June 11, 2012 | Posted By David Lemberg, M.S., D.C.

Does a person have a disease or disorder? Or is the person unwell with an illness? Are the concepts of disease and illness distinct? If we have been lulled to sleep by 100 years of Cartesian diktats from the medical establishment, we may miss the point. But if our thinking is super-sharp, we may be able to detect a critical difference.

A prominent legacy of Cartesian dualism, the mind/body problem, causes a split between the “I” that I know myself to be and the physical body that the “I” inhabits. “I” am a passenger in my body. My body carries “me” around, but we are two separate entities. Thus, my body is something separate from “me” and things can happen to it, e.g., my body can become diseased.

The practice of modern medicine is based on this seemingly real separation. Medical practice, i.e., treatment, focuses on analyzing what’s gone wrong with the body and what can be done to the body to fix it. Outside agencies, primarily drugs and surgery, are brought to bear in attempts, not to heal the underlying problems per se, but rather to cover up the symptoms or remove the thing causing the symptoms. The question, “What has gone wrong with this human system?” is almost never posed. The person is typically not considered as a human whole (a whole human). Rather, the parts of the body are the primary area of investigation. The thyroid, the liver, the inflamed joints, the “unbalanced” neurotransmitters, the heart. These are the concerns, in concert with the diseases affecting these tissues, organs, and physiological systems. Hypertension, diabetes, cancer, depression, back pain. These are the conditions or diseases toward which most medical treatment is directed.

But these conditions are chronic. People don’t get better. Rather, the diseases are “managed”. Persons with hypertension are consigned to a lifetime of medication to maintain their blood pressure within a safe range. Persons with depression can look forward to years of medication therapy with various SSRIs and SNRIs. What is the category error in the medical analysis? How can the wrong step be identified, the cognitive mistake that chooses a path leading to less-than-effective outcomes?

First, it could be acknowledged that the appropriate primary venue for medical care as we currently know it is the acute setting. Traumatic injuries need to be evaluated and treated. A person with an MI needs resuscitation and management. Anaphylaxis may require intubation and medication. Similarly, chronic conditions may require acute care. Some cancers need to be removed. Persons with type I diabetes need insulin. Rheumatoid arthritis may require biologic therapeutics such as etanercept. Thus, treatment, as such, may frequently be necessary.

But if that’s all there is, much is being missed. Investigation of the illness vs. disease antinomy offers a profound opportunity for improved medical care of people as patients. Illness suggests a systems failure. As the human “system” is deeply complex, superficial approaches such as medications and surgery are not likely to be effective in the long-term. As Michel Foucault observes in The Birth of the Clinic: An Archeology of Medical Perception, beginning in the late 1700s the ancient question “What is the matter with you?” was being replaced with “Where does it hurt?”. Foucault suggests that this language, “the discourse about disease”, was associated with an abandonment of the patient from the perspective of communication. The person herself was no longer primary. In a Cartesian split, the focus had shifted permanently to the problems of the body. The concept of the whole person had been lost. We are still at the affect of this split.

The Alden March Bioethics Institute offers graduate online masters in bioethics programs. For more information on the AMBI master of bioethics online program, please visit the AMBI site.

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