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= Disease =
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Introduction
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A disease is a particular abnormal condition that negatively affects
the structure or function of all or part of an organism, and that is
not due to any immediate external injury. Diseases are often known to
be medical conditions that are associated with specific symptoms and
signs. A disease may be caused by external factors such as pathogens
or by internal dysfunctions. For example, internal dysfunctions of
the immune system can produce a variety of different diseases,
including various forms of immunodeficiency, hypersensitivity,
allergies and autoimmune disorders.
In humans, 'disease' is often used more broadly to refer to any
condition that causes pain, dysfunction, distress, social problems, or
death to the person afflicted, or similar problems for those in
contact with the person. In this broader sense, it sometimes includes
injuries, disabilities, disorders, syndromes, infections, isolated
symptoms, deviant behaviors, and atypical variations of structure and
function, while in other contexts and for other purposes these may be
considered distinguishable categories. Diseases can affect people not
only physically, but also mentally, as contracting and living with a
disease can alter the affected person's perspective on life.
Death due to disease is called death by natural causes. There are four
main types of disease: infectious diseases, deficiency diseases,
hereditary diseases (including both genetic diseases and non-genetic
hereditary diseases), and physiological diseases. Diseases can also be
classified in other ways, such as communicable versus non-communicable
diseases. The deadliest diseases in humans are coronary artery disease
(blood flow obstruction), followed by cerebrovascular disease and
lower respiratory infections. In developed countries, the diseases
that cause the most sickness overall are neuropsychiatric conditions,
such as depression and anxiety.
The study of disease is called 'pathology', which includes the study
of 'etiology', or cause.
Concepts
==========
In many cases, terms such as 'disease', 'disorder', 'morbidity',
'sickness' and 'illness' are used interchangeably; however, there are
situations when specific terms are considered preferable.
;Disease
:The term 'disease' broadly refers to any condition that impairs the
normal functioning of the body. For this reason, diseases are
associated with dysfunctioning of the body's normal homeostatic
processes. Commonly, the term is used to refer specifically to
infectious diseases, which are clinically evident diseases that result
from the presence of pathogenic microbial agents, including viruses,
bacteria, fungi, protozoa, multicellular organisms, and aberrant
proteins known as prions. An infection or colonization that does not
and will not produce clinically evident impairment of normal
functioning, such as the presence of the normal bacteria and yeasts in
the gut, or of a passenger virus, is not considered a disease. By
contrast, an infection that is asymptomatic during its incubation
period, but expected to produce symptoms later, is usually considered
a disease. Non-infectious diseases are all other diseases, including
most forms of cancer, heart disease, and genetic disease.
;Acquired disease
:An acquired disease is one that began at some point during one's
lifetime, as opposed to disease that was already present at birth,
which is congenital disease. 'Acquired' sounds like it could mean
"caught via contagion", but it simply means acquired sometime after
birth. It also sounds like it could imply secondary disease, but
acquired disease can be primary disease.
;Acute disease
:An acute disease is one of a short-term nature (acute); the term
sometimes also connotes a fulminant nature
;Chronic condition or chronic disease
:A chronic disease is one that persists over time, often characterized
as at least six months but may also include illnesses that are
expected to last for the entirety of one's natural life.
;Congenital disorder or congenital disease
: A congenital disorder is one that is present at birth. It is often a
genetic disease or disorder and can be inherited. It can also be the
result of a vertically transmitted infection from the mother, such as
HIV/AIDS.
;Genetic disease
:A genetic disorder or disease is caused by one or more genetic
mutations. It is often inherited, but some mutations are random and de
novo.
;Hereditary or inherited disease
:A hereditary disease is a type of genetic disease caused by genetic
mutations that are hereditary (and can run in families)
;Iatrogenic disease
:An iatrogenic disease or condition is one that is caused by medical
intervention, whether as a side effect of a treatment or as an
inadvertent outcome.
;Idiopathic disease
:An idiopathic disease has an unknown cause or source. As medical
science has advanced, many diseases with entirely unknown causes have
had some aspects of their sources explained and therefore shed their
idiopathic status. For example, when germs were discovered, it became
known that they were a cause of infection, but particular germs and
diseases had not been linked. In another example, it is known that
autoimmunity is the cause of some forms of diabetes mellitus type 1,
even though the particular molecular pathways by which it works are
not yet understood. It is also common to know certain factors are
associated with certain diseases; however, association and causality
are two very different phenomena, as a third cause might be producing
the disease, as well as an associated phenomenon.
;Incurable disease
:A disease that cannot be cured. Incurable diseases are not
necessarily terminal diseases, and sometimes a disease's symptoms can
be treated sufficiently for the disease to have little or no impact on
quality of life.
;Primary disease
:A primary disease is a disease that is due to a root cause of
illness, as opposed to secondary disease, which is a sequela, or
complication that is caused by the primary disease. For example, a
common cold is a primary disease, where rhinitis is a possible
secondary disease, or sequela. A doctor must determine what primary
disease, a cold or bacterial infection, is causing a patient's
secondary rhinitis when deciding whether or not to prescribe
antibiotics.
;Secondary disease
:A secondary disease is a disease that is a sequela or complication of
a prior, causal disease, which is referred to as the primary disease
or simply the underlying cause (root cause). For example, a bacterial
infection can be primary, wherein a healthy person is exposed to a
bacteria and becomes infected, or it can be secondary to a primary
cause, that predisposes the body to infection. For example, a primary
viral infection that weakens the immune system could lead to a
secondary bacterial infection. Similarly, a primary burn that creates
an open wound could provide an entry point for bacteria, and lead to a
secondary bacterial infection.
;Terminal disease
:A terminal disease is one that is expected to have the inevitable
result of death. Previously, AIDS was a terminal disease; it is now
incurable, but can be managed indefinitely using medications.
;Illness
:The terms 'illness' and 'sickness' are both generally used as
synonyms for 'disease'; however, the term 'illness' is occasionally
used to refer specifically to the patient's personal experience of his
or her disease. In this model, it is possible for a person to have a
disease without being ill (to have an objectively definable, but
asymptomatic, medical condition, such as a subclinical infection, or
to have a clinically apparent physical impairment but not feel sick or
distressed by it), and to be 'ill' without being 'diseased' (such as
when a person perceives a normal experience as a medical condition, or
medicalizes a non-disease situation in his or her life - for example,
a person who feels unwell as a result of embarrassment, and who
interprets those feelings as sickness rather than normal emotions).
Symptoms of illness are often not directly the result of infection,
but a collection of evolved responses - sickness behavior by the body
- that helps clear infection and promote recovery. Such aspects of
illness can include lethargy, depression, loss of appetite,
sleepiness, hyperalgesia, and inability to concentrate.
;
:A disorder is a functional abnormality or disturbance. Medical
disorders can be categorized into mental disorders, physical
disorders, genetic disorders, emotional and behavioral disorders, and
functional disorders. The term 'disorder' is often considered more
value-neutral and less stigmatizing than the terms 'disease' or
'illness', and therefore is preferred terminology in some
circumstances. In mental health, the term 'mental disorder' is used as
a way of acknowledging the complex interaction of biological, social,
and psychological factors in psychiatric conditions; however, the term
'disorder' is also used in many other areas of medicine, primarily to
identify physical disorders that are not caused by infectious
organisms, such as metabolic disorders.
;Medical condition
:A medical condition is a broad term that includes all diseases,
lesions, disorders, or nonpathologic condition that normally receives
medical treatment, such as pregnancy or childbirth. While the term
'medical condition' generally includes mental illnesses, in some
contexts the term is used specifically to denote any illness, injury,
or disease except for mental illnesses. The Diagnostic and Statistical
Manual of Mental Disorders (DSM), the widely used psychiatric manual
that defines all mental disorders, uses the term 'general medical
condition' to refer to all diseases, illnesses, and injuries except
for mental disorders. This usage is also commonly seen in the
psychiatric literature. Some health insurance policies also define a
'medical condition' as any illness, injury, or disease except for
psychiatric illnesses.
:As it is more value-neutral than terms like 'disease', the term '
medical condition' is sometimes preferred by people with health issues
that they do not consider deleterious. On the other hand, by
emphasizing the medical nature of the condition, this term is
sometimes rejected, such as by proponents of the autism rights
movement.
:The term 'medical condition' is also a synonym for 'medical state',
in which case it describes an individual patient's current state from
a medical standpoint. This usage appears in statements that describe
a patient as being 'in critical condition', for example.
;
:Morbidity () is a diseased state, disability, or poor health due to
any cause. The term may refer to the existence of any form of disease,
or to the degree that the health condition affects the patient. Among
severely ill patients, the level of morbidity is often measured by ICU
scoring systems. Comorbidity is the simultaneous presence of two or
more medical conditions, such as schizophrenia and substance abuse.
:In epidemiology and actuarial science, the term "morbidity rate" can
refer to either the incidence rate, or the prevalence of a disease or
medical condition. This measure of sickness is contrasted with the
mortality rate of a condition, which is the proportion of people dying
during a given time interval. Morbidity rates are used in actuarial
professions, such as health insurance, life insurance, and long-term
care insurance, to determine the correct premiums to charge to
customers. Morbidity rates help insurers predict the likelihood that
an insured will contract or develop any number of specified diseases.
; Pathosis or pathology
:'Pathosis' (plural 'pathoses') is synonymous with 'disease'. The word
'pathology' also has this sense, in which it is commonly used by
physicians in the medical literature, although some editors prefer to
reserve 'pathology' to its other senses. Sometimes a slight
connotative shade causes preference for 'pathology' or 'pathosis'
implying "some [as yet poorly analyzed] pathophysiologic process"
rather than 'disease' implying "a specific disease entity as defined
by diagnostic criteria being already met". This is hard to quantify
denotatively, but it explains why cognitive synonymy is not
invariable.
;Syndrome
:A syndrome is the association of several medical signs, symptoms, or
other characteristics that often occur together, regardless of whether
the cause is known. Some syndromes such as Down syndrome are known to
have only one cause (an extra chromosome at birth). Others such as
Parkinsonian syndrome are known to have multiple possible causes.
Acute coronary syndrome, for example, is not a single disease itself
but is rather the manifestation of any of several diseases including
myocardial infarction secondary to coronary artery disease. In yet
other syndromes, however, the cause is unknown. A familiar syndrome
name often remains in use even after an underlying cause has been
found or when there are a number of different possible primary causes.
Examples of the first-mentioned type are that Turner syndrome and
DiGeorge syndrome are still often called by the "syndrome" name
despite that they can also be viewed as disease entities and not
solely as sets of signs and symptoms.
;Predisease
:Predisease is a subclinical or prodromal vanguard of a disease.
Prediabetes and prehypertension are common examples. The nosology or
epistemology of predisease is contentious, though, because there is
seldom a bright line differentiating a legitimate concern for
subclinical/prodromal/premonitory status (on one hand) and conflict of
interest-driven disease mongering or medicalization (on the other
hand). Identifying legitimate predisease can result in useful
preventive measures, such as motivating the person to get a healthy
amount of physical exercise, but labeling a healthy person with an
unfounded notion of predisease can result in overtreatment, such as
taking drugs that only help people with severe disease or paying for
drug prescription instances whose benefit-cost ratio is minuscule
(placing it in the waste category of CMS' "waste, fraud, and abuse"
classification). Three requirements for the legitimacy of calling a
condition a predisease are:
:* a truly high risk for progression to disease - for example, a
pre-cancer will almost certainly turn into cancer over time
:* actionability for risk reduction - for example, removal of the
precancerous tissue prevents it from turning into a potentially deadly
cancer
:* benefit that outweighs the harm of any interventions taken -
removing the precancerous tissue prevents cancer, and thus prevents a
potential death from cancer.
Types by body system
======================
;Mental
:Mental illness is a broad, generic label for a category of illnesses
that may include affective or emotional instability, behavioral
dysregulation, cognitive dysfunction or impairment. Specific
illnesses known as mental illnesses include major depression,
generalized anxiety disorders, schizophrenia, and attention deficit
hyperactivity disorder, to name a few. Mental illness can be of
biological (e.g., anatomical, chemical, or genetic) or psychological
(e.g., trauma or conflict) origin. It can impair the affected person's
ability to work or study and can harm interpersonal relationships.
The term insanity is used technically as a legal term.
;Organic
:An organic disease is one caused by a physical or physiological
change to some tissue or organ of the body. The term sometimes
excludes infections. It is commonly used in contrast with mental
disorders. It includes emotional and behavioral disorders if they are
due to changes to the physical structures or functioning of the body,
such as after a stroke or a traumatic brain injury, but not if they
are due to psychosocial issues.
Stages
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In an infectious disease, the incubation period is the time between
infection and the appearance of symptoms. The latency period is the
time between infection and the ability of the disease to spread to
another person, which may precede, follow, or be simultaneous with the
appearance of symptoms. Some viruses also exhibit a dormant phase,
called viral latency, in which the virus hides in the body in an
inactive state. For example, varicella zoster virus causes chickenpox
in the acute phase; after recovery from chickenpox, the virus may
remain dormant in nerve cells for many years, and later cause herpes
zoster (shingles).
;Acute disease
:An acute disease is a short-lived disease, like the common cold.
;Chronic disease
:A chronic disease is one that lasts for a long time, usually at least
six months. During that time, it may be constantly present, or it may
go into remission and periodically relapse. A chronic disease may be
stable (does not get any worse) or it may be progressive (gets worse
over time). Some chronic diseases can be permanently cured. Most
chronic diseases can be beneficially treated, even if they cannot be
permanently cured.
;Clinical disease
:One that has clinical consequences; in other words, the stage of the
disease that produces the characteristic signs and symptoms of that
disease. AIDS is the clinical disease stage of HIV infection.
;Cure
:A cure is the end of a medical condition or a treatment that is very
likely to end it, while remission refers to the disappearance,
possibly temporarily, of symptoms. Complete remission is the best
possible outcome for incurable diseases.
;Flare-up
:A flare-up can refer to either the recurrence of symptoms or an onset
of more severe symptoms.
;Progressive disease
:Progressive disease is a disease whose typical natural course is the
worsening of the disease until death, serious debility, or organ
failure occurs. Slowly progressive diseases are also chronic
diseases; many are also degenerative diseases. The opposite of
progressive disease is 'stable disease' or 'static disease': a
medical condition that exists, but does not get better or worse.
;
:A refractory disease is a disease that resists treatment, especially
an individual case that resists treatment more than is normal for the
specific disease in question.
;Subclinical disease
:Also called silent disease, silent stage, or asymptomatic disease.
This is a stage in some diseases before the symptoms are first noted.
;Terminal phase
:If a person will die soon from a disease, regardless of whether that
disease typically causes death, then the stage between the earlier
disease process and active dying is the terminal phase.
Extent
========
;Localized disease
:A localized disease is one that affects only one part of the body,
such as athlete's foot or an eye infection.
;Disseminated disease
:A disseminated disease has spread to other parts; with cancer, this
is usually called metastatic disease.
;Systemic disease
:A systemic disease is a disease that affects the entire body, such as
influenza or high blood pressure.
Classification
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Diseases may be classified by cause, pathogenesis (mechanism by which
the disease is caused), or by symptom(s). Alternatively, diseases may
be classified according to the organ system involved, though this is
often complicated since many diseases affect more than one organ.
A chief difficulty in nosology is that diseases often cannot be
defined and classified clearly, especially when cause or pathogenesis
are unknown. Thus diagnostic terms often only reflect a symptom or
set of symptoms (syndrome).
Classical classification of human disease derives from the
observational correlation between pathological analysis and clinical
syndromes. Today it is preferred to classify them by their cause if it
is known.Loscalzo J1, Kohane I, Barabasi AL. Human disease
classification in the postgenomic era: a complex systems approach to
human pathobiology.
Mol Syst Biol. 2007;3:124. Epub 2007 Jul 10.
The most known and used classification of diseases is the World Health
Organization's ICD. This is periodically updated. Currently, the last
publication is the ICD-10.
Causes
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Only some diseases such as influenza are contagious and commonly
believed infectious. The microorganisms that cause these diseases are
known as pathogens and include varieties of bacteria, viruses,
protozoa, and fungi. Infectious diseases can be transmitted, e.g. by
hand-to-mouth contact with infectious material on surfaces, by bites
of insects or other carriers of the disease, and from contaminated
water or food (often via fecal contamination), etc. Also, there are
sexually transmitted diseases. In some cases, microorganisms that are
not readily spread from person to person play a role, while other
diseases can be prevented or ameliorated with appropriate nutrition or
other lifestyle changes.
Some diseases, such as most (but not all) forms of cancer, heart
disease, and mental disorders, are non-infectious diseases. Many
non-infectious diseases have a partly or completely genetic basis (see
genetic disorder) and may thus be transmitted from one generation to
another.
Social determinants of health are the social conditions in which
people live that determine their health. Illnesses are generally
related to social, economic, political, and environmental
circumstances. Social determinants of health have been recognized by
several health organizations such as the Public Health Agency of
Canada and the World Health Organization to greatly influence
collective and personal well-being. The World Health Organization's
Social Determinants Council also recognizes Social determinants of
health in poverty.
When the cause of a disease is poorly understood, societies tend to
mythologize the disease or use it as a metaphor or symbol of whatever
that culture considers evil. For example, until the bacterial cause
of tuberculosis was discovered in 1882, experts variously ascribed the
disease to heredity, a sedentary lifestyle, depressed mood, and
overindulgence in sex, rich food, or alcohol, all of which were social
ills at the time.
When a disease is caused by a pathogen (e.g., when the disease malaria
is caused by infection by 'Plasmodium' parasites.), the term 'disease'
may be misleadingly used even in the scientific literature in place of
its causal agent, the pathogen. This language habit can cause
confusion in the communication of the cause and effect principle in
epidemiology, and as such it should be strongly discouraged.
Types of causes
=================
;Airborne: An airborne disease is any disease that is caused by
pathogens and transmitted through the air.
;Foodborne: Foodborne illness or food poisoning is any illness
resulting from the consumption of food contaminated with pathogenic
bacteria, toxins, viruses, prions or parasites.
;Infectious: Infectious diseases, also known as transmissible
diseases or communicable diseases, comprise clinically evident illness
(i.e., characteristic medical signs or symptoms of disease) resulting
from the infection, presence and growth of pathogenic biological
agents in an individual host organism. Included in this category are
'contagious diseases' - an infection, such as influenza or the common
cold, that commonly spreads from one person to another - and
'communicable diseases' - a disease that can spread from one person to
another, but does not necessarily spread through everyday contact.
; Lifestyle: A lifestyle disease is any disease that appears to
increase in frequency as countries become more industrialized and
people live longer, especially if the risk factors include behavioral
choices like a sedentary lifestyle or a diet high in unhealthful foods
such as refined carbohydrates, trans fats, or alcoholic beverages.
; Non-communicable: A non-communicable disease is a medical condition
or disease that is non-transmissible. Non-communicable diseases
cannot be spread directly from one person to another. Heart disease
and cancer are examples of non-communicable diseases in humans.
Prevention
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Many diseases and disorders can be prevented through a variety of
means. These include sanitation, proper nutrition, adequate exercise,
vaccinations and other self-care and public health measures.
Treatments
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Medical therapies or treatments are efforts to cure or improve a
disease or other health problems. In the medical field, therapy is
synonymous with the word 'treatment'. Among psychologists, the term
may refer specifically to psychotherapy or "talk therapy". Common
treatments include medications, surgery, medical devices, and
self-care. Treatments may be provided by an organized health care
system, or informally, by the patient or family members.
Preventive healthcare is a way to avoid an injury, sickness, or
disease in the first place. A treatment or cure is applied after a
medical problem has already started. A treatment attempts to improve
or remove a problem, but treatments may not produce permanent cures,
especially in chronic diseases. Cures are a subset of treatments that
reverse diseases completely or end medical problems permanently. Many
diseases that cannot be completely cured are still treatable. Pain
management (also called pain medicine) is that branch of medicine
employing an interdisciplinary approach to the relief of pain and
improvement in the quality of life of those living with pain.
Treatment for medical emergencies must be provided promptly, often
through an emergency department or, in less critical situations,
through an urgent care facility.
Epidemiology
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Epidemiology is the study of the factors that cause or encourage
diseases. Some diseases are more common in certain geographic areas,
among people with certain genetic or socioeconomic characteristics, or
at different times of the year.
Epidemiology is considered a cornerstone methodology of public health
research and is highly regarded in evidence-based medicine for
identifying risk factors for diseases. In the study of communicable
and non-communicable diseases, the work of epidemiologists ranges from
outbreak investigation to study design, data collection, and analysis
including the development of statistical models to test hypotheses and
the documentation of results for submission to peer-reviewed journals.
Epidemiologists also study the interaction of diseases in a
population, a condition known as a syndemic. Epidemiologists rely on a
number of other scientific disciplines such as biology (to better
understand disease processes), biostatistics (the current raw
information available), Geographic Information Science (to store data
and map disease patterns) and social science disciplines (to better
understand proximate and distal risk factors). Epidemiology can help
identify causes as well as guide prevention efforts.
In studying diseases, epidemiology faces the challenge of defining
them. Especially for poorly understood diseases, different groups
might use significantly different definitions. Without an agreed-on
definition, different researchers may report different numbers of
cases and characteristics of the disease.
Some morbidity databases are compiled with data supplied by states and
territories health authorities, at national levels or larger scale
(such as European Hospital Morbidity Database (HMDB)) which may
contain hospital discharge data by detailed diagnosis, age and sex.
The European HMDB data was submitted by European countries to the
World Health Organization Regional Office for Europe.
Burdens of disease
====================
Disease burden is the impact of a health problem in an area measured
by financial cost, mortality, morbidity, or other indicators.
There are several measures used to quantify the burden imposed by
diseases on people. The years of potential life lost (YPLL) is a
simple estimate of the number of years that a person's life was
shortened due to a disease. For example, if a person dies at the age
of 65 from a disease, and would probably have lived until age 80
without that disease, then that disease has caused a loss of 15 years
of potential life. YPLL measurements do not account for how disabled
a person is before dying, so the measurement treats a person who dies
suddenly and a person who died at the same age after decades of
illness as equivalent. In 2004, the World Health Organization
calculated that 932 million years of potential life were lost to
premature death.
The quality-adjusted life year (QALY) and disability-adjusted life
year (DALY) metrics are similar but take into account whether the
person was healthy after diagnosis. In addition to the number of
years lost due to premature death, these measurements add part of the
years lost to being sick. Unlike YPLL, these measurements show the
burden imposed on people who are very sick, but who live a normal
lifespan. A disease that has high morbidity, but low mortality, has a
high DALY and a low YPLL. In 2004, the World Health Organization
calculated that 1.5 billion disability-adjusted life years were lost
to disease and injury. In the developed world, heart disease and
stroke cause the most loss of life, but neuropsychiatric conditions
like major depressive disorder cause the most years lost to being
sick.
Disease category Percent of all YPLLs lost, worldwide Percent of
all DALYs lost, worldwide Percent of all YPLLs lost, Europe Percent
of all DALYs lost, Europe Percent of all YPLLs lost, US and Canada
Percent of all DALYs lost, US and Canada
Infectious and parasitic diseases, especially lower respiratory tract
infections, diarrhea, AIDS, tuberculosis, and malaria 37% 26% 9% 6% 5%
3%
Neuropsychiatric conditions, e.g. depression 2% 13% 3% 19% 5% 28%
Injuries, especially motor vehicle accidents 14% 12% 18% 13% 18% 10%
Cardiovascular diseases, principally heart attacks and stroke 14% 10%
35% 23% 26% 14%
Premature birth and other perinatal deaths 11% 8% 4% 2% 3% 2%
Cancer 8% 5% 19% 11% 25% 13%
Society and culture
======================================================================
How a society responds to diseases is the subject of medical
sociology.
A condition may be considered a disease in some cultures or eras but
not in others. For example, obesity can represent wealth and
abundance, and is a status symbol in famine-prone areas and some
places hard-hit by HIV/AIDS. Epilepsy is considered a sign of
spiritual gifts among the Hmong people.
Sickness confers the social legitimization of certain benefits, such
as illness benefits, work avoidance, and being looked after by others.
The person who is sick takes on a social role called the sick role. A
person who responds to a dreaded disease, such as cancer, in a
culturally acceptable fashion may be publicly and privately honored
with higher social status. In return for these benefits, the sick
person is obligated to seek treatment and work to become well once
more. As a comparison, consider pregnancy, which is not interpreted
as a disease or sickness, even if the mother and baby may both benefit
from medical care.
Most religions grant exceptions from religious duties to people who
are sick. For example, one whose life would be endangered by fasting
on Yom Kippur or during Ramadan is exempted from the requirement, or
even forbidden from participating. People who are sick are also
exempted from social duties. For example, ill health is the only
socially acceptable reason for an American to refuse an invitation to
the White House.
The identification of a condition as a disease, rather than as simply
a variation of human structure or function, can have significant
social or economic implications. The controversial recognition of
diseases such as repetitive stress injury (RSI) and post-traumatic
stress disorder (PTSD) has had a number of positive and negative
effects on the financial and other responsibilities of governments,
corporations, and institutions towards individuals, as well as on the
individuals themselves. The social implication of viewing aging as a
disease could be profound, though this classification is not yet
widespread.
Lepers were people who were historically shunned because they had an
infectious disease, and the term "leper" still evokes social stigma.
Fear of disease can still be a widespread social phenomenon, though
not all diseases evoke extreme social stigma.
Social standing and economic status affect health. Diseases of
poverty are diseases that are associated with poverty and low social
status; diseases of affluence are diseases that are associated with
high social and economic status. Which diseases are associated with
which states vary according to time, place, and technology. Some
diseases, such as diabetes mellitus, may be associated with both
poverty (poor food choices) and affluence (long lifespans and
sedentary lifestyles), through different mechanisms. The term
'lifestyle diseases' describes diseases associated with longevity and
that are more common among older people. For example, cancer is far
more common in societies in which most members live until they reach
the age of 80 than in societies in which most members die before they
reach the age of 50.
Language of disease
=====================
An illness narrative is a way of organizing a medical experience into
a coherent story that illustrates the sick individual's personal
experience.
People use metaphors to make sense of their experiences with disease.
The metaphors move disease from an objective thing that exists to an
affective experience. The most popular metaphors draw on military
concepts: Disease is an enemy that must be feared, fought, battled,
and routed. The patient or the healthcare provider is a warrior,
rather than a passive victim or bystander. The agents of communicable
diseases are invaders; non-communicable diseases constitute internal
insurrection or civil war. Because the threat is urgent, perhaps a
matter of life and death, unthinkably radical, even oppressive,
measures are society's and the patient's moral duty as they
courageously mobilize to struggle against destruction. The War on
Cancer is an example of this metaphorical use of language. This
language is empowering to some patients, but leaves others feeling
like they are failures.
Another class of metaphors describes the experience of illness as a
journey: The person travels to or from a place of disease, and
changes himself, discovers new information, or increases his
experience along the way. He may travel "on the road to recovery" or
make changes to "get on the right track" or choose "pathways". Some
are explicitly immigration-themed: the patient has been exiled from
the home territory of health to the land of the ill, changing identity
and relationships in the process. This language is more common among
British healthcare professionals than the language of physical
aggression.
Some metaphors are disease-specific. Slavery is a common metaphor for
addictions: The alcoholic is enslaved by drink, and the smoker is
captive to nicotine. Some cancer patients treat the loss of their
hair from chemotherapy as a metonymy or metaphor for all the losses
caused by the disease.
Some diseases are used as metaphors for social ills: "Cancer" is a
common description for anything that is endemic and destructive in
society, such as poverty, injustice, or racism. AIDS was seen as a
divine judgment for moral decadence, and only by purging itself from
the "pollution" of the "invader" could society become healthy again.
More recently, when AIDS seemed less threatening, this type of emotive
language was applied to avian flu and type 2 diabetes mellitus.
Authors in the 19th century commonly used tuberculosis as a symbol and
a metaphor for transcendence. Victims of the disease were portrayed
in literature as having risen above daily life to become ephemeral
objects of spiritual or artistic achievement. In the 20th century,
after its cause was better understood, the same disease became the
emblem of poverty, squalor, and other social problems.
See also
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