On Dis-ease

We are all terminally ill. It is a matter of time before we all die. Aging and death remain almost as mysterious as ever. We feel awed and uncomfortable when we contemplate these twin afflictions. Indeed, the very word denoting illness contains its own best definition: dis-ease. A mental component of lack of well being must exist SUBJECTIVELY. The person must FEEL bad, must experience discomfiture for his condition to qualify as a disease. To this extent, we are justified in classifying all diseases as "spiritual" or "mental".

Is there any other way of distinguishing health from sickness - a way that does NOT depend on the report that the patient provides regarding his subjective experience?

Some diseases are manifest and others are latent or immanent. Genetic diseases can exist - unmanifested - for generations. This raises the philosophical problem or whether a potential disease IS a disease? Are AIDS and Haemophilia carriers - sick? Should they be treated, ethically speaking? They experience no dis-ease, they report no symptoms, no signs are evident. On what moral grounds can we commit them to treatment? On the grounds of the "greater benefit" is the common response. Carriers threaten others and must be isolated or otherwise neutered. The threat inherent in them must be eradicated. This is a dangerous moral precedent. All kinds of people threaten our well-being: unsettling ideologists, the mentally handicapped, many politicians. Why should we single out our physical well-being as worthy of a privileged moral status? Why is our mental well being, for instance, of less import?

Moreover, the distinction between the psychic and the physical is hotly disputed, philosophically. The psychophysical problem is as intractable today as it ever was (if not more so). It is beyond doubt that the physical affects the mental and the other way around. This is what disciplines like psychiatry are all about. The ability to control "autonomous" bodily functions (such as heartbeat) and mental reactions to pathogens of the brain are proof of the artificialness of this distinction.

It is a result of the reductionist view of nature as divisible and summable. The sum of the parts, alas, is not always the whole and there is no such thing as an infinite set of the rules of nature, only an asymptotic approximation of it. The distinction between the patient and the outside world is superfluous and wrong. The patient AND his environment are ONE and the same. Disease is a perturbation in the operation and management of the complex ecosystem known as patient-world. Humans absorb their environment and feed it in equal measures. This on-going interaction IS the patient. We cannot exist without the intake of water, air, visual stimuli and food. Our environment is defined by our actions and output, physical and mental.

Thus, one must question the classical differentiation between "internal" and "external". Some illnesses are considered "endogenic" (=generated from the inside). Natural, "internal", causes - a heart defect, a biochemical imbalance, a genetic mutation, a metabolic process gone awry - cause disease. Aging and deformities also belong in this category.

In contrast, problems of nurturance and environment - early childhood abuse, for instance, or malnutrition - are "external" and so are the "classical" pathogens (germs and viruses) and accidents.

But this, again, is a counter-productive approach. Exogenic and Endogenic pathogenesis is inseparable. Mental states increase or decrease the susceptibility to externally induced disease. Talk therapy or abuse (external events) alter the biochemical balance of the brain. The inside constantly interacts with the outside and is so intertwined with it that all distinctions between them are artificial and misleading. The best example is, of course, medication: it is an external agent, it influences internal processes and it has a very strong mental correlate (=its efficacy is influenced by mental factors as in the placebo effect).

The very nature of dysfunction and sickness is highly culture-dependent. Societal parameters dictate right and wrong in health (especially mental health). It is all a matter of statistics. Certain diseases are accepted in certain parts of the world as a fact of life or even a sign of distinction (e.g., the paranoid schizophrenic as chosen by the gods). If there is no dis-ease there is no disease. That the physical or mental state of a person CAN be different - does not imply that it MUST be different or even that it is desirable that it should be different. In an over-populated world, sterility might be the desirable thing - or even the occasional epidemic. There is no such thing as ABSOLUTE dysfunction. The body and the mind ALWAYS function. They adapt themselves to their environment and if the latter changes - they change. Personality disorders are the best possible responses to abuse. Cancer may be the best possible response to carcinogens. Aging and death are definitely the best possible response to over-population. Perhaps the point of view of the single patient is incommensurate with the point of view of his species - but this should not serve to obscure the issues and derail rational debate.

As a result, it is logical to introduce the notion of "positive aberration". Certain hyper- or hypo- functioning can yield positive results and prove to be adaptive. The difference between positive and negative aberrations can never be "objective". Nature is morally-neutral and embodies no "values" or "preferences". It simply exists. WE, humans, introduce our value systems, prejudices and priorities into our activities, science included. It is better to be healthy, we say, because we feel better when we are healthy. Circularity aside - this is the only criterion that we can reasonably employ. If the patient feels good - it is not a disease, even if we all think it is. If the patient feels bad, ego-dystonic, unable to function - it is a disease, even when we all think it isn't. Needless to say that I am referring to that mythical creature, the fully informed patient. If someone is sick and knows no better (has never been healthy) - then his decision should be respected only after he is given the chance to experience health.

All the attempts to introduce "objective" yardsticks of health are plagued and philosophically contaminated by the insertion of values, preferences and priorities into the formula - or by subjecting the formula to them altogether. One such attempt is to define health as "an increase in order or efficiency of processes" as contrasted with illness which is "a decrease in order (=increase of entropy) and in the efficiency of processes". While being factually disputable, this dyad also suffers from a series of implicit value-judgements. For instance, why should we prefer life over death? Order to entropy? Efficiency to inefficiency?

Health and sickness are different states of affairs. Whether one is preferable to the other is a matter of the specific culture and society in which the question is posed. Health (and its lack) is determined by employing three "filters" as it were:

1) Is the body affected?

2) Is the person affected? (dis-ease, the bridge between "physical" and "mental illnesses)

3) Is society affected?

In the case of mental health the third question is often formulated as "is it normal" (=is it statistically the norm of this particular society in this particular time)?

We must re-humanize disease. By imposing upon issues of health the pretensions of the accurate sciences, we objectified the patient and the healer alike and utterly neglected that which cannot be quantified or measured - the human mind, the human spirit.

About The Author

Sam Vaknin is the author of "Malignant Self Love - Narcissism Revisited" and the editor of mental health categories in The Open Directory, Suite101, and searcheurope.com.

His web site: http://samvak.tripod.com

Frequently asked questions regarding narcissism: http://samvak.tripod.com/faq1.html

Narcissistic Personality Disorder on Suite101: http://www.suite101.com/welcome.cfm/npd

In The News:

Are We Naturally Kind?  Psychology Today
The Myth of Self-Esteem  Psychology Today
Psychologists say  The Canberra Times
The Psychology Of Passive  Seeking Alpha
The treatment gap  The News on Sunday
How Does Communication Work?  Psychology Today
Finding the Misophonia Gene  Psychology Today

The Psychology of Torture

There is one place in which one's privacy, intimacy, integrity... Read More

Intuition

I. The Three IntuitionsIA. Eidetic IntuitionsIntuition is supposed to be... Read More

Subconscious Drives Make You Unhappy

Feelings and emotions are nerve impulses.The feel of paper and... Read More

The Joan of Arc Complex

Sometimes I think that I have a mental health problem... Read More

Is China Testing Bio Weapons on Its Own People?

Well the conspiracy theorists are out in full force I... Read More

Fallacies About the Inner Child

Over the past 10 years I have helped individuals who... Read More

Are Observations Objective?

On the outset all observations may seem to be objective,... Read More

Narcissism, Substance Abuse, and Reckless Behaviours

Pathological narcissism is an addiction to Narcissistic Supply, the narcissist's... Read More

What is the Theory of Multiple Intelligences? Part 1: Biological Basis

Howard Gardner's theory of multiple intelligences is based on the... Read More

I?m Sorry! Blame-Game or Accountability?

A powerful tool for health as we approach the new... Read More

Panic Attacks: Effective Ways to Cope

Jill is a 21 y/o college student who used to... Read More

Balancing Brain Lobes - Mutras

When does consciousness exist? Will the sentient robots being created... Read More

Solution Focus Process: Solution Talk vs. Problem Talk Pt I

Solution Talk vs. Problem TalkProblem talk, of course, is talk... Read More

On Empathy

The Encyclopaedia Britannica (1999 edition) defines empathy as:"The ability to... Read More

A Case for Multiple Intelligences Based Classroom Instruction

Although many high school age students tend to think and... Read More

Narcissistic Personality Disorder (NPD) At a Glance

Most narcissists (75%) are men.NPD is one of a "family"... Read More

Its Never Too Late

First of all, a bit of background: A high school... Read More

Solution Focus Process: Solution Talk vs. Problem Talk Pt 2

It is crucial that interviewing with helpee progress toward solutions.... Read More

Short Story: The Next Level of Humanity

"Hey Mac, have you ever been thinking of someone and... Read More

Get Out of Jail Free: Stop Being Defensive

When Marcus and Sally first met they immediately felt like... Read More

The End of Psychotherapy

In two articles entitled "We Are Not Our Personalities" and... Read More

Hypnosis: A Brief History

Evidence of hypnotic-like phenomena appears in many ancient cultures. The... Read More

Metaphors of the Mind (Part II)

Storytelling has been with us since the days of campfire... Read More

Biometrics

ABSTRACTBiometric identification refers to identifying an individual based on his/her... Read More

Animal to Animal Telepathy

There has been much study on Telepathy in the animal... Read More