On the Distinction between Disease and Illness

In this century a strong tendency has developed to debate social issues in psychiatric terms. Whether the topic is criminal responsibility, sexual deviance, feminism, or a host of others, claims about mental health are increasingly likely to be the focus of discussion. This growing preference for medicine over morals, which might be called the psychiatric turn, has an obvious appeal. In the paradigm health discipline, physiological medicine, judgments of health and disease are normally uncontroversial. The idea of reaching comparable certainty about difficult ethical problems is an inviting prospect. Unfortunately our grasp of the issues that surround the psychiatric turn continues to be impeded, as does psychiatric theory itself, by a fundamental misunderstanding of the concept of health. With few exceptions, clinicians and philosophers are agreed that health is an essentially evaluative notion. According to this consensus view, a value-free science of health is impossible. This thesis I believe to be entirely mistaken. I shall argue in this essay that it rests on a confusion between the theoretical and the practical senses of health, or in other words, between disease and illness.