Elementary concepts of medicine: IV. Sickness from illness and in health

In the definition of illness that we put forward in the preceding essay, the specific difference that makes a case of somatic anomaly one of illness is its being, actually or potentially, manifest (adversely) to the affected person – overt or patent in this meaning. The manifestations that are subjective, perceptible to the affected person alone, are properly termed symptoms; and those that are objective in the sense of being perceptible to both the affected person as well as to others constitute not symptoms but a subtype of signs of the illness: patient-perceptible signs. These two types of manifestation, already present or potentially emerging in the future, are the ones involved in the illness-defining specific difference among the somatic anomalies that constitute the proximate genus of illness. Other manifestations are, naturally, objective but not perceptible to the affected person – signs from tests (‘physical’, ‘laboratory’). These simple propositions, again, differ from what we find in medical dictionaries. Symptom is said to be ‘any subjective evidence of disease or of a patient's condition, i.e. such evidence as perceived by the patient; a noticeable change in a patient's condition indicative of some bodily or mental state’ (Dorland 1994), or ‘any morbid phenomenon or departure from the normal in structure, function, or sensation, experienced by the patient and indicative of disease’ (Stedman 1995). And sign is defined as ‘an indication of the existence of something; any objective evidence of a disease, i.e. such evidence as is perceptible to the examining physician, as opposed to the subjective sensations (symptoms) of the patient’ (Dorland 1994), or as ‘any abnormality indicative of disease, discoverable on examination of the patient; an objective symptom of disease, in contrast to a symptom which is a subjective s. of disease’ (Stedman 1995). What binds symptoms and patient-perceptible signs, and makes them outstandingly significant, is that these manifestations, and these alone, take away from the affected person's feeling, and lay presumption of being, healthy; they, when already present, represent unwellness and thus constitute the person's ‘complaints’ to the doctor. For this all-important, patient-relevant segment of the manifestations of a somatic anomaly – the segment which is involved in our definition of illness – there now is, remarkably, no established term; and ‘unwellness’, while correct, is awkward. We take the appropriate term for patient-perceptible manifestations of illness to be ‘sickness’. A person with patent illness, we find natural to say, is sick from the illness; and if the illness is latent, then the person, while ill rather than healthy, is not sick from this illness. This again brings us to examine our medical dictionaries. The one that equates illness with sickness and specifies disease as something else (Dorland 1994) defines various particular sicknesses under ‘sickness’. A number of the definitions incongruously involve the term ‘disease’, and some others involve ‘illness’. What characterizes all of those sicknesses, athlete's sickness, altitude sickness and morning sickness among them, is a particular, less-than-specific type of manifestation to the patient in conjunction with a specific cause and, notably, absence of a defined somatic anomaly as the proximate genus. Another medical dictionary, the one that equates disease as well as illness with sickness (Stedman 1995), specifies a similar, limited set of particular sicknesses (rather than all diseases/illnesses). To us these sickness entities are not ones of illness nor ones of sickness caused by illness; they are ones of sickness as a result of definitional causes other than illness-defining somatic anomalies; they are entities of sickness in health. With the dictionaries thus strikingly confusing about the concept of sickness, to us it is simply lack of feeling and/or overtly being well (physically). A person who is sick may or may not have an illness – illness-defining somatic anomaly – as a basis for this. Our usage of ‘sickness’ in relation to illness, we wish to underscore, is by no means novel. To quote scripture: Elisha arrived in Damascus when King Ben-hadad of Aram was ill. The King . . . said to Hazael, ‘Take a gift and go to meet the man of God, and through him inquire the Lord: will I recover from this illness?’ . . . Now, when Elisha had taken sick with the illness of which he was to die, . . . [italics added] (Miles 1995, pp. 182–183) The concept of sickness remains incompletely apprehended when not having adopted a disciplined approach to the definition of particular sicknesses, to the specification of the essence that is always present in and unique to a particular sickness. Common to the definitions of all the particular sicknesses in the two dictionaries are two structural features. For one, a particular type of unwellness is described as present (and thus not merely potentially present in the future); and for another, causal origin, other than somatic anomaly, of the unwellness is consistently specified. This is incongruous with the general equatings in those dictionaries of sickness with illness and/or disease, with definitions of particular illnesses and diseases not routinely having this structure – they are commonly defined in terms of somatic anomaly alone, with no definitional role for its manifestations in unwellness. (Pleonastic description of potential manifestations in unwellness is commonplace, however, obfuscating conveyance of the definitional essence.) Proper conceptualization of particular sicknesses rests on appreciation of the principle that the particularity is to pertain to the nature of the unwellness or to that of its cause, but not both (as in these dictionaries). Thus, nausea with vomiting constitutes a sickness, irrespective of its cause (whether an illness or, say, the use of a medication or involvement in a poorly tolerated type of motion without appropriate medication); and sicknesses in this same sense also are whatever combinations of elements of unwellness – these elements being symptoms and/or signs only when they are manifestations of illness. On the other hand, sickness caused by the use of a medication is ‘medication sickness’ (cf. motion sickness) irrespective of what type of unwellness the medication is causing; similarly, sickness manifesting syphilis is ‘syphilis sickness’ irrespective of what type of sickness ‘the great imitator’ happens to have as its overt manifestation; and this non-specific kind of conceptualization/definition of type of sickness on the basis of its cause alone should be applied whenever cause is involved in the definition (as the specific difference in the proximate genus of sickness). To summarize, whereas it is our position that illness is a somatic anomaly manifest, or in the future potentially manifest, to the affected person, these illness-defining manifestations consist of symptoms (inherently subjective) and those signs (inherently objective) that are overt in the sense of being recognized by (and bothersome to) the affected person. The individual aggregate of these patient-relevant manifestations of illness, distinct from its consequences, we believe should be referred to as the sickness in which the illness is manifest to the individual. Sickness can also have causation which does not involve illness. Particular sicknesses are to be conceptualized in terms of the nature of the aggregate of elements of unwellness or the nature of the cause(s) of this, but not both of these jointly. Much confusion about the concept of sickness prevails.

Fetched live from OpenAlex and de-inverted. Abstracts are not stored in this database: the inverted indexes are 8.6 GB of the frame’s 9.3 GB of text, and the host has 13 GB free.