Concepts of Health and Disease. Interdisciplinary Perspectives

This collection of essays by forty-four authors from diverse disciplines explores the meanings attached to the concepts of health and disease and the consequences of each. The editors, Caplan, Engelhardt, and McCartney, provide general and chapter introductions which emphasize the importance of viewing the varying perspectives as a foundation for the approaches of biomedical research and health care in our country. Lest these issues seem esoteric or purely academic, the authors remind us that personal, professional, and cultural definitions of "what is health" and "what is disease" have direct bearing upon the choices a society makes in the structure, goals, and role of its health care institutions, programs, and practices. Similarly, the kinds of preventive, educational, and therapeutic actions a society takes systematically affect the way in which health and disease are subsequently defined. The first section of essays sets the stage by posing a series of polemics. Should medicine, as argued by Kass, restrict its concern (and therefore its practice) to issues rigidly defined by physiological factors? Or should medicine extend its concerns to the promotion of optimal states of health and well-being? Is health a state of being at all? if so, should we define it by degree of pathology, or by statistical analysis, or through culturally determined values? Or, as Engelhardt argues, is health best understood as a unifying concept which serves as a regulative ideal, rather than as a state of being? In this case health is what we strive for, but the possibility of reaching "health" is another matter. The second section of the book provides a historical perspective on efforts to understand and evaluate disease. Is disease an ontological entity, a set of internal physical changes, or a set of externally manifested physical, mental, and social states? Certainly labeling a state of being as "disease" has serious consequences not only for the individual so labeled, but also for political, economic, and social systems. The third section illuminates this point with examples of biases and prejudices which have crept into the medical classification of disease. Power groups in our society have periodically associated conditions of birth, such as being female or black, with physical limitations which in turn restrict the range of activities and social responsibilities allowed these groups. At times, specific behaviors such as drug addiction, masturbation, and alcoholism have been classified as diseases. Those labels carry with them the license for medical professionals to "treat" individuals so labeled as if they were sick, as well as "allowing" or "forcing" these individuals to assume the sick role with its rights and restrictions. When a member of society is defined as sick, the medical system, and society as a whole, absorbs the direct and indirect economic and social costs for this care. Mental health and illness pose as dramatic illustrations of the theoretical issues in