医学人类学 2 - Illness vs Disease 疾病与病痛

History of medical anthropology

Medical systems were an implicit theme in anthropological studies in the first half of 20th Century.

1960s-70s definition of the field

Anthropologists turn to the study of biomedicine

Growth of applied anthropology

“The Meaning of Symptoms and Disorders” - by Keinman

- Illness (something that the person has)

- Includes how patients subjectively perceive, live with, and respond to symptoms

- The culturally shaped innately “human” experience of affliction

Illness problems

- make people live uncomfortably

- Illness problems are difficulties created directly or indirectly as a result of the conditions produced by illness, whether the loss of a job, a partner, or independence.

- Disease (something that the organ has)

- What practitioners have been trained to see

- Includes professional and technical biomedical understanding of affliction

Patient tells doctor the illness problem - the doctor translates that into a disease problem

Sickness (something that the population has)

- The understanding of a disorder in its generic sense in relation to macro-social forces.

- How illness has meaning

Symptom as meaning (how we understand the symptom, eg use of metaphor; how do think about the body)

Illness category as meaning - (cancer, AIDS, etc.) particular stigma around; social location, cultural orientation

Question:

According to Arthur Kleinman, what are the difference between “illness” and “disease?” Illustrate with an example.

According to Arthur Kleinman, illness is different from the disease. Illness includes how the patient feels about the discomfort, how the patient subjectively perceives, how the discomfort affects the patient’s life, family, social network, and how the patient responds to the discomfort. Illness may directly or indirectly cause illness problems such as losing the job or partner. These problems will always make the patient uncomfortable to live, but these problems are not primarily biological issues.

Patients who feel the illness may bring illness problems to practitioners, who will then translate and turn it into the disease problem. Disease describes how practitioners are trained to diagnose and treat the alternation in the biological body regarding the “normal state.” The disease involves biomedical and technical models that describe the physiological mechanism of a typical human body narrowly.

That said, illness is more subjective that describes what happens on the person, whereas disease always has a standard and is more objective that describes what happens on specific body parts.

For example, if a man’s penis is unable to become hard during sexual intercourse, this will result in the discomfort in his sexual life and may lead to divorce because his wife is not satisfied. Because of this significant change in his family, this man may perform poorly during work and lose his job. So he becomes low self-esteem and loses his partner and job. These are all about the man’s feelings and changes in his life, which describes the illness. When he sees a doctor, the doctor will define his problem as Erectile Dysfunction, which may be caused by a limited amount of blood flowing to the penis. This biological problem described by the doctor has a diagnosis standard, which is the disease.