When do symptoms become a disease? Are there rules or norms, currently or in the past, that tell us when a particular collection of largely symptom-based criteria has enough specificity, utility, or plausibility to justify the appellation disease ? The history of numerous symptom-based diagnoses in use today suggests partial answers to these questions. The 19th-century shift to understanding ill health as a result of specific diseases, increasingly defined more by signs than symptoms, led to a loss of status for illnesses that possessed little clinical or laboratory specificity. Nevertheless, clinicians then and now have used symptom-based diagnoses. Some of these diagnoses owe their existence as specific diseases to the norms and practices of an older era much different from our own. Others have not only thrived but have resisted plausible redefinition done by using more "objective" criteria. Many strategies, such as response-to-treatment arguments, quantitative methods (for example, factor analysis), and consensus conferences, have been used to find or confer specificity in symptom-based diagnoses. These strategies are problematic and have generally been used after symptom-based diagnoses have been recognized and defined. These historical observations emphasize that although biological and clinical factors have set boundaries for which symptoms might plausibly be linked in a disease concept, social influences have largely determined which symptom clusters have become diseases.
". Solche chronisch rezidivierende oder persistierende medizinisch ungeklärte körperliche Symptome werden in der Inneren Medizin als funktionelle somatische Syndrome ( FSS ) bezeichnet [ Mayou 2002 ] . Aber ab wann kann eine Ansammlung von körperlichen Symptomen als FSS definiert werden und besitzt genug Spezifität , um als " Krankheit " bezeichnet zu werden [ Aronowitz 2001 ] ? "
"How specific symptoms are accepted as a disease is partly governed by cultural norms in society ( Aronowitz 2001 ) . Also , ability to work seems to be governed by the expectations and beliefs of the individual and society ( Turk et al . "
[Show abstract][Hide abstract] ABSTRACT: Chronic neck pain, a common cause of disability, seems to be the result of several interacting mechanisms. In addition to degenerative and inflammatory changes and trauma, psychological and psychosocial factors are also involved. One common type of trauma associated with chronic neck pain is whiplash injury; this sometimes results in whip-lash-associated disorder (WAD), a controversial condition with largely unknown pathogenetic mechanisms. We studied the prevalence of chronic neck pain of traumatic and non-traumatic origin and compared the prevalence of, sociodemographic data, self-perceived health, workload and chronic lowback pain in these groups. In a ready-made questionnaire (MONICA study), we added questions about cervical spine and low-back complaints. 6,000 (72%) completed a self-administered questionnaire. 43% reported neck pain: 48% of women and 38% of men. Women of working age had more neck pain than retired women, a phenomenon not seen in men. 19% of the studied population suffered from chronic neck pain and it was more frequent in women. A history of neck trauma was common in those with chronic neck pain. Those with a history of neck trauma perceived their health worse and were more often on sick-leave. About 50% of those with traumatic and non-traumatic chronic neck pain also had chronic low-back pain. We assessed the subjective and objective neuropsychological functioning in 42 patients with chronic neck pain, 21 with a whiplash trauma, and 21 without previous neck trauma. Despite cognitive complaints, the WAD patients had normal neuropsychological functioning, but the WAD group especially had deviant MMPI results—indicating impaired coping ability and somatization.WAD patients had no alterations in cerebral blood-flow pattern, as measured by rCBF-SPECT and SPM analysis, compared to healthy controls. This contrasts with the non-traumatic group with chronic neck pain, which showed marked blood-flow changes. The blood-flow changes in the non-trau-matic group were similar to those described earlier in pain patients but— remarkably enough—were different from those in the WAD group. Chronic neck pain of whiplash and non-traumatic origin appears to be unique in some respects. A better understanding of the underlying pathological mechanisms is a prerequisite for prevention of the development of such chronic pain syndromes and for improvement of the treatment of patients with severe symptoms.
"It positions the condition in the medical arena, and starts the ball rolling. Aronowitz (2008) has written about how diagnoses result from social framing mechanisms and consensus (Aronowitz, 2001), while Brown (1995) has demonstrated a complex range of interactions between lay and professionals, institutions and industries which underpin disease discovery. In any case, there are numerous social factors which shape the diagnosis, and in turn, provide a mechanism by which medicalisation can be enacted. "
[Show abstract][Hide abstract] ABSTRACT: Disease classification is an important part in the process of medicalisation and one important tool by which medical authority is exerted. The demand for, or proposal of a diagnosis may be the first step in casting life's experiences as medical in nature. Aronowitz has written about how diagnoses result from social framing mechanisms (2008) and consensus (2001), while Brown (1995) has demonstrated a complex range of interactions between lay and professionals, institutions and industries which underpin disease discovery. In any case, there are numerous social factors which shape the diagnosis, and in turn, provide a mechanism by which medicalisation can be enacted. Focussing on diagnostic classification provides an important perspective on the human condition and its relationship to medicine. To illustrate how layers of social meaning may be concealed in a diagnosis, this paper uses as heuristic the relatively obscure diagnosis of Female Hyposexual Desire Disorder which is currently surfacing in medical and marketing literature as a frequent disorder worthy of concern. I describe how this diagnosis embodies long-standing fascination with female libido, a contemporary focus on female hypersexuality, and commercial interest of the pharmaceutical industry and its medical allies to reify low sexual urge as a pathological disorder in women.
Social Science [?] Medicine 04/2010; 70(7):1084-90. DOI:10.1016/j.socscimed.2009.11.040 · 2.89 Impact Factor
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