- Dec 2022
I came here after recalling a critique by Bessel van der Kolk's "The Body Keeps the Score: Brain, Mind, and Body in the Healing of Trauma" regarding the disease model and it's negative impact on adequately helping people with trauma. van der Kolk's critique was similar to Marc Lewis' critique of the disease model as it applies to addiction from "The Biology of Desire: Why Addiction Is Not a Disease". This made me wonder what the term "disease" actually means and whether or not some general consensus existed within the medical community. This article suggests there is no such consensus.
This article is by Jackie Leach Scully who holds a "PhD in cellular pathology, University of Cambridge; BA (Hons) in biochemistry, University of Oxford; MA in psychoanalytic studies, Sheffield University".
Scully does several insightful things in this paper the following are the ones that were most salient to me upon the first read: - distinguishes "disease" from "disability" - contrasts the "social model" and "medical model" perspectives on "disability" - The "medical model" referred to here is probably what Lewis & van der Kolk are critiquing as the "disease model".<br /> - Are the "medical" and "disease" model different? - the social model seems to have arisen as a response to the inadequacy of the medical model
- "The social model's fundamental criticism of the medical model is that it wrongly locates 'the problem' of disability in biological constraints, considering it only from the point of view of the individual and neglecting the social and systemic frameworks that contribute to it. The social model distinguishes between impairment (the biological substrate, such as impaired hearing) and the disabled experience. In this view the presence of impaired hearing is one thing, while the absence of subtitling on TV is quite another, and it is the refusal of society to make the necessary accommodations that is the real site of disability. A social model does not ignore biology, but contends that societal, economic and environmental factors are at least as important in producing disability."
- brings up a subtle point that there are two jumps "from gene to phenotype, and from phenotype to experience" and that some of the arguments mentioned "suggest that the 'harm' of the impairment is not straightforwardly related to phenotype. What ought to concern us about disease and disability is the disadvantage, pain or suffering involved, and in a sense the impairment is always a kind of surrogate marker for this experience."