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What makes a disease a disease?

What makes a disease a disease?

What makes a disease a disease?

A new book about what makes a disease a disease, takes a humorous (yet informed) look into the cultural side of disease and human health, and what happens on its borderlines.

Canberra-based scientist Mike McRae read for a master’s degree in health culture, he says to get a “better understanding about disease from a cultural perspective”. This after starting his career in science in pathology at Queensland medical laboratory. His passion for sicence lead to a hunger to know more. Over the years McRae has written extensively on science and developed educational resources, including for the likes of In September 2018 he is set to publish a new book, Unwell? What makes a disease a disease.

“I wrote the book initially as a relatively academic piece, keen to make sure I had the science and history right. But after I wrote the first draft I was encouraged to weave more of my own journey in there. I don’t consider myself sick, or even a great expert. I’m a passionate science writer with an opinion and a big mouth. But on reflection I found just how much of my own life – not to mention of those around me – are affected by how we define disease. So Unwell turned from a textbook to a patchwork of historical events, contemporary research, and my own life experiences,” McRae says of the book.

The self-confessed science and history geek sat down with to discuss diseases, wellness and what you can do to lead a healthier life.

So, what exactly makes a disease a disease?

There are two answers to this question. The simpler, and maybe more trite answer is the World Health Organisation and the American Psychiatric Association, who each put together a book that encodes long lists of diseases of the body and the mind. Catalogues like those are the closest we have to a global consensus on how to distinguish and treat illness, and are based largely on literature reviews, petitions, and discussions with the medical community.

But the more philosophical answer is a little more complicated. If we put on our anthropologist’s hat, we could say anyone community of people treats a phenomenon as a disease when a condition meets three criteria; it’s an abnormal form, function or behaviour; it compromises our ability to fulfill an expectation or meet a responsibility; and it’s not our fault. Think of a hangover – it’s not an everyday event; it impedes your ability to work; but you did it to yourself. If it was food poisoning, you might have more luck saying you’ve got a disease.

It’s not a perfect answer, but really there isn’t one. It is complicated, which is why we revise those books every couple of decades and change our mind on whether various conditions are diseases or not.

Not only do these criteria have ill-defined boundaries, responsibility and blame are more moralistic than biological concepts. This makes disease ripe for stigma – either you’re broken, or you’re bad. Take your pick.

How has our understanding and interpretation of disease changed in the past two decades?

The information age has made it easier for people to find others who share their health experiences, or learn from communities of experts. That’s tremendously empowering, helping people feel less alone and potentially providing opportunities that help ease suffering.

But it isn’t without risk. It’s not always easy for us to pick out who or what to trust. In my first book, Tribal Science (UQP, 2011), I write about how our brain is a social organ that builds knowledge collectively largely based on who we identify with, and that isn’t always going to lead us in the most helpful direction where our health and wellbeing is concerned.

How can we be more responsible for our own health?

The single best thing any of us could do for our health is to develop a long-term, trusting relationship with an expert well versed in evidence-based medicine, such as an empathetic general practitioner. In an ideal world they would act as an advocate for your health and wellbeing, and would know how to talk with you because they understand the personal details of your life.

Unfortunately, the modern world has gotten in the way a bit in less than ideal ways. Short consultation times, expensive appointments, staff turnover, and unstable home bases can all force our hand, meaning most of us don’t have a trusting, long-term relationship with a single doctor. Those consults can leaving us feeling less like a friend seeking assistance and more like a defendant on trial. I’d love for that to change, and maybe one day it will. But for now we have a medical system that is geared towards suiting us as a group and not as individuals.

In the meantime we need to understand that disease isn’t a strict dichotomy of blame versus absolution. Our bodies can cause us to suffer in a bunch of ways, and often we just don’t know why.

Finding a solution doesn’t always need to be a matter of fixing biology. There are other factors we can take into consideration in alleviating the suffering of ourselves or others, such as being flexible with our expectations and accommodating diverse needs. The first step is pretty simple; have a conversation and ask ‘How can we help?’. It’s surprising how rarely that happens.

Unwell: What makes a disease a disease? By Mike McRae (UQP, $29.85)

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