In Sickness and in Health
IN RECENT DAYS doctors have become the targets of considerable anger. The reasons given for this anger are varied, ranging from the charge that not enough people are being given proper medical care to the complaint that doctors fail to react to patients as individuals. It is safe to say that among almost all parties to this debate, process has become confused with product. Since most people would agree that the product of medical care is health, it seems at first glance obvious that the process of medical care should be primarily concerned with the eradication of disease.
There is, however, more to it than that; but in order to define the process of medical care with any kind of precision, one must attempt first to cut through a fog of confusion about these matters in which facts are often inextricably bound up with personal feelings, and both facts and feelings must therefore be taken into account.
The process of care-this is the first of a number of distinctions I shall be making in this essay-involves latent as well as manifest functions on the part of both doctor and patient. The manifest function of the doctor is the cure of disease: the making well of the lungs in pneumonia, the heart in heart attacks, etc. The latent function is healing, a mysterious process that makes well the man who owns the lungs or heart or kidneys. This distinction implies in turn-what I believe to be the case-that there is a difference between disease in an organ of the body and the illness of the whole man. In the following pages I shall use the word “illness” to mean what the patient feels when he goes to the doctor’s office, and “disease” to mean what the patient has after leaving the doctor. Disease, then, is something an organ has; illness is something a man has.
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