ABSTRACT
The point of departure for this article is a review of the discussion between Twaddle and Nordenfelt on the concepts of disease, illness, and sickness, and the objective is to investigate the fruitfulness of these concepts. It is argued that disease, illness, and sickness represent different perspectives on human ailment and that they can be applied to analyze both epistemic and normative challenges to modern medicine. In particular the analysis reveals epistemic and normative differences between the concepts. Furthermore, the article demonstrates, against Nordenfelt’s claim, that the concepts of disease, illness, and sickness can exist without a general theory of health. Additionally, the complexity of different perspectives on human ailment also explains why it is so difficult to give strict definitions of basic concepts within modern health care.
I. INTRODUCTION
The triad of disease, illness, and sickness has been applied to denote medical, personal, and social aspects of human ailment. The distinction between illness and disease has been noted in theoretical medicine since the 1950s (Feinstein, 1967; Parsons, 1951, 1958, 1964). Andrew Twaddle first applied the full triad in his doctoral dissertation defended in 1967 (Twaddle, 1968, 1994a, p. 22). The distinction between disease, illness, and sickness has become commonplace in medical sociology, medical anthropology, and philosophy of medicine.2 In recent years, the triad has been elaborated and more strictly defined (Sachs, 1988; Twaddle, 1994a, 1994b), but also fundamentally challenged (Nordenfelt, 1994). Lennart Nordenfelt has argued that the triad3 is fruitful only within the context of a general theory of health (Nordenfelt, 1987, 1994).
The point of departure for this article is the discussion between Twaddle and Nordenfelt of the triad (Nordenfelt, 1994; Twaddle, 1994a, 1994b). Its objective is to investigate whether the triad of disease, illness, and sickness remains fruitful, despite the critique. This will be done by addressing the following questions:
_ What is the triad’s explanatory power? In particular, how can it be applied to analyze a) controversial cases and b) epistemic and normative challenges to modern medicine?
_ What is the relation among the concepts of the triad? In particular, is there a primacy of any of the concepts?
_ Can the concepts of the triad be upheld only within the framework of a general theory of health, as Nordenfelt claims?
_ Can the triad shed light on why it appears to be so difficult to define basic concepts within modern health care?
To address these questions, I will apply a provisional definition of the triad and confront it with difficult cases discussed in the literature.
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