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Diseases as real entities or nominalist constructs?

One of the lasting positive impacts of social constructivism on the history of medicine is the notion that diseases are a social constructs. This is not to deny, of course, that there is a biological substrate for illnesses and conditions that lead to the specific deterioration of bodily functions and ultimately to the death of the organism. It just means that there is no necessary distinct, discrete and permanent biological reality behind conditions labelled with disease names.

Until recently, I naïvely assumed that the constructivist notion of disease was a product of the 1970s and 1980s. Turns out, however, that this is not a new idea among historians. Already in 1922, historian of medicine Charles Singer wrote in a review of P. G. Crookshank, ed., Influenza, that:

We are doubtless too accustomed to think of a disease as itself an entity, as an existence in itself rather than as a mental concept used to cover a group of sick people who exhibit certain phenomena in common.

and continues:

The confusion has been encouraged by the great advance of bacteriology in modern times and its success in showing that certain symptom complexes are invariably associated with certain organisms. Yet there are dangers in confusing the mental concept of a disease and the actual collection of cases of sick people from whom the concept is derived.

This is interesting: Singer was apparently quite ahead of the current understanding. Does anyone know about a good study of the history of the constructivist understanding of disease?

(Singer’s review is quoted in the Then and Now column in TLS, 21 May 2009)

Thomas Söderqvist

Author Thomas Söderqvist

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