| Book Review | Health and History, 7.2

Book Review

Health, Disease, and Illness: Concepts in Medicine. Edited by Arthur L. Caplan, James J. McCartney and Dominic A. Sisti (Georgetown University Press, Washington, DC, 2004, pb, ISBN 1-5890-1014-0) xiv + 311 pp.

This anthology provides a provocative but certainly not exhaustive review of the interface of health, disease, and illness—a domain that serves as the focus for various disciplines, including history, medical anthropology, health sociology, public or population health, and last but not least, philosophy and theology. The editors of the volume are all philosophers—or, more specifically, bioethicists—and most of the contributors fit into these disciplinarian categories. Some of the essays, however, were written by representatives from history, sociology, psychiatry, and science and technology studies.

Part I focuses on 'Historical Discussions of Health, Disease, and Illness' and includes eight essays, virtually all drawn from classical works, ranging from Galen's discussion on 'natural faculties' and Maimonides' essay on 'diseases of the soul' to Ssasz's antipsychiatry treatise on the 'myth of mental illness' and Engel's call for the need for a biopsychosocial medicine as a counterpoint to biomedical reductionism. Part II includes six essays on 'Characterizing Health, Disease, and Illness' which grapple with the concept of health, the distinction between disease and illness, and, even more specifically, the distinction between mental and physical illness. This section also includes an essay by Caplan that argues that ageing can be viewed as an 'unnatural' or 'medical' process—an argument that runs counter to the common sociological assertion that bodily processes such as birthing and menopause should not be 'medicalized.'

Part III on 'Clinical Applications of the Concepts of Health and Disease: Controversies/Consensus' includes six essays that critique the biomedical tendency to define ambiguous sexual characteristics, hyperkinesis, chronic fatigue syndrome, premenstrual syndrome, menopause, and Alzheimer disease as illnesses or abnormal conditions. Part IV on 'Normalcy, Genetic Disease, and Enhancement: the Future of the Concepts of Health and Disease' continues this critique and consists of the final seven essays. It focuses on recent issues emanating from developments in biotechnology and the Human Genome Project, such as the medicalization of aesthetic surgery and the effort to identify genetic diseases and define normalcy, intellectually and biologically. Caplan, one of the editors, contributed the last essay titled 'What's morally wrong with eugenics?' which obviously reflects his discomfort with some of the implications associated with these recent developments.

Regardless of one's personal views on the various issues raised in this volume, all of the essays should provide for stimulating reflection and discussion in courses in the health sciences. Despite this, the volume is highly Euro-centric in that virtually all of the essays, with one exception, focus on examples drawn from western societies, particularly the United States. The one exception is a historic and racist essay by Samuel A. Cartwright entitled 'Report on the diseases and physical peculiarities of the Negro race.' The volume does not include a single contribution by an anthropologist, despite the fact that there are a growing number of medical anthropologists who are now working in bioethics. Finally, the volume is medico-centric in that, with the exception of some of the historical essays, all of the issues discussed are drawn from biomedicine and give absolutely no attention to indigenous medical systems or professionalized traditional medical systems, such as Ayurveda and Unani in South Asia or Chinese medicine, or the wide array of therapeutic systems that come under the rubric of 'complementary and alternative medicine,' ironically a biomedical construction, which has taken western societies by storm since the early 1970s.

Aside from these shortcomings, the essays in this volume recognize that health, disease, and illness are more than merely physiological or emotional states but are also socio–cultural constructions, mediated by factors such as gender. Unfortunately, they downplay the impact of class, race, and ethnicity and, at a more macroscopic level, political–economic factors, including global capitalism or neo-liberalism and environmental degradation upon these interrelated phenomena. Health, disease, and illness are not absolute states of being but highly elastic concepts that must be evaluated in a larger socio–cultural context. They are shaped by access to and control over the basic material and nonmaterial resources that sustain and promote life at a high level of satisfaction.

Hans Baer

University of Melbourne

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