When do symptoms become a disease?
ABSTRACT 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.
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ABSTRACT: To review the content and psychometric characteristics of 6 published tests currently available to aid in the study, diagnosis, and treatment of motor speech disorders in children. We compared the content of the 6 tests and critically evaluated the degree to which important psychometric characteristics support the tests' use for their defined purposes. The tests varied considerably in content and methods of test interpretation. Few of the tests documented efforts to support reliability and validity for their intended purposes, often when relevant information was probably available during the test's development. Problems with the reviewed tests appear related to overly broad plans for test development and inadequate attention to relevant psychometric principles during the development process. Recommendations are offered for future test revisions and development efforts that can benefit from recent research in test development and in pediatric motor speech disorders.American Journal of Speech-Language Pathology 03/2008; 17(1):81-91. DOI:10.1044/1058-0360(2008/007) · 1.64 Impact Factor
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ABSTRACT: A significant proportion of symptoms are medically unexplained. People experience illness but no pathological basis for the symptoms can be discerned by the medical profession. Living without a clinical diagnosis or medical explanation has consequences for such patients. This paper reports on a small qualitative interview-based study of 18 neurology outpatients in England who live with such medically unexplained symptoms (MUS). The findings broadly concur with those identified in the related literatures on medically unexplained syndromes and unexplained pain: the difficulties of living with uncertainty; dealing with legitimacy; and a resistance to psychological explanations of their suffering. From a thematic analysis of the interview data we identify and elaborate on three related issues, which we refer to as: 'morality'; 'chaos'; and 'ambivalence'. Although this article presents empirical data its aim is primarily conceptual; it integrates the findings of the empirical analysis with the existing literature in order to try to make some sociological sense of the emergent themes by drawing on sociological and cultural analyses of risk and the body. We draw on Bauman's concept of ambivalence to suggest that the very processes associated with more precise 'problem solving' and 'classification' do, in fact, generate even more uncertainty and anxiety. On the one hand, we seek closure and certainty and yet this leaves no means of living with uncertainty. Indeed, society does not readily grant permission to be ill in the absence of disease. We conclude by suggesting that an appreciation of the experience of such embodied doubt articulated by people who live with MUS may have a more general applicability to the analysis of social life under conditions of late modernity.Social Science & Medicine 04/2006; 62(5):1167-78. DOI:10.1016/j.socscimed.2005.07.030 · 2.56 Impact Factor
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ABSTRACT: Celem tekstu jest współczesna interpretacja zaproponowanej przez Andrew Twaddle’a triady pojęć choroba-poczucie dyskomfortuchorowanie oraz ukazanie jej aktualności dla współczesnej debaty nad naturą fenomenu choroby. Główna teza pracy głosi, że pojęcia te nie mają charakteru statycznego, lecz wzajemnie na siebie wpływają, co sprawia, że rzeczywista granica między nimi jest nieostra. Akcentuję zarazem, że wbrew tendencji do redukcji fenomenu choroby do sfery biologicznej – o uznaniu danego zjawiska za chorobę decyduje także subiektywna definicja jednostki i czynniki społeczne. Choroba jest więc szczególnym procesem negocjacyjnym, w którym uczestniczą pacjent, lekarz i instytucje społeczne. Wszystkie trzy kategorie z triady nie są zaś systemami zamkniętymi, lecz wzajemnie się konstytuującymi.