Chapter 19 Concepts of health, illness and disease

Health and illness are concepts that relate to social and moral values as much as they relate to disease. Medicine is particularly concerned with identifying and treating diseases: this model of disease is called biomedicine, drawing as it does on medical sciences with an emphasis on biological abnormality. Biological abnormalities are not found for all diseases (e.g. some mental illness), and biomedicine is only one way of looking at the ill health that people experience. Health and illness are also rooted in everyday experience so it is also important to understand how people feel when they are ill, and what their own interpretations of their symptoms are (Radley, 1994). In this way, health care can be provided more sensitively, doctors can get a fuller picture of what ails their patients and patients can be part of the process of identifying what is wrong with them and what can be done about it.

Health has also become an important concept in recent years, especially through an increasing emphasis on promoting well-being as well as preventing illness (Crawford, 1987). However, health is not easy to define. Health, illness and disease mean different things to different people. We will consider the extent to which these concepts are as much social (that is, to do with society) and personal (to do with individual experience) as they are to do with pathology.

Disease

Defining disease may at first seem to be quite straightforward. However, changes in medical knowledge may alter our understanding (e.g. many diseases are now thought to have a genetic component) and new symptoms and diseases may appear or be discovered (e.g. HIV/AIDS, myalgic encephalomyelitis). Typically, in western medicine, disease refers to pathological changes diagnosed by signs, symptoms and tests: it is considered to be objective and medically defined. Yet, as the above examples show, definitions are not fixed but change over time in the light of new knowledge and experience. Homosexuality used to be defined as a disease but is now much more socially accepted as a lifestyle choice; used to be seen as immoral, but it is now often typified as a disease. Heart disease, although existing before the 20th century, was seldom considered a specific cause of death until this century. We are increasingly able to define disease at earlier and earlier stages, or even identify risk factors for disease. This can lead to many more people being defined as diseased, or ‘at risk’, even in the absence of any symptoms. So, it is possible to feel quite well but for disease to be present.

Armstrong (1994) has argued that normality plays a crucial role in how medicine defines disease. If the definition of normal relates to what is statistically normal, or an average measure, it is not always clear-cut where the normal becomes the abnormal or pathological. What is normal for one person may not be normal for another, or whole populations may display some kind of pathology which, while representing disease or risk of disease, is normal in some sense. Normality can also be seen as being socially rather than biologically defined. Here, normality is viewed more in terms of what is considered acceptable or desirable. Mental illness, for example, is very much rooted in culture, and what is considered abnormal behaviour varies across cultures. An extreme example would be the labelling of political dissidents as mentally ill, as occurred in the former Soviet Union. There are also concerns about possible overdiagnosis of mental illness amongst some ethnic minority groups, such as Afro-Caribbean men in the UK. Some disabled people challenge the medical definitions of their conditions and argue that it is society that disables them (see pp. 118–119). Disease, then, is not such a straightforward concept.

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