Three Perspectives: Disease, Sickness & Illness (Underlying pathology; biologically defined: the practitioner’s perspective. The illness seen in terms of a biological theory of disorder) Illness (The person’s subjective experience of their symptoms. What the patient brings to the doctor) Sickness (Social & cultural conceptions of the condition: cultural beliefs and reactions such as fear or stigma. These affect how the patient reacts, and also what is considered a disorder suitable for medical treatment) Disease = biomedical representation of a condition in terms of etiology, symptom complexes & biological explanations. Every culture has beliefs about health and disease; these are learned by individuals, who incorporate these beliefs (fear of cancer; belief that thinness is desirable, etc) into their presentation of symptoms to the doctor. So, the underlying disease is filtered through cultural perceptions to produce the illness as presented to you. This sometimes leads to phenomena such as “the hidden diagnosis” – the idea that a patient sometimes comes to you with a symptom that is not what they actually want to discuss, but they are afraid to raise the real issue (their parents are fighting; they fear they may have an incurable condition, etc). Sickness = more diffuse societal view of the diagnostic label. E.g. what does “cancer” mean to people? The answer varies hugely according to their culture The Illness = the individual’s reaction to the disease, as modified by social & cultural expectations The good MD has to be aware of each level. Insufficient to treat only the disease without treating how it is affecting the patient. Sometimes, cultural views affect our classification of disease: Thomas Szasz spoke of the myth of mental illness 1