The Three Aspects of Malady - PDF document

The Three Aspects of Malady e English language has the luxury of having four dierent words that describe decient health states: disease , illness , sick - ness and malady . Malady is a term that is not used very oen and it does not have a specic denota - tion: the other three terms do. It is customary to use the word dis - ease in a medical sense, referring to the medical denition of a con - dition that negatively aects the functioning of an individual. e medical denition will include references to laboratory ndings and to the (diminished) perfor - mance of dierent body systems. Usually, the denition of a disease will include notions about caus - ative and risk factors, ideas about the way in which the pathologi - cal processes develop, statements about the prognosis, and reac - tions to dierent treatments. e word illness is used to de - scribe what persons feel about themselves. ey describe their feelings in various ways, some - times referring to a particular or - gan (in France, the liver is oen seen as being at the bottom of things, the reason for feeling ill; the Slavs use the same word for life and the stomach and com - plain about its malfunction, Irani - ans and others refer to their heart, and so on). Sometimes, when feel - ing ill, patients are uncertain what words to use to describe their state and will choose words that they feel attract the attention of their doctor or their family. us, when seeking help from doctors ,they will refer to pain in organs and when speaking to their family they will talk about functioning, complain of being tired, unable to do things, and so forth. Sickness is a word describing yet another aspect of not being in good health. It refers to the soci - etal recognition of the state of ill - ness. Societies recognize certain states of dysfunction and disease as being suciently important to be given sickness benets that in - clude the permission to be absent from work, reimbursement for expenses incurred in the process of treatment and possibly other support. Unfortunately, the three terms do not cover the same ter - ritory. ey overlap to an ex - tent that will vary from country to country and from one social group to another. Some people who have a disease do not feel ill. Some of those who feel ill or even very ill do not seem to have any physical reason for it, no tissue damage, no dysfunction in the Paths of Medicine Paths of Medicine by Norman Sartorius � Croat Med J. 2006;47:350-1 350 www.cmj.hr main body systems. Sometimes sickness will cover people who are neither diseased nor feel ill: such was the case with the psy - chiatric treatment of dissidents. In some instances people have a disease that is not being rec - ognized by society as being suf - ciently important to receive sickness benets. A number of questions arise from this conundrum. Should people who say that they are feeling ill without having any demonstrable tissue damage be considered as malingerers? Should we try to discover an un - treatable disease in people who do not feel ill? What should be done to assess needs for care – count the numbers of peo - ple who feel ill (and will come forward to seek help), or count those who have a medically diag - nosable disease reg

ardless of how they feel? Or dene needs on the basis of epidemiological studies that dene a case in accordance with the ocial denition of sickness? And how should we evaluate the success of a health service – by establishing wheth - er the population is satised (be - cause those who feel ill have re - ceived help)? Or should we be considering that a service is suc - cessful if all the people who have a disease have been reached re - gardless of whether they need or want any help from the health service system? ere are conditions that would be considered a sickness by society, a disease by the medi - cal profession and an illness by those who suer from them. eir number, however, is not all that large as one would think and for conditions that do not fall into this group the questions listed above (and many others) will arise. ere is no strict rule that could be followed to answer them nor is it possible to reject any of the three denitions. It is therefore necessary that phy - sicians and public health deci - sion makers remain aware of the three aspects (and territories) of maladies with which they are dealing even if that complicates their life and their actions. Such is the world in which we live. 351 Paths of Medicine main body systems. Sometimes sickness will cover people who are neither diseased nor feel ill: such was the case with the psy - chiatric treatment of dissidents. In some instances people have a disease that is not being rec - ognized by society as being suf - ciently important to receive sickness benets. A number of questions arise from this conundrum. Should people who say that they are feeling ill without having any demonstrable tissue damage be considered as malingerers? Should we try to discover an un - treatable disease in people who do not feel ill? What should be done to assess needs for care – count the numbers of peo - ple who feel ill (and will come forward to seek help), or count those who have a medically diag - nosable disease regardless of how they feel? Or dene needs on the basis of epidemiological studies that dene a case in accordance with the ocial denition of sickness? And how should we evaluate the success of a health service – by establishing wheth - er the population is satised (be - cause those who feel ill have re - ceived help)? Or should we be considering that a service is suc - cessful if all the people who have a disease have been reached re - gardless of whether they need or want any help from the health service system? ere are conditions that would be considered a sickness by society, a disease by the medi - cal profession and an illness by those who suer from them. eir number, however, is not all that large as one would think and for conditions that do not fall into this group the questions listed above (and many others) will arise. ere is no strict rule that could be followed to answer them nor is it possible to reject any of the three denitions. It is therefore necessary that phy - sicians and public health deci - sion makers remain aware of the three aspects (and territories) of maladies with which they are dealing even if that complicates their life and their actions. Such is the world in which we live. 351 Paths of Medicine