The concept of “disease” can be defined in different ways, depending upon the approach and the most important criterion chosen by scholars. Whereas both value-requiring and dysfunction-requiring definitions of the concept of “disease” are applicable to particular cases but inappropriate for others, they should, therefore, be combined for constructing a complex concept.
The first value-requiring definition of disease offered by Lester King is based on the culturally-relative values. Therefore, according to this definition, the condition can be regarded as a disease if it is assumed so by the community. For example, masturbation or slave’s desire to escape was condemned by the society of the nineteenth century, but are regarded as normal today (Schwartz, 2005, p. 5). On the other hand, the Chinese practices of foot-binding, which deformed people’s feet and left them unable to walk, were considered normal in the past. Therefore, this value-requiring definition of disease does not pass the test of the time and makes the definition rather confusing.
Another value-requiring definition, offered by Culver and Gert, focuses on objective values and uses the aspect of harm as the main criterion for distinguishing between healthy and unhealthy conditions. This definition assumes that disease means that a person suffers or is at increased risks of suffering. In that regard, in the case of Mr. Smith discussed at the beginning of the article under analysis, had a malady not only when he had a fever, but also when he had a running nose because he was already under the risks of the further spread of infection in his body. However, in the frames of this value-requiring definition, pregnancy can be regarded as a malady because it can result in serious complications and even death. Similarly, the slave’s escape or even dark skin of an individual can lead to negative social implications and increased risks, and therefore can be regarded as maladies. Though this value-requiring definition focuses on objective values, it has a number of limitations.
Alternatively, dysfunction-requiring approaches to the definition of the disease use the presence of biological dysfunction as the main criterion for the definition of impairment (the term offered by Boorse, who promoted the idea of eliminating the value judgments from the definition of disease). Importantly, this approach uses statistical data and considers the specifics of the reference class to which an individual belongs. In that regard, Mr. Smith’s pneumonia can be regarded as impairment because it leads to the organism’s partial dysfunction. However, the main challenge for Boorse’s theory was the statistical calculation of what is normal functioning for a particular class of living beings. For instance, if a particular segment of the human brain is responsible for being attracted by the opposite sex, the phenomenon of homosexuality can be regarded as impairment because it is associated with the failure of the segment of the brain to function like in the rest of the representatives of the brain.
The solution to the limitations of both value-requiring and dysfunction-requiring approaches was offered by Wakefield who combined these theories, creating a concept of harmful dysfunction. According to this approach, a disorder is a condition which deprives an individual of certain benefits and leads to his/her inability to perform a certain natural function, prescribed by the evolutionary stage of the organism.
Therefore, due to the limitations of value-requiring and dysfunction-requiring theories, their combination in the form of the concept of harmful dysfunction offered by Wakefield can be an effective solution for defining the concept of disease or the synonymous terms used by different theoreticians.
Reference
Schwartz, P. (2005). Decision and discovery in defining “disease”. Web.