The illness-disease dichotomy and the biological-clinical splitting of medicine

Abstract

In a recent paper, Sharpe and Greco (2019) argue that some clinical conditions, such as chronic fatigue syndrome (sometimes called myalgic encephalomyelitis), should be treated by altering the patient's experience and response to symptoms without necessarily searching for an underlying cause. As a result, we should allow for the existence of ‘illnesses without (underlying) diseases’. Wilshire and Ward (2019) reply that this possibility requires unwarranted causal assumptions about the psychosocial origins of conditions not predicted by a disease model. In so doing, it is argued that Sharpe and Greco introduce epistemological and methodological problems with serious medical consequences, for example, patients feel guilt for seeking treatment for illnesses that only exist ‘all in the mind’, and medical researchers are discouraged from looking for more effective treatments of such conditions. We propose a view that integrates the insights of both papers. We abandon both the strict distinction between disease and illness and the naïve unidirectional account of causality that accompanies it. This, we claim, is a step towards overcoming the current harmful tendencies to conceptually separate (1) Symptom management and disease-modifying treatments. (2) Rehabilitative-palliative care and ‘causal’ curing. (3) Most importantly, biomedicine and clinical medicine, where the latter is currently at risk of losing its status as scientific.

Efficacy of Repetitive Transcranial Magnetic Stimulation for Acute Central Post-stroke Pain: A Case Study

“…Further, objective changes in neurophysiologic parameters indeed paralleled the decrease in pain, suggesting that reports of pain perception were credible. Nevertheless, these neurophysiological changes can be the effect rather than the cause of psychological, placebo-induced changes if one accepts a bidirectional brain-mind relationship ( 36 , 37 ). In the present study, only the iSP was used as a measure of transcallosal inhibition to reduce patient's burden to a minimum.…”

Körpererfahrung und Körperinteraktion in der psychotherapeutischen Anamnese- und Befunderhebung

“…Der Fokus liegt dabei, orientiert an den Konzepten der 4E-Kognitionsforschung (embodied, embedded, enactive, extended) 1 , einer phänomenologisch-hermeneutisch-psychodynamischen 18 bzw. ökologischen Psychotherapie 13 , und im Kontrast zu starrem Kategoriedenken, „naiven unidirektionalen Kausalitätsannahmen“ 29 und rein Evidenz-basiertem „wissenschaftlichem Materialismus“ 8 , auf folgenden „live“-diagnostischen Methoden:…”

COVID-19 pandemic: why time-dependent rehabilitation is forgotten

“…One might speculate that such a situation reflects the obsolete yet widespread and tenacious idea that PRM is just a generic approach to late, chronic sequelae of ‘true’ diseases. Dichotomous thinking is still dominant in medicine, segregating science from assistance, cure from care, acute from chronic care, causes from symptoms, treatment from palliation, theory-based biology from clinical empiricism [ 14 ]. Perhaps policymakers still view PRM as characterized by the latter terms within these artificial contrasts rather than a point of delivery of a unique continuum of cure and care.…”