Making Sense of Health, Illness & Disease

Illness as the Primary Concept in Health Care: Appreciating the rle of

Human Agency
Stephen Tyreman PhD, MA, DO
The 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.