Who Are the Rightful Owners of the Concepts Disease, Illness and Sickness? A Pluralistic Analysis of Basic Health Concepts

Abstract

The article uses a producer-consumer theory from philosophy of mind and language to analyse the meaning of basic health concepts like disease, illness and sickness. The core idea of the producer-consumer perspective is that a person who has an incomplete understanding of a term can associate it with the same concept as a linguistic expert, if both of them are willing to defer to the same contextual or general norms of meaning. Using “disease” as an example, the article argues that the producer-consumer theory implies that if patients were normally willing to defer to a standard expert concept of disease, it would be reasonable to assume that the concept of disease is this concept. However, it is empirically well documented that many patients are not willing to defer to health workers’ understanding of lay health concepts like “disease”. This means that the overall conceptual analysis of disease and other lay health concepts should be pluralistic—the concepts belong within what Wittgenstein calls different language-games. This conceptual pluralism is inconsistent with assumptions many theorists have made when attempting to develop general definitions of basic concepts of ill health. Furthermore, the pluralistic analysis has striking implications for how conceptions of meaning should be accepted as sound; participants in health discourses are entitled to use basic health terms like “health” and “illness” in accordance with their own language-games, and health workers should therefore acknowledge a diversity of meaning in patient communication. Nevertheless, health professionals can often secure a communicative platform of shared concepts by understanding patients’ language games, and by achieving contextual aims of agreement about meaning.