Health and Disease

Health and disease seem at first glance to be obvious and opposing concepts. We are either healthy or suffering from some disease. In practice, however, health and disease are neither clearly defined nor mutually exclusive. Asthmatics and diabetics have won Olympic gold medals, and amputees can live to a ripe old age. "Healthy" people in their eighties cannot do things they could easily have done half a century before; they may still be able to perform tasks they could not have as healthy infants. Conditions that would be perceived as a disease in one society might be considered perfectly normal in another.

Fresco showing doctor giving treatment to sick man with cut on leg (1443) by Domenico di Bartolo. Due to the strong influence of religion during the Middle Ages, illness was often blamed on supernatural forces or sins committed by the sick person. © THE ART ARCHIVE/SANTA MARIA DELLA SCALA HOSPITAL SIENA / DAGLI ORTI (A)

Health is a more problematic and conditional state than is disease, and it is generally less visible historically. It is less likely to be noticed by the individual or commented on by healers or philosophers. Often, health is simply the default mode, the condition to which people revert after they recover from some illness. Illness is of course not the same as disease. The former is a subjective experience, suffered by a person; the latter is more objective, in that others, especially medical practitioners, share in its conceptualization. The diagnosis, or naming, of the disease generally presupposes some notion of its cause. There may be different frameworks of putative causation operating between patients and their healers. The patient may believe he or she fell ill because of exposure to the cold or consumption of the wrong kind of food. The doctor may have other ideas. For most of human history, however, doctors and patients shared similar causative cosmologies. With the rise of modern biomedicine, the potential divergence of the explanatory frameworks increased. This separation of the conceptual worlds of doctor and patient is part of the power, and the problems, of modern medicine.

More constant are the normative dimensions of health and disease. Health, however conceived, has positive qualities, disease negative ones. Aesthetics plays a large part in contemporary judgments on these matters. Sumo wrestlers and weight lifters are perceived as healthy, even if their life expectancies may be less than those of ninety-pound weaklings. Straight teeth are considered healthier than crooked ones. Plump women in some cultures are considered healthier than their leaner sisters; in other times and places, the reverse is the case. Sunbathing is a relatively recent phenomenon among the lighter skinned races; malignant melanoma has caused a reevaluation of the relative merits of the aesthetic and the medical.

All of these examples point to the complexity and historical contingency of perceptions of health and disease. Following Alexander Pope's dictum, "this long disease, my life," this essay will use disease as the standard and assume that notions of health are somehow implicit in the historical perception of disease.