Wikipedia

Disease

This is thelatest accepted revision,reviewedon6 November 2024.

For other uses, seeDisease (disambiguation)."Maladies" redirects here. For the 2012 film, seeMaladies(film)."Ailment" redirects here. Not to be confused withAliment.

Adiseaseis a particular abnormal condition that adversely affects the structure orfunctionof all or part of an organism and is not immediately due to any externalinjury.[1][2]Diseases are often known to bemedical conditionsthat are associated with specificsigns and symptoms.A disease may be caused by external factors such aspathogensor by internal dysfunctions. For example, internal dysfunctions of theimmune systemcan produce a variety of different diseases, including various forms ofimmunodeficiency,hypersensitivity,allergies,andautoimmune disorders.

"The Sick Girl", 1882,National Gallery of Denmark

In humans,diseaseis often used more broadly to refer to any condition that causespain,dysfunction,distress,social problems,ordeathto the person affected, or similar problems for those in contact with the person. In this broader sense, it sometimes includesinjuries,disabilities,disorders,syndromes,infections,isolated symptoms, deviantbehaviors,and atypicalvariationsof 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 calleddeath by natural causes.There are four main types of disease: infectious diseases,deficiency diseases,hereditary diseases(including both genetic andnon-genetic hereditary diseases), and physiological diseases. Diseases can also be classified in other ways, such ascommunicableversusnon-communicablediseases. The deadliest diseases in humans arecoronary artery disease(blood flow obstruction), followed bycerebrovascular diseaseandlower respiratory infections.[3]In developed countries, the diseases that cause the most sickness overall areneuropsychiatric conditions,such asdepressionandanxiety.

The study of disease is calledpathology,which includes the study ofetiology,or cause.

Terminology

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Concepts

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In many cases, terms such asdisease,disorder,morbidity,sicknessandillnessare used interchangeably; however, there are situations when specific terms are considered preferable.[4]

Disease
The termdiseasebroadly refers to any condition that impairs the normal functioning of the body. For this reason, diseases are associated with the dysfunction of the body's normalhomeostatic processes.[5]Commonly, the term is used to refer specifically toinfectious diseases,which are clinically evident diseases that result from the presence ofpathogenicmicrobial agents, including viruses,bacteria,fungi,protozoa, multicellular organisms, and aberrant proteins known asprions.Aninfectionorcolonizationthat does not and will not produce clinically evident impairment of normal functioning, such as the presence of the normalbacteria and yeasts in the gut,or of apassenger virus,is not considered a disease. By contrast, an infection that is asymptomatic during itsincubation period,but expected to produce symptoms later, is usually considered a disease.Non-infectious diseasesare all other diseases, including most forms ofcancer,heart disease,andgenetic 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 iscongenital disease.Acquiredsounds 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 alsoconnotesafulminantnature
Chronic condition or chronic disease
Achronic diseaseis one that persists over time, often for 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
Acongenital disorderis one that is present atbirth.It is often agenetic disease or disorderand can beinherited.It can also be the result of avertically transmitted infectionfrom the mother, such asHIV/AIDS.
Genetic disease
Agenetic disorderor disease is caused by one or more geneticmutations.It is often inherited, but some mutations are random andde novo.
Hereditary or inherited disease
A hereditary disease is a type of genetic disease caused by genetic mutations that arehereditary(and can run in families)
Iatrogenic disease
Aniatrogenic diseaseor condition is one that is caused by medical intervention, whether as a side effect of a treatment or as an inadvertent outcome.
Idiopathic disease
Anidiopathic diseasehas 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 thatautoimmunityis the cause of some forms ofdiabetes 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 areassociatedwith certain diseases; however, association does not necessarily implycausality.For example, a third factor might be causing both the disease, and the associated phenomenon.
Incurable disease
A disease that cannot becured.Incurable diseases are not necessarilyterminal diseases,and sometimes a disease's symptoms can be treated sufficiently for the disease to have little or no impact onquality of life.
Primary disease
A primary disease is a disease that is due to aroot causeof illness, as opposed to secondary disease, which is asequela,orcomplicationthat is caused by the primary disease. For example, acommon coldis a primary disease, whererhinitisis a possible secondary disease, orsequela.A doctor must determine what primary disease, a cold or bacterial infection, is causing a patient's secondaryrhinitiswhen deciding whether or not to prescribe antibiotics.
Secondary disease
A secondary disease is a disease that is asequelaorcomplicationof 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 bacteria and becomes infected, or it can be secondary to a primary cause, that predisposes the body to infection. For example, a primaryviral infectionthat weakens theimmune systemcould lead to a secondary bacterial infection. Similarly, a primaryburnthat 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 termsillnessandsicknessare both generally used as synonyms fordisease;however, the termillnessis occasionally used to refer specifically to the patient's personal experience of their disease.[6][7][8][9]In this model, it is possible for a person to have a disease without being ill (to have an objectively definable, butasymptomatic,medical condition, such as asubclinical infection,or to have a clinically apparent physical impairment but not feel sick or distressed by it), and to beillwithout beingdiseased(such as when a person perceives a normal experience as a medical condition, ormedicalizesa non-disease situation in their 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 ofevolved responses–sickness behaviorby the body – that helps clear infection and promote recovery. Such aspects of illness can includelethargy,depression,loss of appetite,sleepiness,hyperalgesia,and inability toconcentrate.[10][11][12]
Disorder
A disorder is a functional abnormality or disturbance that may or may not show specific signs and symptoms. Medical disorders can be categorized intomental disorders,physical disorders,genetic disorders,emotional and behavioral disorders,andfunctional disorders.[13]The termdisorderis often considered more value-neutral and less stigmatizing than the termsdiseaseorillness,and therefore is preferred terminology in some circumstances.[14]In mental health, the termmental disorderis used as a way of acknowledging the complex interaction ofbiological, social, and psychological factorsinpsychiatricconditions; however, the termdisorderis also used in many other areas of medicine, primarily to identify physical disorders that are not caused by infectious organisms, such asmetabolic disorders.
Medical condition or health condition
Amedical conditionorhealth conditionis a broad concept that includes all diseases,lesions,disorders, or nonpathologic condition that normally receives medical treatment, such aspregnancyorchildbirth.While the termmedical conditiongenerally includes mental illnesses, in some contexts the term is used specifically to denote any illness, injury, or diseaseexceptfor mental illnesses. TheDiagnostic and Statistical Manual of Mental Disorders(DSM), the widely used psychiatric manual that defines allmental disorders,uses the termgeneral medical conditionto refer to all diseases, illnesses, and injuries except for mental disorders.[15]This usage is also commonly seen in the psychiatric literature. Somehealth insurancepolicies also define amedical conditionas any illness, injury, or disease except for psychiatric illnesses.[16]
As it is morevalue-neutralthan terms likedisease,the termmedical conditionis sometimes preferred by people with health issues that they do not consider deleterious. However, by emphasizing the medical nature of the condition, this term is sometimes rejected, such as by proponents of theautism rights movement.
The termmedical conditionis also a synonym formedical 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 beingin critical condition,for example.
Morbidity
Morbidity(fromLatinmorbidus'sick, unhealthy') is a diseased state,disability,or poor health due to any cause.[17]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 byICU scoring systems.Comorbidity,or co-existing disease, is the simultaneous presence of two or more medical conditions, such asschizophreniaandsubstance abuse.
Inepidemiologyandactuarial science,the termmorbidity(alsomorbidity rateormorbidity frequency) can refer to either theincidencerate, theprevalenceof a disease or medical condition, or the percentage of people who experience a given condition within a given timeframe (e.g., 20% of people will getinfluenzain a year).[18]This measure of sickness is contrasted with themortality rateof 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 premiums charged 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(pluralpathoses) is synonymous withdisease.The wordpathologyalso has thissense,in which it is commonly used by physicians in themedical literature,althoughsome editors prefer to reservepathologyto its other senses.Sometimes a slightconnotativeshade causes preference forpathologyorpathosisimplying "some [as yet poorly analyzed]pathophysiologic process"rather thandiseaseimplying "a specific disease entity as defined by diagnostic criteria being already met". This is hard to quantifydenotatively,but it explains whycognitive synonymyis not invariable.
Syndrome
Asyndromeis the association of severalsigns and symptoms,or other characteristics that often occur together, regardless of whether the cause is known. Some syndromes such asDown syndromeare known to have only one cause (an extrachromosomeat birth). Others such asParkinsonian syndromeare 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 includingmyocardial infarctionsecondary tocoronary artery disease.In yet other syndromes, however, thecause 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 thatTurner syndromeandDiGeorge syndromeare 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
Prediseaseis asubclinicalorprodromalvanguard of a disease.Prediabetesandprehypertensionare common examples. Thenosologyor epistemology of predisease is contentious, though, because there is seldom abright linedifferentiating a legitimate concern for subclinical or premonitory status and theconflict of interest–drivenover-medicalization(e.g., by pharmaceutical manufacturers) or de-medicalization (e.g., by medical and disability insurers). Identifying legitimate predisease can result in useful preventive measures, such as motivating the person to get a healthy amount of physical exercise,[19]but labeling a healthy person with an unfounded notion of predisease can result inovertreatment,such as taking drugs that only help people with severe disease or paying for treatments with a poorbenefit–cost ratio.
One review proposed three criteria for predisease:
  • a high risk for progression to disease making one "far more likely to develop" it than others are- for example, apre-cancerwill 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.[20]

Types by body system

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Mental
Mental illnessis a broad, generic label for a category of illnesses that may include affective oremotionalinstability, behavioral dysregulation, cognitive dysfunction or impairment. Specific illnesses known as mental illnesses includemajor depression,generalizedanxiety disorders,schizophrenia,andattention 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 relationship.[citation needed]
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 astrokeor a traumatic brain injury, but not if they are due topsychosocialissues.

Stages

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In an infectious disease, theincubation periodis the time between infection and the appearance of symptoms. Thelatency periodis 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, calledviral latency,in which the virus hides in the body in an inactive state. For example,varicella zoster viruscauseschickenpoxin theacute phase;after recovery from chickenpox, the virus may remain dormant in nerve cells for many years, and later causeherpes zoster(shingles).

Acute disease
Anacute diseaseis a short-lived disease, like thecommon cold.
Chronic disease
Achronic diseaseis one that lasts for a long time, usually at least six months. During that time, it may be constantly present, or it may go intoremissionand periodicallyrelapse.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.[21]AIDSis the clinical disease stage ofHIV infection.
Cure
Acureis the end of a medical condition or a treatment that is very likely to end it, whileremissionrefers to the disappearance, possibly temporarily, of symptoms. Complete remission is the best possible outcome for incurable diseases.
Flare-up
"Flareup" redirects here. For the Transformers character, seeFlareup (Transformers).
See also:Exacerbation
A flare-up can refer to either the recurrence of symptoms or an onset of more severe symptoms.[22]
Progressive disease
Progressive diseaseis a disease whose typical natural course is the worsening of the disease until death, serious debility, or organ failure occurs. Slowly progressive diseases are alsochronic diseases;many are alsodegenerative diseases.The opposite of progressive disease isstable diseaseorstatic disease:a medical condition that exists, but does not get better or worse.
Refractory disease
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 calledsilent disease,silent stage,orasymptomatic disease.This is a stage in some diseases before the symptoms are first noted.[23]
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.
Recovery
See also:ConvalescenceandRecuperation
Recovery can refer to the repairing of physical processes (tissues, organs etc.) and the resumption of healthy functioning after damage causing processes have been cured.

Extent

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This rash only affects one part of the body, so it is a localized disease.
Localized disease
Alocalized diseaseis one that affects only one part of the body, such asathlete's footor aneye infection.
Disseminated disease
Adisseminated diseasehas spread to other parts; with cancer, this is usually calledmetastatic disease.
Systemic disease
Asystemic diseaseis a disease that affects the entire body, such asinfluenzaorhigh blood pressure.

Classification

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Main articles:NosologyandMedical classification

Diseases may be classified by cause,pathogenesis(mechanismby which the disease is caused), or bysymptoms.Alternatively, diseases may be classified according to theorgan systeminvolved, 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.[24]

The most known and used classification of diseases is theWorld Health Organization'sICD.This is periodically updated. Currently, the last publication is theICD-11.

Causes

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See also:Cause (medicine)andTransmission (medicine)

Diseases can be caused by any number of factors and may be acquired orcongenital.Microorganisms,genetics, the environment or a combination of these can contribute to a diseased state.[25]

Only some diseases such asinfluenzaare contagious and commonly believed infectious. Themicroorganismsthat cause these diseases are known as pathogens and include varieties of bacteria, viruses, protozoa, and fungi.Infectious diseasescan be transmitted, e.g. by hand-to-mouth contact with infectious material on surfaces, by bites ofinsects or other carriersof the disease, and from contaminated water or food (often viafecalcontamination), etc.[26]Also, there aresexually 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 appropriatenutritionor other lifestyle changes.

Some diseases, such as most (butnot all) forms ofcancer,heart disease,and mental disorders, arenon-infectious diseases.Many non-infectious diseases have a partly or completely genetic basis (seegenetic disorder) and may thus be transmitted from one generation to another.

Social determinants of healthare the social conditions in which people live that determine their health. Illnesses are generally related to social, economic, political, andenvironmental circumstances.[27]Social determinants of health have been recognized by several health organizations such as the Public Health Agency ofCanadaand the World Health Organization to greatly influence collective and personal well-being. The World Health Organization's Social Determinants Council also recognizesSocial determinants of health in poverty.

When the cause of a disease is poorly understood, societies tend to mythologize the disease or use it as ametaphoror symbol of whatever that culture considers evil. For example, until the bacterial cause oftuberculosiswas discovered in 1882, experts variously ascribed the disease toheredity,asedentary lifestyle,depressed mood,and overindulgence in sex, rich food, or alcohol, all of which weresocial illsat the time.[28]

When a disease is caused by apathogenicorganism (e.g., whenmalariais caused byPlasmodium), one should not confuse thepathogen(the cause of the disease) with disease itself. For example,West Nile virus(the pathogen) causesWest Nile fever(the disease). The misuse of basic definitions inepidemiologyis frequent in scientific publications.[29]

Types of causes

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Regular physical activity, such as riding a bicycle or walking, reduces the risk of lifestyle diseases.
Airborne
Anairborne diseaseis any disease that is caused by pathogens and transmitted through the air.[30]
Foodborne
Foodborne illnessor food poisoning is any illness resulting from the consumption of food contaminated with pathogenic bacteria, toxins, viruses, prions or parasites.[31]
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.[32]Included in this category arecontagious diseases– an infection, such asinfluenzaor thecommon cold,that commonly spreads from one person to another – andcommunicable diseases– a disease that can spread from one person to another, but does not necessarily spread through everyday contact.
Lifestyle
Alifestyle diseaseis 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.[33]
Non-communicable
Anon-communicable diseaseis a medical condition or disease that is non-transmissible.[34]Non-communicable diseases cannot be spread directly from one person to another.Heart diseaseandcancerare examples of non-communicable diseases in humans.[35]

Prevention

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Main article:Preventive medicine

Many diseases and disorders can be prevented through a variety of means. These includesanitation,propernutrition,adequateexercise,vaccinationsand otherself-careandpublic healthmeasures,such as obligatoryface maskmandates[citation needed].

Treatments

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Main article:Therapy

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 wordtreatment.Among psychologists, the term may refer specifically topsychotherapyor "talk therapy". Common treatments includemedications,surgery,medical devices,andself-care.Treatments may be provided by an organizedhealth care system,or informally, by the patient or family members.

Preventive healthcareis 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 inchronic diseases.Curesare 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.[36]

Treatment formedical emergenciesmust be provided promptly, often through anemergency departmentor, in less critical situations, through anurgent carefacility.

Epidemiology

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Main article:Epidemiology

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 inevidence-based medicinefor identifyingrisk factorsfor diseases. In the study of communicable and non-communicable diseases, the work of epidemiologists ranges fromoutbreakinvestigation 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 asyndemic.Epidemiologists rely on a number of other scientific disciplines such asbiology(to better understand disease processes),biostatistics(the current raw information available),Geographic Information Science(to store data and map disease patterns) andsocial sciencedisciplines (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.[37]

Some morbidity databases are compiled with data supplied by states and territories health authorities, at national levels[38][39]or larger scale (such as European Hospital Morbidity Database (HMDB))[40]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

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Disease burdenis 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. Theyears 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, theWorld Health Organizationcalculated that 932 million years of potential life were lost to premature death.[41]

Thequality-adjusted life year(QALY) anddisability-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.[41]In the developed world,heart diseaseandstrokecause the most loss of life, butneuropsychiatric conditionslikemajor depressive disordercause the most years lost to being sick.

Disease category Percent of all YPLLs lost, worldwide[41] Percent of all DALYs lost, worldwide[41] Percent of all YPLLs lost, Europe[41] Percent of all DALYs lost, Europe[41] Percent of all YPLLs lost, US and Canada[41] Percent of all DALYs lost, US and Canada[41]
Infectious and parasitic diseases, especiallylower respiratory tract infections,diarrhea,AIDS,tuberculosis,andmalaria 37% 26% 9% 6% 5% 3%
Neuropsychiatric conditions,e.g.depression 2% 13% 3% 19% 5% 28%
Injuries,especiallymotor vehicle accidents 14% 12% 18% 13% 18% 10%
Cardiovascular diseases,principallyheart attacksandstroke 14% 10% 35% 23% 26% 14%
Premature birthand otherperinataldeaths 11% 8% 4% 2% 3% 2%
Cancer 8% 5% 19% 11% 25% 13%

Society and culture

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Obesitywas a status symbol inRenaissanceculture: "The Tuscan GeneralAlessandro del Borro",attributed toAndrea Sacchi,1645.[42]It is now generally regarded as a disease.

How a society responds to diseases is the subject ofmedical sociology.

A condition may be considered a disease in some cultures or eras but not in others. For example,obesitycan represent wealth and abundance, and is a status symbol in famine-prone areas and some places hard-hit byHIV/AIDS.[43]Epilepsyis considered a sign of spiritual gifts among theHmong people.[44]

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 thesick role.A person who responds to a dreaded disease, such ascancer,in a culturally acceptable fashion may be publicly and privately honored with highersocial status.[45]In return for these benefits, the sick person is obligated to seek treatment and work to become well once more. As a comparison, considerpregnancy,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 byfastingonYom Kippuror during the month ofRamadanis exempted from the requirement, or even forbidden from participating.[46][47]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 theWhite House.[48]

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 asrepetitive stress injury(RSI) andpost-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 viewingagingas a disease could be profound, though this classification is not yet widespread.

Leperswere people who were historically shunned because they had an infectious disease, and the term "leper" still evokessocial 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 povertyare diseases that are associated withpovertyand low social status;diseases of affluenceare 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 asdiabetes mellitus,may be associated with both poverty (poor food choices) and affluence (long lifespans and sedentary lifestyles), through different mechanisms. The termlifestyle diseasesdescribes diseases associated with longevity and that are more common among older people. For example,canceris 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

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Anillness narrativeis a way of organizing a medical experience into a coherent story that illustrates the sick individual's personal experience.

People usemetaphorsto make sense of their experiences with disease. The metaphors move disease from an objective thing that exists to anaffectiveexperience. The most popular metaphors draw onmilitaryconcepts: Disease is an enemy that must be feared, fought, battled, and routed. The patient or the healthcare provider is awarrior,rather than a passive victim or bystander. The agents of communicable diseases areinvaders;non-communicable diseases constitute internalinsurrectionorcivil 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. TheWar on Canceris an example of this metaphorical use of language.[49]This language is empowering to some patients, but leaves others feeling like they are failures.[50]

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".[49][50]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.[51]This language is more common among British healthcare professionals than the language of physical aggression.[50]

Some metaphors are disease-specific.Slaveryis a common metaphor foraddictions:The alcoholic is enslaved by drink, and the smoker is captive to nicotine. Some cancer patients treat the loss of their hair fromchemotherapyas ametonymyor metaphor for all the losses caused by the disease.[49]

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.[49]More recently, when AIDS seemed less threatening, this type of emotive language was applied toavian fluandtype 2 diabetes mellitus.[52]Authors in the 19th centurycommonly used tuberculosisas a symbol and a metaphor fortranscendence.People with 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.[51]

See also

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References

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