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Health, Disease, Illness:

Conceptual Puzzles
Subhradev Sen1

P h.D(pursuing), M.Sc.(Statistics),
Lecturer in Biostatistics, Malabar Cancer Centre, Kerala, India
Abstract
The author emphasizes certain puzzles related to the conceptual expressions of health, disease and illness. The article also points out some
practical issues related to health in diseased or non-diseased phenomenon
advocating ethical and theoretical descriptions.

The Concept
The concept of health is one of the understandings which would help with both
theoretical problems in philosophy and practical problems in medicine. The theoretical problems are due to philosophers, at least if we count from Plato and
Aristotle [1], who have claimed that expressions such as good man behave in
most of the ways like the expression healthy man, which are pertinent while discussing morality in medical analogy. Later may be analogous to the former if we
do not have any theoretical difficulties in doing so. This advocates descriptive
nature of ethical theories as healthy is a descriptive concept so may be good.
The immediate reply those who reject descriptivism, is to ask whether healthy is
purely descriptive? Can it be thought as a formal alteration of healthy ?

Physical health practice problems


Even if we confine ourselves in physical health, there are severe practical issues
that may be termed as problems. If medicine is the art of healing, how nearer to
normality has the patient to be dragged before it can be claimed that the exercise
of the art was justified at least to some extent? Is health perhaps the absence
of disease or illness? But is illness the same thing as diseases, and health just
the absence of these, or it is something more positive in some opposite sense of
physical negativity? A patient can have a disease and yet may not rightly be called
as ill if the disease is controlled under certain practical regulations and doctrines,
say for example a patient with diabetes. Thus the whole notion of counting or

e-mail:subhradev.stat@gmail.com

classifying illness, as opposed to disease is a bit strange to hear. Here necessitates


a statement and I quote from myself One who is fit to live can be called healthy.
Arguments in any frame work (against and/or in favor) postulates appreciation,
if not impossible in the way of descriptive medical ethics and rationality [2].

Dostors Doctrines
Doctors trend, in fact, to evoke neither of these words, but the more non-interment
word condition. They do this because it is actually useful to be able to describe
the patients condition without committing oneself about its etiology, and by saying that he or she has a certain disease one may so relegate oneself. Moreover,
not all conditions are pathological, but all diseases are, at least by definition [3].
If a doctor claims that a patient has a certain condition, he does not presume
that it is a bad condition. Therefore, not all the conditions treated by doctor are
diseases. There are even bad conditions which are not diseases, such as injuries
and wounds. For example, a dog (possibly not carrying rabies) bitten person or
a person knocked by a motor vehicle who needs few stitches only. But if it is a
virus or a bacterium that has attacked me, I do have a disease.

Matter of size or invisibility?


Now the question is, why do the attack of viruses or bacteria are been counted
as diseases, but not the attacks of comparatively larger species like a dog or of
motor vehicles? It is simply a matter of size or of invisibility? If one has a tape
warm or a guinea warm (which are quite larger in size), does he have a disease?
Does it make any difference that the warm can be seen but its eggs cannot? Does
it make a difference that the warm, can eventually be seen, while active in some
sense inside the patient, whereas dogs and motor vehicles, whose attacks are
likewise not called diseases, are always outside the body? Does a disease have
to be something always in one? And if so, in what sense of in ? Scabies like
skin diseases are called diseases although the organism which cause them are on
the surface of skin and do not go in the body. Is the difference between these
organisms and fleas only one of size or of visibility?

Natural kind
Now we can actually see viruses and bacilli through modern electronic microscopes;
but the diseases they might cause came to be called diseases before we could do
this. On the other hand, we can always see dogs or a motor vehicle. So, we may
argue that the word disease is used for conditions whose cause was not visible
before the invention of microscopes. It should be noted that, in order to identify
a condition as disease we do not have to know what its cause is (for example,
think of the disease cancer). For very such reasons, the names of diseases are
what logicians call natural kind terms [4]. Fortunately, or otherwise I would
not comment, the puzzles about why dog bites are not diseases does not affect

very much, because they can certainly claim the attention and care of doctors,
irrespective of whether termed as disease or not.

A crucial puzzle
However, the puzzle that I am now coming to is decisive to our understanding of
the role of the art of healing. Before we classify something as a disease, does it
have to be something bad ? Is it possible that there could be a wholly beneficial
disease? Or there could be disease which is neither beneficial nor harmful? Seems
not, but we have to be very careful saying so. If a soldier is prevented by a mild
attack of viral fever from being sent back to the battle in which he is more likely
to be killed, it was in his interest to have the disease.

References
[1] Aristotle. Nicomachean Ethics (translated and edited by Crisp, R.). Cambridge
University Press, 2000.
[2] Williams B. Ethics and the limits of Philosophy. Fontana, London, 1985.
[3] Daniels N. Just Health Care. Cambridge University Press, 1985.
[4] Hare R.M. Essays in Ethical Theory. Oxford University Press, 1989a.

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