Conceptualising illness and disease: reflections on Sharpe and Greco (2019), by Carolyn Wilshire , Tony Ward in BMJ …Medical Humanities [Published Online First: 11 December 2019] doi: 10.1136/medhum-2019-011756


Article abstract:

In a recent paper, Sharpe and Greco suggest that chronic fatigue syndrome/myalgic encephalomyelitis (MECFS) can be viewed as an instance of “illness without disease”, and consequently, treatment should be directed towards altering the patient’s experience of, and response to, their symptoms.

We discuss two broad issues that arise from Sharpe and Greco’s article, one relating to the assumptions they make about MECFS and its treatment specifically, and the other relating to their conceptualisation of the illness/disease dichotomy. We argue that the term “illness without disease”, in the sense that Sharpe and Greco use it, is problematic because it can lead to unwarranted causal assumptions.

Following these critical comments, we present a new framework for conceptualising the relationship between explanatory disease models and the experience of illness.

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We have argued here that, in medicine, it is not appropriate to make claims about causation on the basis of non-specific observations, in which direction of causation has not been clearly established, or simply because there is a lack of anything better.17

Causal claims that are phrased at a psychological level of description need to be subjected to the same tests as any other causal claim.

Treatments founded on unsubstantiated claims—even psychological ones—can do harm, no matter how well intentioned they are.  Even if patients are not directly harmed by the treatment, they may bear other costs. For example, they may feel personally responsible if they fail to recover. Also, any concerns they do raise may be dismissed, or even caricatured.

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