Disease concept

Tree Disease Concepts. 2nd Ed. Manion, P.D. Prentice-Hall Englewood Cliffs, NJ, 1991. 

Jellinek, E. M. (1960). The disease concept of alcoholism. New Haven, CT College and University Press. 

The traditional explanation either leans on lack of norms and morals or rests the case on a disease concept. The former has ancient roots and is represented for instance by Plato "From the moment of their birth men have a desire for food and drink. Every living creature has an instinctive love of satisfying this desire whenever it occurs, and the craving to do so can fill a man s whole being, so that he remains quite unmoved by the plea that he should do anything except satisfy his lust for the pleasures of the body, so as to make himself immune to all discomfort." (Plato 1970,782). "Give a man correct education, and these instincts will lead him to virtue, but educate him badly and he ll end up at the other extreme," Plato states. Obviously lack of education is seen to be the core problem. Aristotle used the term akrasia, signifying the weakness of the will that makes man unable to resist temptations. 

While the approaches of morals and norms dominated in the past, the disease concept arose to prominence during this century. One of its most prominent advocates, E. M. Jeltinek (1960), emphasized that alcoholism is not caused by lack of moral knowledge or strength but by a bodily disease that deserves both medical attention and protection... 

Jellinek, E. M. 1960. The Disease Concept of Alcoholism. New Brunswick Hillhouse, 1960. 

Another source of influence on alcoholics is the treatment process itself, since a major goal of treatment, especially in the U.S., is to convince the alcoholic of the validity of the disease concept, and to remove the personal stigma associated with the negative stereotype of the alcoholic. (Babor et al. 1986,99,107 my italics). 

This marked the beginning of the final solution to the problem. For, having accepted the disease concept, doctors... 

Mizuno Y, Takubo H, Mizuta E, Kuno S. Malignant syndrome in Parkinson s disease concept and review of the literature. Parkinsonism Relat Disord 2003 9(Suppl l) S3-9. 

Figure 2. Illustration of the test/disease concept. these values [16].

Stephen E. Ross, also writing in t c Annals of Internal Medicine, explains Memes are infectious agents in psychosomatic illness. What is a meme It is a virulent idea... [that] can be found at the core of these diverse disorders... such disease conceptions, which 1 [Ross] term psychosomatic memes, act as transmissible templates.If we let doctors make up diagnoses and infectious agents out of whole cloth, why not let patients make up diseases out of symptoms ... 

The APA defines substance dependence (addiction) as a cluster of symptoms indicating that the individual continues use of the substance despite significant substance-related problems. Evidence of tolerance and withdrawal symptoms are included in the list of symptoms, but neither tolerance nor withdrawal is necessary or sufficient for a diagnosis of substance dependence. Dependence (addiction) requires three or more of the symptoms, whereas abuse can be diagnosed when only one or two symj)-toms are present. The chronic, relapsing nature of dependence (addiction) fulfills criteria for a chronic disease, but because of the voluntary component at initiation, the disease concept is controversial. 

The exact origins of Rush s disease concept of Negritude were these. About 1798, white spots began to appear on the body of a Negro slave named Henry Moss. In three years, he was almost entirely white. Moss had the symptoms of an hereditary disease we now know as vitiligo. This condition, characterized by progressive loss of skin pigmentation, occurs in both white and colored people. In the United States, approximately one person in a hundred suffers from it. 

For many decades, but especially since the days of Senator Joseph McCarthy, the insinuation of homosexuality about one s adversaries has become an accepted strategy in American political life. If homosexuality is an illness— like any other"—then why do psychiatrists not protest its use as a means of social degradation and political disqualification For a further discussion of the hypocrisy of the disease concept of homosexuality, see Chapter 13. 

The next excerpt illustrates Gide s penetrating insight into the disease concept of sexual inversion, and, mutatis mutandis, into mental illness generally. 

But these are not the only possible, or indeed actually existing, relationships between psychiatrists and patients, or priests and parishioners. Some of their relationships are, and were, wholly voluntary and mutually consensual. The discussion about the disease concept of homosexuality (and mental illness generally) narrows down to two questions, and our answers to them. First, should psychiatrists have the right to consider homosexuality a disease (however defined) I say Of course they should. If that concept helps them, they will be wealthier if it helps their patients, the patients will be happier. Second, should psychiatrists have the power, through alliance with the State, to impose their definition of homosexuality as a disease on unwilling clients I say Of course they should not. I have presented my reasons for this opinion elsewhere. ... 

Our position on the disease concept of homosexuality and its social control through medicine could be vastly clarified were we to apply to it our experience with the heresy concept of homosexuality and its social control through religion. Indeed, the parallels between these two sets of theoretical concepts and social sanctions need to be extended only to include one additional consideration— the legitimacy or illegitimacy of combining religious and medical ideas and practices with political power. 

The diagnostic process is an inferential exercise in observation, differentiation and classification. .. it allows a more rational basis for prognosis and treatment... Diseases are the outcomes of biological changes that can be understood as processes of nature. .. The disease concept in psychiatry is fundamentally no different from that in general medicine. ... 

However, in 1960, E. M. Jelhnek presented an argument that alcohohsm was a medical disease. Following Jelhnek s work, the American Psychiatric Association began to use the term disease to describe alcohohsm and the American Medical Association followed in 1966. As with many concepts and theoretical models in this field, the disease concept was originahy apphed to alcoholism and has been generalized to addiction to other drugs. 

In the disease concept of alcoholism/addiction, the condition is viewed as a primary disease. That is, it is not caused by another condition (e.g., depression or family problems). The disease is progressive, with predictable stages including a loss of control over drinking and/or drug use. In addition, the disease of alcoholism/addiction is chronic (continues for life), and it is incurable. In this conceptualization of the disease concept, the only justifiable goal is abstinence from alcohol and illicit drugs. 

The disease concept is associated with Alcoholics Anonymous and Narcotics Anonymous.Furthermore, the most widely emulated approach to treatment, the Minnesota Model developed by the Hazeldon Foundation, incorporates the disease concept of alcoholism/addiction in its treatment program. 

In the late 1980s, books were published that criticaed the disease concept of alcoholism, primarily due to the lack of evidence that ah alcohohcs/addicts lost control of their use of alcohol and other drugs in ah instances, some people classified as alcoholics/addicts returned to moderate levels of use, and the stages of the disease did not seem to follow a predictable sequence with many people. ... 

Alcoholics Anonymous does not take any official position on the disease concept or any other controversial issue. The disease concept is associated with Alcoholics Anonymous because many participants in this program subscribe to the disease concept. 

As a means of both secondary and tertiary prevention, a combination of one-to-one consultation (interview and advice), followed by a group seminar with practical training, a repetitive seminar and a workplace visit has proven to be effective. During the initial consultation, the individual health and disease concept, respectively, are assessed, and the degree of motivation for improvement of protective behavior is... 

Manion P D 1981 Tree disease concepts. Prentice-Hall Englewood Cliffs, 399 pp... 

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