Making Sense of Health, Illness & Disease

Illness as the Primary Concept in Health Care: Appreciating the rle of Human Agency Stephen Tyreman PhD, MA, DOThe Concepts of Health, Illness & Disease The first challenge is to come to a view on the relationships between health, illness and disease. A basic assumption within modern medicine is that health is the absence of disease (Scadding 1988) and illness is the patients personal experience of disease. On this analysis disease is the primary concept in medicine. Health will follow if disease is understood and controlled. This is based on the premise that both are primarily biological issues and, in the absence of abnormal or harmful biological effects, the normal physiological processes of the body tend to produce healthy function. A useful corollary is that disease, as a local abnormality, is more amenable to analysis and intervention than are health and illness its easier to remove disease than to enhance health.

The problem is that it is not clear that health, illness and disease are purely biological issues. Its not just the fact that biological approaches to chronic illness have not produced the anticipated benefits. It is now well accepted that psychosocial factors play a major part, notjust in the experience of illness, but also in the development of disease. (This idea was first proposed by Engel in his classic paper of 1977) Without major progress in overcoming the body/mind problem, this remains a key hurdle for the biological medical model. Until now the problem has been sidestepped by bolting on psychosocial elements as causal or risk factors to the more central biological explanations.

My thesis is that we have reached the point where it is necessary to undergo a major review of these issues and their fundamental assumptions and to explore alternative models of illness and health care. First we need to identify just where the problems lie.