Mental illness, general practice and society

Abstract

Abstract My work as a general practitioner is based on an attempted articulation of clear distinctions between concepts of illness, disease and health (Heath 1995). Illness describes the patient ‘s subjective experience. It is the first vague feelings of something being not quite right and it is, and was always, the starting point of the whole end eavour of medicine. In illness, the body makes its presence felt in a way that does not happen in health. No one notices his or her throat until it is sore. Illness is necessarily lonely because no one can share the direct experience of a symptom, and almost all illness carries implicit fear of a diminished life or untimely death. Disease is quite different and is the stuff of biomedical science. It is a theoretical construct and the means by which humanity has tried to control and make sense of the experience of illness. Each disease is a reified abstraction developed by a process of describing patterns of both symptoms and physical signs, which different patients appear to have in common. As these patterns are refined, the patients come to be described as suffering from the same disease. Thus, bio- medical science is based on a series of relatively crude generalizations, which we recognize as diseases.