History Of The Concepts

Health and disease are among the fundamental experiences of human life. The concepts that people in various cultures have used in an attempt to understand and respond to those experiences have to do with the way humans relate to nature and culture. The concepts of health and disease have far-reaching consequences for diagnosis and therapy, the attitude and behavior of physicians, how patients deal with disease, social attitudes and structures, the shape of moral choices, and the cultural significance of sickness and wellness behaviors.

Health and disease are not merely medical terms; they are also vital themes in art, philosophy, theology, sociology, and psychology. In fact, these very disciplines remind medicine again and again of its distinctly anthropological character, in the sense that medicine deals with the nature and destiny of humans. Neither medicine nor the concepts of health and disease with which it deals can be properly understood by using the starkly contrasting categories of natural sciences and human sciences as a framework. Just as medicine cannot be reduced to either of the two, so it is also necessary to connect nature and culture in order to understand health and disease.

A universally valid definition of health has been as hard to formulate as a universally valid definition of disease.

Health and disease are physical, social, psychological, and spiritual phenomena that can be represented in concepts that are both descriptive and normative (the latter meaning based on norms), although these two sorts of concepts have not always been clearly distinguished in the historical development of these ideas. Humans not only determine what will be regarded as health and disease; at the same time they also interpret these experiences and decide how to respond to them.

Concepts of disease and health are especially important because they influence the manner and goal of medical treatment. Thus a mechanical or technologically structured understanding of disease (which views the human as a defective machine) requires a mechanical or technologically structured therapy (regarded as repair) and therapeutic relationship (a relationship of technician to defective machine). More personal or holistic concepts urge corresponding types of therapy and healer-patient relationships.

Contemporary medicine increasingly faces the task not only of overcoming sickness but also of preserving health. Prevention and rehabilitation play increasingly important roles alongside curative therapies. Treatment is understood to include attentive caring and support. Chronic suffering and death place different demands on the doctor-patient relationship than do acute illnesses. In light of such developments, concepts of health and disease require new definitions. A historical retrospective may assist in arriving at those definitions.

This entry does not attempt to offer a thorough cross-cultural analysis of concepts of health and disease; rather, it presents essential dimensions and changes in these concepts in the general course of history, their relationships with sociocultural backgrounds, and their practical and ethical consequences (Diepgen, Gruber, and Schadewaldt; Riese; Rothschuh; Schipperges, Seidler, and Unschuld; Temkin). A consideration of these historical developments can stimulate new reflections and initiatives, but history differs from any theoretical system. History has its own rules and logic. A progressionist explanation of the gradual development of notions of health and disease is inadequate. There are continuities and discontinuities, progress and regress, even within a single event or movement. This complex nature of history in general characterizes the history of medicine and specifically the history of the concepts of health and disease.

Health and disease suggest a variety of meanings from psychological, social, and spiritual perspectives. The word illness in the English language refers to the subjective or personal side of disease, whereas disease refers to the medical conception of pathological abnormality. It is possible for a person to feel ill without having a disease, and conversely, to have a disease without feeling ill. The term sickness transcends both of these concepts by focusing on social consequences. The concept of the sick role corresponds to the social nature of disease. The way in which societies vary in their interpretations of physical and mental disorders and in their treatment of and symbolic reactions to them reflects the cultural dimension of disease.

Nonetheless, some basic categories will be useful in the following discussion. One category is the explanation of disease, illness, and sickness. From a physical perspective, the different approaches of the past attribute disease to either liquid or solid components of the body or to the relationship between the body and the soul. Other distinctions refer to whether diseases should be regarded as existing entities (the ontological notion of disease) or as phenomena affecting individual persons in a variety of ways (the symptomatic notion of disease); and whether and to what extent the constitution and disposition of the individual (endogenous factors) and/or external (exogenous) factors play a significant role in determining health and disease.

A second category concerns response to disease, illness, and sickness. These responses have frequently been shaped by the explanation of disease, illness, and sickness. These two categories evolved into the science and clinical practice of medicine.

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