding of disease and tools for managing it. Health—rather than cost containment, specific conditions, or technologies—should be the central focus (...) for health care and health-care reform. A compelling reason to focus on health comes from the observation that the prevalence of disease over the .. (shrink)

In proportion to other serious illnesses, diseases of the brain and mind represent the greatest—and still increasing—public health burden that Western societies are facing. Consequently, scientists, governments, advocacy groups, and public health authorities are committed to research to tackle the causes and consequences of neurological and psychiatric diseases and to find cures for them. As neuroscience research progresses, ethicists and neuroscientists face numerous ethical challenges to the integration of frontier application of research—neurotechnology—with the delivery of high-quality healthcare. In this special (...) neuroethics issue, we have invited distinguished scholars with diverse disciplinary backgrounds to present their reflections and research on the ethical dimensions of this crucial integration. (shrink)

Deep brain stimulation (DBS) represents a promising new frontier in medicine and neuroscience for managing disorders of mental health that represent an enormous burden of disease on our societies. The caution and significant restraint of leaders in the evolution of DBS today stand in sharp and refreshing contrast to previous episodes in history. In embracing the anticipatory and pragmatic problem-solving approach of neuroethics to clinical neuroscience, four significant paradoxes for DBS today come to the fore: caution and innovation, capacity and (...) allocation of resources, notions of wellness and disease, and the high-stakes/high-benefit imperative of communicating about science. Tackling these paradoxes is the focus of this article. (shrink)

" Dr. Cassell discusses the world of the sick, the healing connection and healer's battle, the role of omnipotence in the healer's art, illness and disease, and ...