Physical Mental and Social Diseases

It has been argued that only somatic diseases are legitimately diseases, while mental diseases are problems with living (Szasz). Following similar lines of argument, individuals have contended that enterprises such as psychotherapy are tantamount to applied ethics (Breggin), or that the cure of somatic disease constitutes the prime goal of medicine (Kass).

In response, some argue that such stark dichotomies or dualisms fail to offer satisfactory accounts of reality. If mental life is dependent on brain function, then all mental diseases can, in some sense, be tied to physical pathology or abnormal anatomy. For example, depression can be presumed to be dependent on a neurophysiological substrate, and thus, in principle, is open to pharmacological treatment. If one views diseases as explanatory models for the organization of signs and symptoms, then it does not matter whether the signs and symptoms identify physiological states ("I have a rash") or psychological states ("I feel depressed"). Nor does it matter whether models employed to correlate these phenomena are pathophysiological or psychological. Most accounts of disease will, in fact, mingle physical and psychological symptoms. As a consequence, one may come to view distinctions among somatic, psychological, and social models of disease in terms of pragmatic needs—of accenting the usefulness of particular modes of therapeutic intervention. One may even advance sociological models of disease, construing diseases primarily in terms of social variables and giving secondary place to the pathophysiological.

Distinctions between medical and nonmedical models of therapy, unlike somatic, psychological, and sociological accounts of disease, are often meant to contrast the autonomy of clients in nonmedical therapeutic models with the dependence of patients on healthcare practitioners in medical models. Talcott Parsons characterized the "sick role" as: (1) excusing ill individuals from some or all of their usual responsibilities; (2) holding them not responsible for being ill (though they may be responsible for becoming sick); (3) holding that they should attempt to become well (a therapeutic imperative) and seek out experts to treat their illness. Medical models tend to support paternalistic interventions by healthcare practitioners and to relieve patients of responsibility for directing their own care. Nonmedical models, in contrast, tend to accent the patient's responsibility.

Somatic models of disease may be employed within both medical and nonmedical models of therapy. For example, hypertension may be treated with antihypertensive agents or by enjoining the afflicted individuals to find ways to change their lifestyles with regard to stress, eating patterns, and so on. The same is true of psychological models of disease. Depression can be treated chemotherapeutically or by enjoining individuals to make changes in their ways of living.

As predisposing factors toward particular diseases become better known and easier to control or avoid, individuals are held increasingly responsible for becoming ill, even though they will remain nonresponsible for being ill. A person is not held to be responsible for having bronchogenic carcinoma in the same way that one is responsible for being a willful malingerer. In other words, one cannot be told to stop having cancer, but one can be held responsible for having developed cancer through one's smoking habits. As the impact of lifestyle on the development of diseases becomes clearer, the responsibility of individuals for their health may increase the possible scope of nonmedical models of therapy.

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