Myth #4: Diseases are Discrete Entities

Modern medical practice is essentially built upon the idea that deviance comes in discrete packages ("disease," "infection," "disorder," "syndrome," etc.). This leaves the following tasks for medical researchers and health practitioners:

1. Refine the definition of the deviance-entity; draw sharper boundaries.
2. Improve the process by which it can be recognized according to its symptoms.
3. Identify the cause(s).
4. Discover potential treatments.

If a patience presents a heretofore unencountered set of symptoms, medical professionals immediately attempt to determine "what" this person "has," and isolate the essence of this newly discovered entity.

This regimen has produced two major tendencies:
1. The proliferation of diseases and disorders. As new realities are encountered, new entities are devised to account for them. Additionally, new diseases mean new research programs, new grants, more journal articles, more conferences, different ways to market treatments: in effect, more ways to circulate capital and sustain the work of those in R&D fields.

2. Growing prevalance of certain diseases. In part, this occurs when new experiences are not separated into new disease categories, forcing already existing ones to expand. And in part, this results from the pathologizing of characteristics that were previously viewed in a different light. Once again, from an economic standpoint, escalating rates of disease mean expanded investment in research and increased markets for treatments.

This is not to say, of course, that capital investments are the only (or even most important) driving force behind these tendencies, or that the medical establishment does not accept these premises concerning the nature of disease with all intellectual sincerity.

However, this does highlight the way in which our propensity to view health in terms of discrete, material entities is shaped by a capitalist organization of social institutions (including those related to medical research and public health), in which capital investments are discretely categorized and allocated according to quantifiable outcomes; goals and results are measured in terms of material inputs; and individual human bodies serve as the primary site of intervention (as opposed to integrated social processes).

This all occurs in the face of one undeniable fact: it is really hard to define diseases in such a way that they may be sustained as discrete entities. In actuality, we don't discover diseases; they are not just sitting there, waiting for us to learn of their existence. We create diseases, disorders, syndromes, etc. Faced with a complex and variable reality, we impose categories upon our experience in order to simplify and more easily understand it. Oftentimes definitions of diseases are based more upon history and accident than on any coherent set of principles. Furthermore, a single disease may present such widely varying symptoms that any two people may experience it in entirely different ways, and the causes may be multiple or unknown. (Autism is a great example.) Why, then, should it be considered a single "thing"? Still, we proceed as though the categories that we have created have an essence and an existence all of their own, and our task is to simply discover what that essence is.

There are significant social and political implications as to what behaviors and conditions become pathologized (or de-pathologized, in the case of the removal of "homosexuality" as a psychiatric disorder). What we see as a "problem" is deeply socially embedded. It should also be noted that the creation of "problems" is, in itself, a strategy that is employed by dominant forces to mobilize social and political resources, as well as capital flows, in the service their own agenda. Not that every new disease is a conscious and strategic creation of a conspiring economic elite, but one should be aware of the way in which this generalized (and non-uniformally applied) strategy can be employed in the domain of health.