Is the living environment viewed as biology

illness (from Middle High German sickness, sickness, synonymous with weakness, suffering, distress) is the disruption of the function of an organ, the psyche or the entire organism.

The sick girl(The syge pige) by Michael Ancher, 1882

definition

Disease and health

Illness is often defined in terms of health. However, health has also been defined as the ideal state of optimal wellbeing, and illness is not the only possible cause of poor health.[1] The transitions between “health” and “illness” are fluid. Much may ultimately be a question of perspective. For example, the term disorder of wellbeing has become commonplace for limitations in physical or mental well-being without an objectifiable medical disease value. On the other hand, conditions that can be defined as pathological can also exist without subjective psychological stress.

The normal function results from the regularity of the life processes; to varying degrees it includes the ability to adapt to changed internal and external conditions. Their judgment by people also shows dependency on their norms.

As a functional disorder, illness can affect different areas of living being and develop in their interactions. Physiological functions are essential characteristics of life. Organisms exist in complex environments and maintain, renew and change through constant material and energetic exchange. Many types of organisms live in social contexts. The functions of life also include behavior. So-called higher organisms have emotional functions. The personality and sociality of people also function depending on their cultural world.

The assignment of diseases of a specific living being to abstract "diseases" is considered important in connection with the development of therapeutic approaches and their administrative and economic framework conditions. One system is the International Statistical Classification of Diseases and Related Health Problems (ICD10).[2] However, whether there are abstract diseases in an ontological sense is controversial.

medicine

For centuries, medicine has endeavored to clearly define and delimit the general term disease.[3][4] In doing so, she has to deal with various clinical pictures and specific diseases.

If a person has the feeling of being “sick” or if someone has already been diagnosed with an illness, one speaks of a person in medicine Patient.

Individual complaints of a patient can be symptoms of definable diseases. Several symptoms that typically occur simultaneously are called a syndrome (Symptom complex) designated. Symptoms or symptom complexes pointing to a common cause (Etiology) traceable, let the determination of a specific disease (Disease) in the sense of modern medicine (→ main article pathogenesis). This seems clear when necessary or sufficient causes of the disease can be determined. For defined infectious diseases z. B. specific pathogens necessary; some congenital diseases occur inevitably with certain molecular genetic changes. Often, however, diseases cannot be clearly traced back to demonstrable causes. Sometimes they are then defined by regular structural or functional phenomena. This is the totality of all phenomena typical of a disease Clinical picture (Syn. entity), which can be observed in more or less different forms. The study of diseases is pathology.

Appropriate examinations (diagnostics) are required to detect diseases in individual patients. In this way, findings are collected which can be used to establish a diagnosis.

Law

The fact that the transitions between “health” and “illness” are fluid also raises legal problems. The content of the term “illness” itself is hotly debated, especially in the area of ​​social security law.[5]

Illness in the sense of social security law is a disorder of physical or mental well-being, thus a deviation from the norm "health". (cf. § 120 Abs. 1 Z 1 ASVG, according to which illness "Is an irregular state of mind or body that makes medical treatment necessary".)

The German On March 21, 1958, the Federal Supreme Court legally defined: “Illness is any disturbance of the normal condition or normal activity of the body which has been cured, ie. H. can be eliminated or alleviated. ”According to a more recent formulation in the German health and accident insurance system, illness is understood to mean“ an irregular physical or mental state that requires medical treatment and / or results in incapacity for work ”(BSGE 35, 10, 12 f. ). As a result, the medical concept of illness is not congruent with the social law. Decisive criteria for the assessment as an illness in social law are:

  • Need for treatment (not for age-related symptoms; cosmetic treatments that are purely aesthetic in nature (such as hair transplantation), but very much if there is a recognized medical need (such as correction of the nasal septum), treatment of scars)
  • Outward perceptibility (e.g. disharmonies of the genetic values ​​do not fulfill the facts)
  • Improvement of the condition or prevention of aggravation (the treatment must be promising according to the principles of medical science)

The last point can be problematic for incurable diseases, as there is no improvement possible in such cases.

This is what it is in social security law Ailments (§ 154 ASVG). These are irreparable ailments, the development of which is complete and the possibility of medical influence in the sense of a cure, improvement or prevention of aggravation is not possible. Accident complaints and their consequences are covered in the Switzerland from a legal point of view not included in the term “illness”.[6]

Historical and cultural aspects

Portrait of Field Marshal Alessandro Marchese del Borro († 1656)[7]

The classification, the measure of the “normality” of transgressing changes in a person, depends heavily on the culture and the epoch. That was obesity (Obesity) A status symbol in the Renaissance, nowadays it is generally considered to be pathological.[8]

Typical reactions in severe illness

Serious illness in particular has to be processed not only cognitively but also emotionally. There are very typical ways of reacting to dealing with a disease[9]:

  • Withdrawal into child dependency: On the one hand, this regression can be good and conserve energy reserves, but on the other hand it can also culminate in an excessive demand for attention and care.
  • Denial: The disease is denied and thus a good handling of it is prevented.
  • Rationalization and postponement: The problems of the illness are pushed onto other causes and the illness is denied as the cause.
  • Anxiety Reactions - Depressive Reactions

Systematics

Systematic classification of diseases is known as nosology (pathology). The names of the diseases, the delimitation of individual ones Clinical pictures (Entities) against each other and the systematics of diseases are subject to constant change (see list of historical disease names). The modern classification of diseases in the medical disease model can be roughly organ-related according to the main diagnostic groups (MDC, Major Diagnostic Categories).

The International Classification of Diseases (ICD-10) or, for the oncological field, according to the ICD-O allows a more precise classification.

A classification based on known or suspected causes is according to

  • Hereditary diseases (caused by heredity)
  • Infectious diseases (caused by infections)
  • Accidents and injuries (caused by external influences)
  • Poisoning, chemical burns, burns and other damage caused by chemical or physical noxa
  • Degenerative diseases (caused by wear and tear on organs or cells)
  • Autoimmune diseases (the immune system fights healthy cells)
  • Tumor diseases (cells degenerate and grow uncontrollably)
  • Iatrogenic diseases (caused by treatment)
  • Mental illness
  • Social diseases
    • Diseases of civilization (poor diet, lack of exercise, etc.)
    • Deficiency Diseases
  • Diseases caused by food.

Characteristics that, statistically speaking on their own, increase the rate of occurrence of certain clinical pictures without being solely responsible for them by their nature, are referred to as so-called risk factors. A classic example is the positive statistical correlation between the increase in blood pressure and the occurrence of cardiovascular diseases.

Psychosomatic medicine attempts a mental-physical approach and healing, taking into account the emotional and social causes as well as the personality and life fate of the patient. Outside of evidence-based medicine, other causes of illness, including metaphysical connections, are assumed. The sociology of medicine deals with the social conditions of illness and the course of illness as well as the state control of the health system.

Causes and course

In modern medicine, the causes of diseases are changes in parts of the body (and thus also their function), so-called organ pathological findings considered (→ main article pathology, psychopathology and phytopathology).

The causes of these changes can be divided into internal and external factors. Internal factors include the general aging process, hereditary diseases and inherited susceptibilities / predispositions, embryonic malformations and mental illnesses. These can hardly be influenced. In contrast, external factors such as social conditions, stress, nutrition, environmental conditions and pathogens can be easily influenced.

Illness - treated or untreated - leads to healing, remission, relapse (or several relapses), suffering or death.

Frequently used terms that describe the course over time are acute (sudden onset - e.g. flu-like infection), subacute (gradual onset - e.g. hepatitis B), chronic (longer course - e.g. multiple sclerosis), chronically relapsing (recurring - e.g. "chronic" bronchitis) and foudroyant or fulminant (onset "like a lightning bolt" and with a difficult course - e.g. sepsis).

Disease model

A disease model is an epistemological approach with the aim of explaining a disease in a simplified model.

A discussion of disease models has arisen from the question of what is the objective difference between normal and abnormalthan is morbid. This distinction usually does not concern the judgment of the patient himself, but that of those around him. It is aimed at the supposedly sick person and reflects the views of the next of kin and the social environment about illness. It thus also includes a sociological and epidemiological aspect, which z. B. is of interest in medical sociology and social psychiatry.

Another approach concerns the controversy between continuous and inconsistent treatment approach. The consistent approach states that a uniform health explanation principle is sufficient for both healthy and sick people. The inconsistent principle states that special legal processes take place for the sick, which require specialized treatment depending on the type of case identified. The demand for a uniform treatment principle goes back to Ludolf von Krehl's demand that the doctor should not treat different diseases, but rather keep an eye on the sick person as a person. This principle contributes greatly to the humanization of the treatment of the sick and removes the social stigma of the abnormal and incomprehensible from the sick.[10]

literature

  • Rudolf Degkwitz, Helmut Siedow (Eds.): On the controversial concept of psychiatric illness. Volume 2 of the Locations of psychiatry. Urban & Schwarzenberg, Munich 1981, ISBN 3-541-07972-X.
  • William Heberden: Commentaries on the history and cure of diseases. London 1802 et al .; Reprint with an introduction by Paul Klemperer. New York 1962
  • Ingo-Wolf Kittel: Systematic considerations on the term "sick" ... (1981; 2001 ern. Synergetisches-heilen.de)
  • Rainer Lutz: Health and Enjoyment: Euthyme Basics of Behavior Therapy. In: J. Margraf: Behavioral Therapy Textbook. Vol. 1, Berlin 1996
  • Karl Eduard Rothschuh: Concepts of medicine past and present. Hippocrates, Stuttgart 1978
  • Hermann Metzke: Lexicon of historical disease names, Degener & Co., Insingen 1995, ND 2005, ISBN 3-7686-1051-9
  • Karl Eduard Rothschuh (Ed.): What is sickness Scientific Book Society, Darmstadt 1975
  • Hans Schaefer: The concept of illness. In: Maria Blohmke et al. (Ed.): Manual of Social Medicine. Vol. III. Stuttgart 1976
  • Willi Seitz: Behavior disorders. In: Dieter Rost: Concise dictionary of educational psychology. 2nd edition, PVU, Weinheim 2001
  • Susan Sontag: Illness as a metaphor. Fischer, Frankfurt 1981

Web links

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  • Disease in the Historical Lexicon of Switzerland

Individual evidence

  1. Constitution of the World Health Organization. (PDF) as of March 7, 2006, p. 1 (German translation)
  2. ↑ DIMDI: ICD-10 homepage
  3. ↑ p. Breinersdorf: Experiment on the current standpoint of the theories of medicine, Bey Iohann Friedrich Korn the Elder (Ed.), 1804, p. 44, GoogleBooks
  4. ↑ Wolfgang Gerok, Christoph Huber, Thomas Meinertz, Henning Zeidler: The internal medicine, Schattauer Verlag, 2006, p. 4ff, ISBN 3-7945-2222-2, GoogleBooks
  5. ↑ U. Meyer: Illness as a term that triggers benefits in social security law. In: Swiss medical newspaper, 2009; 90: 14, pp. 585-8
  6. ↑ Swiss Federal Law on the General Part of Social Insurance Law, Art. 3 Illness, admin.ch; last viewed on April 26, 2009
  7. ↑ Carol Gerten-Jackson: The Tuscan General Alessandro del Borro. Retrieved January 8, 2011.
  8. Haslam DW, James WP: Obesity. In: Lancet. 366, No. 9492, 2005, pp. 1197-209. doi: 10.1016 / S0140-6736 (05) 67483-1. PMID 16198769.
  9. ^ Bridegroom: Psychosomatic Medicine
  10. ↑ Rudolf Degkwitz et al. (Ed.): Mentally ill. P. 442