Concepts of Disease: Logical Features and Social Implications

CONCEPTS OF DISEASE: LOGICAL FEATURES AND SOCIAL IMPLICATIONS HORACIO FABREGA, JR., M.D.* Introduction It is a truism that conceptualizations about disease have important social implications. Medicine, an institution of society, is defined in terms of its concern with disease. The very definition of disease, as we shall see, is a product of historically determined social happenings. Medical activities, thus, are rooted in socially structured categories. In addition, since definitions of disease seem to entail the phenomena of human suffering, consequences of medical activities bear directly or indirectly on the lives of members of society. So central and basic is a concern with disease in the minds of persons tied to medicine that, quite often, the meanings and logical properties of the term "disease" are taken for granted or left unexamined. Developments in contemporary society have brought into focus the organization and delivery of health services and challenged traditional medical orientations and goals. Problems involving the distribution and quality of medical care have been emphasized. Many of the issues that have been raised can be seen as reflections and even outcomes of the meanings of key medical terms, especially that of "disease." It will prove instructive to examine these issues by relating them analytically to concepts of disease. In order to accomplish this in a clear manner it will be necessary to review different approaches to the study of disease in society [1-8]. The essay, in summary, represents an attempt to provide a logical analysis of concepts of disease with the aim of clarifying their meanings and social implications. It is hoped that this analysis will clarify problematic aspects of medical care and education . * Department of Psychiatry, Michigan State University, East Lansing, Michigan 48823. I wish to thank Herbert E. Hendry and Peter K. Manning for unselfishly making themselves available to me during my efforts to formulate the material in this essay. I, however, naturally assume responsibility for it. Perspectives in Biology and Medicine · Summer 1972 | 583 I. Disease as a Biological Discontinuity In a biologistic perspective the term "disease" designates a medical concept whose meaning or intension involves an abnormality in function and/or structure of any part, process, or system of the body.1 The range of application of the term or the class of things to which it applies—its extension—would include such things as appendicitis, elevated blood pressure, enlarged heart, or diabetes. In any particular instance of its use, the term might refer to one of these items. Part of the difficulty of discussing the meanings of disease stems from the fact that the term itself can function semantically and syntactically in a number of different ways. The term "disease" can be used as follows: 1.As an abstract general term, purporting to refer to each or any of the members of the class of "diseases" that includes hypertension, diabetes, etc. For example: (a) "Diseases found in this community tend to be more serious." (b) "Diseases due to bacteria have always plagued mankind." In each instance the term "diseases" functions as a general abstract term. However, the meaning context provided by each sentence differs, serving to narrow the focus of the term: (a) a subgroup of diseases that are serious, and (b) any and all diseases caused by bacteria. 2.With a singularizing modifier the term can purport to refer to exactly one thing. For example: "That disease has an abrupt onset"; or "the disease that he has." In these instances, the term together with the singularizing modifier function as an abstract singular term. A different and independent manner of classifying the term follows : 1. As a denotative term, purporting to refer to things. For example : "The disease" had an abrupt onset. Here the abstract general 1 The delimitation of the body as the significant locus of events of illness, events having direct experiential consequences, was an obvious necessary prerequisite for developments that were in time to culminate in the specification of the biological substrates of disease. At least three aspects of medical experience probably contributed directly to the view of disease or illness as a manifestation of bodily processes having periodicity and precise identity. The first was the general ubiquity of crises we...