Disease and illness Distinctions between professional and popular ideas of sickness

Abstract

The dysfunctional consequences of the Cartesian dichotomy have been enhanced by the power of biomedical technology. Technical virtuosity reifies the mechanical model and widens the gap between what patients seek and doctors provide. Patients suffer "illnesses"; doctors diagnose and treat "diseases". Illnesses are experiences of discontinuities in states of being and perceived role performances. Diseases, in the scientific paradigm of modern medicine, are abnormalities in the function and/or structure of body organs and systems. Traditional healers also redefine illness as disease: because they share symbols and metaphors consonant with lay beliefs, their healing rituals are more responsive to the psychosocial context of illness. Psychiatric disorders offer an illuminating perspective on the basic medical dilemma. The paradigms for psychiatric practice include multiple and ostensibly contradictory models: organic, psychodynamic, behavioural and social. This mélange of concepts stems from the fact that the fundamental manifestations of psychosis are disordered behaviours. The psychotic patient remains a person; his self-concept and relationships with others are central to the therapeutic encounter, whatever pharmacological adjuncts are employed. The same truths hold for all patients. The social matrix determines when and how the patient seeks what kind of help, his "compliance" with the recommended regimen and, to a significant extent, the functional outcome. When physicians dismiss illness because ascertainable "disease" is absent, they fail to meet their socially assigned responsibility. It is essential to reintegrate "scientific" and "social" concepts of disease and illness as a basis for a functional system of medical research and care.

“I suddenly felt I’d aged”: A qualitative study of patient experiences of polymyalgia rheumatica (PMR)

“…E experience) [18] is also highly relevant to PMR. Given that PMR is a heterogenous condition, affects older age groups (who will have a huge range of comorbidities, life experiences and coping strategies), causes pain and disability and is treated with medication capable of causing significant harm, pronounced.…”

Patient experience and psychiatric discourse

“…[1][2][3][4][5] The patient's experience of sickness is translated into abnormality of structure and function. It is conceptualised using universal models in terms of disease, learnt maladaptive thinking and behaviour or problematic childhood and adult relationships.…”

Explanatory models in psychiatry

“…These included Leon Eisenberg's (1977) distinguishing fundamental features of disease and illness that highlighted limitations of exclusively biological and technical approaches to medical practice. The work of George Engel (1977) focused on advancing the biopsychosocial model of psychiatry and medicine, arguing that each perspective alone was inadequate, and together they were complementary.…”

“…Eisenberg (1977) pointed out that models were important and useful because they helped to construct reality and to lend meaning to a chaotic world. They are rightly regarded as particularly important for research because they determine the kind of questions we ask, the kind of data we gather, and the ways we analyse and interpret them.…”