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The Realm of Disease

In The Realm of Disease, we grapple with the fundamental question: What is a disease? This query has long been a central focus in the philosophy of medicine, and for good reason. The way we define disease has far-reaching implications, shaping everything from treatment decisions to health insurance policies. When we classify a condition as a disease, we make a powerful statement about its legitimacy, its severity, and its claim on resources.

There are two main schools of thought when it comes to defining disease: naturalism and normativism. Naturalism, an extension of the naturalistic view of health, sees diseases as simply dysfunctioning physiological systems. In this view, a disease is a deviation from the biological norm, a malfunction in the machinery of the body. The contrasting view (normativism), which we might call the ‘values-based’ approach, sees diseases as states that we consider undesirable or detrimental. From this perspective, it’s not just the objective biological reality that counts, but also our subjective judgments about that reality. A condition is considered a disease when we view it as damaging, unpleasant, or in need of treatment.

Both of these views have their merits and their drawbacks. Naturalism has the appeal of objectivity, of grounding disease in the solid facts of biology. But it struggles to account for the value-laden nature of disease attribution. After all, we don’t consider every biological quirk or deviation to be a disease. There’s an element of judgment involved, a decision about what states of the body are acceptable and what states demand medical intervention.

Normativism, in contrast, puts values front and center. It acknowledges that disease is not just a biological phenomenon, but a social and cultural one as well. What counts as a disease can vary across time and place, depending on what a given society considers normal, desirable, or harmful. The analogy of weeds in a garden is apt here: just as a weed is simply a plant we’ve decided we don’t want, a disease is a bodily condition we’ve decided is undesirable.

But normativism has its limits too. Taken to an extreme, it could suggest that diseases are purely a matter of opinion, that any condition could be a disease if enough people dislike it. This seems to miss something important about the biological reality of disease, the fact that diseases involve real disruptions of bodily function, not just disapproved differences.

This is where hybridism comes in, offering a middle path between naturalism and normativism. Hybridism says that for a condition to be a disease, it must meet two criteria: it must involve abnormal physiological functioning, and it must be disvalued or harmful. In other words, a disease is a biological malfunction that we care about, that we see as a problem in need of solving.

This two-pronged view helps to make sense of many of our intuitions about disease. It’s why we consider cancer a disease (it involves a clear biological malfunction that causes immense harm), but not left-handedness (which is a biological deviation but not one we consider inherently negative). It’s also why the line between health and disease can shift over time, as our values and understanding evolve.

Pregnancy, for instance, is a natural biological process that has been increasingly medicalized over the past century. While medical intervention can be lifesaving in high-risk pregnancies, there is concern that the routine use of medical procedures and technologies in low-risk pregnancies may be unnecessarily pathologizing a normal physiological event.

From a naturalistic perspective, pregnancy involves significant physiological changes, but these changes are not inherently dysfunctional or abnormal. They are part of the body’s adaptive response to support the development of a new life. However, the medicalization of pregnancy has often framed these changes as deviations from a non-pregnant norm, suggesting a disease-like state in need of management.

From a normativist perspective, the classification of pregnancy as a disease or a natural state is heavily influenced by cultural values and expectations. In some contexts, pregnancy is viewed as a natural and celebrated part of life, while in others, it is seen as a medical condition to be carefully monitored and controlled. These differing values can shape the way pregnancy is approached by healthcare systems and experienced by individuals.

The hybridist view would suggest that pregnancy, in and of itself, is not a disease. While it involves significant biological changes, these changes are not inherently dysfunctional or harmful. However, when complications arise that threaten the health of the mother or fetus, the pregnancy may cross the threshold into a disease state that requires medical intervention.

Hybridism also sheds light on the dual nature of medicine, its constant balancing of the aims of care and cure. When we can’t fully correct the biological abnormality of a disease (cure), we can still work to mitigate its harms and improve quality of life (care). Both of these are valid medical goals, reflecting the two foundations of disease in hybridism.

Of course, hybridism isn’t perfect. It still leaves room for debate and disagreement about what counts as abnormal functioning, or what harms are sufficient to warrant the disease label. But it provides a useful framework for navigating these complex issues, one that honors both the biological and the normative dimensions of disease.

Ultimately, how we define disease is more than just a philosophical puzzle. It has real implications for how we practice, allocate resources, and understand our own bodies and experiences. By grappling with these questions, we can develop a richer, more nuanced view of health and illness – one that recognizes the interplay of fact and value, of biology and culture, in shaping the human condition.

Categorizing Disease

Diseases can be classified in various ways, each offering a unique perspective and serving different purposes in healthcare. These include topographic (by bodily region), anatomic (by specific organs), physiological (by body functions), pathological (by disease processes), etiologic (by causes), epidemiological (by population patterns), and statistical (by data-driven criteria) classifications. Each approach contributes to a comprehensive understanding of diseases, guiding prevention, diagnosis, treatment, and healthcare planning, but to truly understand disease and our role as practitioners in it, we must also understand its natural course – the inherent trajectory that a condition takes over time, regardless of any interventions we might employ. This understanding is crucial as it fundamentally shapes how we approach disease interventions and what expectations we set for recovery or management.

When we look at the natural course of diseases, we can broadly categorize them into three types: self-limiting diseases, chronic diseases, and degenerative diseases. Each of these categories has its own unique characteristics that profoundly impact both prognosis and the approach to care.

Self-limiting diseases are the ones that tend to resolve on their own, without the need for any heavy-handed intervention. Think of the common cold, or a minor skin infection. In these cases, the body’s innate healing wisdom is usually enough to overcome the illness given enough time. For herbalists working with self-limiting conditions, our role is often more about supporting the body’s own healing process and easing any uncomfortable symptoms, rather than aggressively fighting the disease itself.

Chronic diseases, on the other hand, are the long-haulers. These are conditions like autoimmune diseases that can persist for years, often waxing and waning in severity over time. They’re characterized by periods of flare-ups, where symptoms surge, followed by periods of remission where things settle down. The pattern of chronic diseases can be influenced by all sorts of factors – stress, diet, environmental triggers, you name it. As herbalists, understanding the ebb and flow of chronic diseases allows us to fine-tune our approach, offering more intensive support during flare-ups and focusing on maintaining resilience during remissions.

Then there are degenerative diseases, the ones that progressively worsen over time, no matter what we do. Think of conditionslike ALS or advanced stage cancers. With these diseases, the focus of herbal medicine often shifts towards palliative care – using our plant allies to improve quality of life and ease suffering, even if we can’t ultimately reverse the course of the disease.

Understanding the natural trajectory of different diseases is absolutely essential for us as herbalists. It helps us separate out the true impact of our interventions from the normal waxing and waning of a condition. So many folks come to us for help when their symptoms are at their peak, especially with self-limiting or chronic conditions. If we don’t understand the natural course, we might attribute their inevitable improvement to our herbs, rather than the body’s own resilience. Misattributing the natural course of a disease to the effects of herbal interventions risks squandering the precious potential of our botanical allies.

Understanding the natural course of the disease also helps guide us in when to intervene more actively, and when to take a step back and let the body do its thing. It’s about respecting the innate wisdom of the body, and knowing when interventions are truly needed versus when they might be unnecessary or even getting in the way.

Ultimately, being grounded in the natural course of diseases is about practicing with integrity and setting realistic expectations. We have a responsibility to our clients to be upfront about what herbal medicine can and can’t do in the face of different types of diseases and illnesses. It’s about not overpromising, and being clear about when we’re aiming for symptom relief or health building versus actually directly changing the trajectory of a disease.

When we weave this understanding into the fabric of The Realm of Disease, it adds a necessary depth and nuance to our whole conception of disease. It reminds us that diseases are not static entities, but dynamic processes that unfold over time. And it challenges us to constantly refine our approach, to make sure we’re working with the body’s own healing impulses, not against them.

In the end, grappling with the natural course of disease is about embracing the complexity and the mystery that’s inherent in the work we do. It’s about having the humility to know when to step in and when to step back, and the wisdom to see each client’s journey with fresh eyes. By grounding ourselves in this understanding, we can show up as more effective, more empathetic, and more truly holistic herbalists.

Disease and Herbal Medicine

As we conclude our exploration of the Realm of Disease, it’s important to reflect on the complex relationship between the pathology paradigm of modern biomedicine and the holistic approach of herbal medicine. While the pathology paradigm has undoubtedly led to significant advancements in our understanding and treatment of diseases, it also has limitations.

The limited attention to physical symptoms and their immediate causes, the inclination to break things down into their smallest parts, and the focus on urgent, severe diseases rather than long-term, complex health issues – these are all features of the disease-centered approach that can result in a partial understanding of health and restrict the capacity for genuinely helpful, personalized care.

In an ideal world, modern biomedicine would acknowledge these limitations and work hand in hand with holistic practitioners to address the full spectrum of human health – physical, mental, emotional, and spiritual. But the reality is that we live in a world of overworked doctors, constrained by time and resources, often unable to dig deep into the root causes of a patient’s suffering.

Studies have shown that the average doctor’s visit lasts a mere 15 minutes, with only 9 of those minutes spent face-to-face with the patient. In such a rushed environment, it’s no wonder that complex, chronic conditions often get reduced to a set of symptoms to be managed with a quick prescription.

This is where the modern herbal clinician has a crucial role to play. By being familiar with common pathologies and red flags, we can serve as a safety net, catching potentially serious conditions and making appropriate referrals. By understanding the language and diagnostic criteria of biomedicine, we can communicate effectively with conventional providers and ensure our clients receive integrated, coordinated care.

But our role goes beyond just catching diseases. As herbalists, we have the privilege and the responsibility to hold space for the whole person, to listen deeply to their unique story, and to address the multitude of factors – lifestyle, stress, environment, and more – that contribute to their overall health and well-being.

In this way, we can bridge the gap between the pathology paradigm and the holistic understanding of health. We can provide the individualized, patient-centered care that is so often lacking in the rushed pace of modern medicine. And we can empower our clients to take an active role in their own healing journey, armed with the knowledge and tools to cultivate true, lasting wellness.

So while an understanding of pathology is indeed essential for the modern herbal clinician, it is not the end-all-be-all of our practice. It is a tool in our toolkit, a lens through which we can view the complexities of human health. But it is not the only lens, and it is not sufficient on its own.

Realm of Disease Conclusion

As we conclude our exploration of the Realm of Disease, it’s important to recognize that while the biomedical understanding of disease is crucial for identifying and treating biological dysfunctions, it does not fully capture the complexity of the human experience of illness and health. The concept of disease, with its focus on objective pathological processes and mechanisms, provides an essential framework for understanding and addressing the biological aspects of illness. However, to truly comprehend the multifaceted nature of health and healing, we must also consider the subjective, lived experience of the individual.

This leads us to the Realm of Experience, which encompasses the personal, subjective dimensions of both illness and health. In this realm, we explore how factors such as perception, meaning-making, and the therapeutic relationship itself can profoundly shape an individual’s journey through illness and towards well-being.

The Realm of Experience recognizes that illness is not merely a biological phenomenon, but a deeply personal and transformative experience that affects all aspects of an individual’s life. It acknowledges that the way a person interprets and assigns meaning to their illness can significantly influence their coping strategies, treatment preferences, and overall quality of life.The Realm of Experience also highlights the positive dimensions of health and well-being, reminding us that health is not simply the absence of disease, but a dynamic state of vitality, resilience, and wholeness.

In the next section, we will explore the Realm of Experience and how this dimension of health and illness can inform and enrich our practice. By attending to both the biological and experiential aspects of health and illness, we can cultivate a more nuanced and compassionate understanding of the human condition, ultimately leading to more effective and transformative approaches to supporting well-being.

Next in this series: Part 5 – The Realm of Experience

 

 The botanical illustrations used in this post were created by Annie SewDev.