When was the last time you saw your doctor? If you’re health-conscious, then your probably follow a schedule – health is wealth after all. Not all people share the same sentiment though, and some haven’t even seen the inside of a clinic for years. Why, you ask? It all boils down to different concepts of ill health.
Illness, Disease, and Disability
There are actually three ways in which we can describe ill health: (1) as a general feeling of illness, (2) as a set of symptoms pertaining to a disease, or (3) as a failure of a part of one’s bodily system.
Remember those times when you just “feel sick” or “just about to get a fever”? Illness is a general feeling of unwellness – it’s a subjective list of sensations that tell a person that something is amiss within his body. Since it is subjective, this means that any kind of discomfort can be perceived as an illness regardless of any kind of outside evaluation. Taken to its pathological extreme, we have a somatoform disorder, a mental illness associated with extreme cases of ill-health without medical evidence.
This now leads us to the next concept of ill health: disease: A disease is a set of symptoms that has been verified by the medical community. If the sensations that you are feeling fall within the perimeter of the symptoms of a particular disease, then you are, in fact, ill. This is a global agreement among experts that the symptoms you are feeling is labeled a particular name. Either you have a disease, or you don’t have it.
The last concept of ill health, disability, pertains more to the dysfunction of a body tissue, organ, or system (Smithson, 2005). It allows the understanding the body can break down and therefore make someone ill. There is a distinction between disease and disability because a disease might not be due to dysfunction of a body part. For example, the common cold is a disease because of the body’s natural immune response and not because there is something wrong with the body per se.
All three concepts intersect in some way. Someone who can feel palpitations all his life (illness) but is yet to be diagnosed with Wolff-Parkinson-White Syndrome (disease), a congenital heart defect (disability), is an excellent example.
But more important is to note that the difference in perceptions can affect the outcome of a diagnosis. Ill people might not perceive symptoms as an illness (e.g. hypertension doesn’t have overt symptoms) even if it’s already a disease. Some who feel unwell might have illnesses that are somatoform in nature, meaning they feel ill even without the symptoms. In this case, feeling “well” sometimes does not equate to being disease-free, and not finding a disease doesn’t mean that you are not really ill.
The Clinical Iceberg
The different concepts of ill health may be able to explain the behavior of patients with regards to medical treatment. Since there are instances in which the sensations of illness do not really coincide with peer-approved symptoms of disease, there is a big chance that a lot of diseases go undiagnosed and untreated. If you have a disease but don’t show symptoms, then chances are you won’t go for treatment. The same goes for the other end of the spectrum; hypochondriacs feel ill regardless of the real deal.
Simply said, patients are generally more predisposed to think in terms of illness and doctors think by manner of diseases. The disparity between the two perspectives is the most probable reason why there is only a fraction of the population who goes to a doctor for medical help. This is what epidemiologist John Last has dubbed the Clinical Iceberg, a metaphor for the countless unseen cases in medicine.
Mental health is the most affected by the above concepts, more so because the realm of the mind is something that people can intuitively think about. Why go to a shrink when friends can give the same therapeutic outcome? But let it be known that not all psychological issues are normal problems of living. Sometimes there is a real disorder lurking in the shadows.
With this said, it really doesn’t hurt to go for a consultation once in a while.
Smithson, R. (2005). AQA AS Health and Social Care. Philip Allan Publishers, Ltd.
McKinlay, J. & Link, C. (2007). Measuring the Urologic Iceberg: Design and Implementation of The Boston Area Community Health (BACH) Survey. European Urology, 52(2), 389-396. doi: 10.1016/j.eururo.2007.03.013.