illness

illness Concepts of illness cannot be understood just in terms of the absence of good health. Advances in the science of genetics are so persuasive to many apparently healthy people that they have agreed to allow double mastectomy or removal of the colon merely because the physician has advised them of the likelihood of cancer at some future date. Conversely, sufferers from conditions like chronic fatigue syndrome or Gulf War illness claim extreme disability in the absence of a proven organic cause and in the face of scientific denial that there is anything ‘really’ the matter save malingering or ‘yuppie flu’. The desire by lawyers, especially in the US, to exculpate their clients has led to recognition of any number of novel illnesses, including battered spouse syndrome and junk food ‘madness’, which rely only on the ability of a lawyer to persuade a jury of the ‘reality’ of an illness for the defence to be effective. The way in which medical care is funded has ‘medicalized’ a number of conditions once considered moral failings, including compulsive gambling, alcoholism, drug addiction, and obesity. Finally, some illnesses seem almost to be the result of fashion trends, or to have their roots in the social stigma attached to a particular gender, race, or class. Some examples are chlorosis, hysteria, neurasthenia, ‘reefer madness’, shell shock, recovered memory, epidemic violence among black men, attention deficit disorder, and even alien abduction syndrome.

Attitudes to illness

In the developed world it is indeed science that holds principal authority over the patient's contested body, with respect to deciding about whether or not a person is ‘really’ ill, what sort of treatment is required, and who will pay for it. But other authorities are at work as well, including government bureaucrats, insurance companies, politicians, the media, history, the law, and even the patient, whose subjective judgements about his or her state of health hold greater or lesser sway according to any number of circumstances.

Other societies have respected, or even worshipped, other authorities, which have in turn shaped concepts of illness. Shamanistic cultures even today conceive of illness in ways that seem to us supernatural or magical. If a person has been cursed or has committed some transgression, the true nature of the problem is discovered and an appropriate remedy sought. Supernatural diseases require supernatural cures, which often involve consultation with a dead relative, who intervenes with the gods or with powers of Nature to restore health. All this is conducted quite publicly, often under the guidance of an experienced healer, who may supply a suitable story as to why an illness has occurred. The satisfactory nature of this system is attested to by its enduring popularity, even when scientific medicine is offered as an alternative. Illness in shamanistic societies can affect individuals, but also afflicts families or even entire villages. The cure in such cases often involves isolation of an offending individual from the group, at least until the situation returns to normal.

Ancient Greek physicians were among the first to distinguish themselves from what are usually called temple healers, that is, healers relying on resort to the gods. They did so not by offering better cures for illnesses, at least not by modern scientific lights, but by appealing to the fashion for rational philosophy among the upper classes of society. Hippocratic physicians debated with their rivals in the marketplace in the same way that philosophers did, and their writings are among the earliest testimonies to the Greek understanding of nature.

The Hippocratic corpus of texts, most of which date from between 430 and 330 bce, were the work of many different authors. In a particularly significant text, On the Sacred Disease, the writer dismissed the notion that epilepsy was caused by the gods or by supernatural influence. Every disease was in some sense divine, the writer argued, because nature itself was divine. But the proximate cause of the sacred disease and indeed of every disease was entirely natural and therefore by implication subject to natural remedies. Epilepsy was caused by a congestion of phlegm that stopped up the brain and made the sufferer fall down and lose consciousness. One could easily see this by examining the brains of goats, which were particularly subject to the condition and had very phlegmy brains. This is scientific nonsense, of course, but it is also totally rational, within its own terms of reference, and was based partly on observation.

Illness, for the Greek physician, was a lack of balance and harmony with nature. The physician was therefore a student not only of the individual body, or microcosm, but of its place in the larger natural world, or macrocosm. This sort of thinking is particularly apparent in another Hippocratic work, Airs, Waters, Places. In that treatise, the writer outlined how environmental factors dictated the sorts of illnesses people suffered from and how the physician, often an itinerant, had to study the environment of the ill person before treatment could be effective. The treatise is also intensely political. The traditional enemies of the Greek city states were characterized as flabby, lazy, and decadent, as a consequence of the hot eastern environment they inhabited, and were subject to diseases of sloth as a result.

Acceptance of science

It can be argued that, after the rebirth of science in the seventeenth century, the concept (and conquest) of illness marched forward quickly. Thomas Sydenham (1624–89), the English Hippocrates, revived rational observation and dismissed excessive theorizing about disease. John Snow (1813–58) demonstrated the water-borne nature of cholera with his study of the Broad Street pump. Louis Pasteur (1822–95) and Robert Koch (1843–1910) pioneered bacteriology, and science's triumph over disease seemed nearly complete. But in fact objections to rational or scientific concepts of illness have been strenuous throughout history. These attacks are characteristically levelled against medical ‘experts’ and are largely based on cultural conflict and the vast area of human experience that science-based medical practice appears to neglect.

The Roman gentleman Pliny the Elder, who died in the eruption of Mt. Vesuvius in ad 79, wrote one of the earliest and most influential attacks on rational Greek medicine in his encyclopaedia of natural history. For him, Greek physicians were not only foreigners, but murderers, preening sodomites and, worst of all perhaps, experts, who separated medicine from the general knowledge that a paterfamilias like Pliny believed was necessary to care for his estate, including its health. Greek physicians more than anyone were responsible, Pliny concluded, for ruining the morals of Rome. For aristocrats like Pliny, medicine need not be complicated. A proper regimen of health was really all that was necessary. Traditional folk remedies and rituals, like cabbage stew or inhaling the breath of farm animals, usually did the trick. These things could be learned from friends and relatives, or from reading the right kinds of books oneself.

Pliny's fulminations against medical experts enjoyed a wide audience especially among medieval and Renaissance humanists, who lauded not only the great encyclopedist's learning but also his advocacy of rural retirement and domestic economy as the road to good health and the way to avoid illness. The humanist poet Petrarch (1304–74) wrote a famous invective against learned physicians, directed at Pope Clement VI, advising him to dismiss his doctors, who did nothing but belch lies with their medicine-smeared tongues and waste people's time. Geoffrey Chaucer (?1340–1400), an open admirer of Italian humanism, echoed similar sentiments in his Nun's Priest's Tale, one of the Canterbury Tales. In this epic, the old widow who ruled the farm survived happily on very little money and needed only a temperate diet, exercise, and a glad heart to keep her healthy. Like a true Stoic, she expected to experience illness, old age, and death, but by careful living and above all by self-sufficiency she managed to be happy nonetheless without resort to physicians and medicines. Her chickens, vain to the last, believed otherwise and suffered for it.

Another sort of dissent came from religious and medical reformers like Paracelsus (1493–1541) and Van Helmont (1579–1644), who, like medical humanists, elevated folk practice, nationalism, and use of the vernacular in their medical ideas. Paracelsians and Helmontians objected to humoural explanations of illnesses. These explanations were based on the Greek idea that disease affected the entire body and was thus ‘systemic’ and individualized. Humoural illnesses required gradual treatment under expert guidance that could take weeks or even longer. The dissident Paracelsus and his followers argued otherwise. Often employing militaristic metaphors, Paracelsus argued for what would later be called the ‘ontological’ theory of disease — that is, the theory that diseases were caused by agents that attacked the body from outside and affected it only locally. Disease entities thus had a real existence outside the sufferer and affected similar people in similar ways. The purpose of therapeutics, then, was to apply counteragents, usually chemical ones, which would act quickly against the attacker.

Van Helmont elaborated on Paracelsus's hypotheses, as did others, and it is tempting to assume that the two men somehow prefigured the germ theory and modern medical chemistry. But Paracelsian and Helmontian world views undermined traditional medical authority much more radically than is immediately apparent. Like Pliny and like some Christian humanists, these medical philosophers argued that bodily ills were caused by occult and mystical influences. For them, the Greek idea of the natural cause of disease could explain very little. Paracelsus went further, to argue that ontological disease agents were poisons of sorts that were unleashed astrologically by chemical disturbances in the heavens. Exactly how this was accomplished remains unclear. But arguments like these crop up from time to time against totally materialistic explanations of the origin of bodily ills. A medical system that excludes from consideration notions of the mystical, occult, spiritual, or religious will never be entirely satisfying to many. To the understandable sufferer's question ‘Why me? Why now?’ the scientific physician might offer a statistical observation or simply deny that such concerns have anything to do with medicine. A medical astrologer could answer the sufferer very easily, as long as the patient believed in the validity of the explanation.

Faye Getz

Bibliography

Bynum, W. F. (1993). Nosology. In Companion encyclopedia of the history of medicine, (ed. W. F. Bynum and R. Porter Routledge). London and New York.
Levi-Strauss, C. (1963). The sorcerer and his magic. In Structural anthropology. Basic Books, New York.
Lloyd, G. E. R. (ed.) (1978). Hippocratic Writings. Penguin Books, New York.

See also health; shamans.