The word DISEASE and the phrase DISEASE CONCEPT:

Definitions and A Perspective

Disease - A disease is any perturbation in any physiological system of an organism which changes the function of that system and leads to negative consequences for the organism when compared to a healthy, normal, standard. Implied in this definition is that the cause of this change is outside the control of the organism; it happens to the organism. Thus, when we speak of a disease there is no blame, no recrimination, no guilt, and no stigma. Also, a behavior such as an addiction can't be a disease. It can only be a symptom of a disease. Symptoms are inherently outward manifestations of a disease or disease process located within the body. (read: http://www.nvo.com/hypoism/thirdmilleniumn4aconferencekeynoteaddressonhypoism/ on this web site) Diseases are necessarily anchored in a bodily organ or organs through a pathophysiology such as genetic, traumatic, infectious, immune, malignant, toxic, degenerative, or others affecting parts of the body. Lay people, especially, but frequently physicians as well, confuse the distinction between a disease and a symptom. This distinction has caused harmful confusion in the field of addictionology from the time "alcoholism" was first mislabeled a disease by Bill Wilson and then by Dr. Jellinek.

I want to further discuss the critical principle of the DISEASE CONCEPT of medicine right here. Disease is the first word mentioned in the book and the understanding of the disease concept (as I understand and use it) is so important for perspective into my argument in favor of the disease of Hypoism, or any argument about whether something is a disease or not and the implications of that word. For millennia, humans attributed illness to complicated, mysterious, and superstitious forces of the universe-gods, devils, humors, animals, spirits, etc. Treatments were based on these causes and were equally complicated and ritualized. When science began to understand the realities of the workings of the human body and its interactions with natural external realities such as bacteria, poisons, parasites, and viruses, as well as internal realities such as arteriosclerosis and immune disorders, as causes of disease, as opposed to humors and spirits, the theory of the disease concept of medical disease was born. Scientists who studied human diseases found that each disease was based on a simple pathological principle, ran a predictable course, had predictable complications, and had a reasonably predictable outcome based on physiological (based on the science of the body- biology) intervention. As biology continued to improve its understanding of the body and nature, more and more diseases were removed from the status of superstitious and the supernatural category and placed within the category of the disease concept. Diseases with complicated and tortuous etiologies, courses, and treatments became amenable to simple disease concepts and simple treatments based on scientifically understood principles. If you read a medical textbook from 1900 and compare it to one written in 1999, you will see how many times this has occurred. As new physiologies are understood, previously complicated diseases have become commonplace and simple. The biologically simplest organs are understood easily as are their diseases. The biologically more complicated organs are understood last. The biology of the brain is a quantum leap or two more complicated than any other system in the body. We are still in the dark ages in our understanding of the physiology of the brain, and, consequently, our understanding of physiologically based diseases of the brain is meager. That doesn't mean that the same disease concepts don't hold true for them-they do. Addictive disease, when the physiology is understood, will have the same simple scientific and medical description as pneumococcal pneumonia does today. One disease -- One physiology. This is the context in which I see Hypoism today. One disease (HYPOISM) -- One Physiology (the physiology of limbic diversity). My concept of Hypoism simplifies the morass of complicated and multifactorial causes of addictions and is predictable. Future science will determine this. (In fact, since writing the book from which this discussion is taken, several predictions of the hypothesis have already been substantiated, thus confirming Hypoism.) For these reasons, I find the medical disease concept of Hypoism so appealing and compelling.

Let's discuss, from a societal perspective, the implications of the medical disease concept vs. the psychological concept of disease. In common terms, the medical disease concept says the particular malady from which you are suffering happens to you and thus you are not held personally responsible for having caused it. The accepted treatments are presented to you by the experts in the field, and you are allowed to choose the treatment which suits your own needs, hopefully (but not necessarily) guided by scientific studies comparing the benefits, or lack thereof, for each particular treatment. How you deal with it is up to you, guided by your friends, family, and experts. As an adult, you have the right to choose your treatment, as long as your disease has no proven negative effect on anyone else (society). If your disease is proven or thought to have effects on other people (such as being contagious and deadly), your treatment may well be dictated by society. Even if that is the case, it is your body that is sick, not your self, not your soul, not your spirit, not your person.

The psychological concept of disease says you caused your own disease due to deranged mental processes chosen by yourself willingly, usually as a conscious or unconscious defense to some childhood emotional trauma. In other words, it happens by you. The onus is on you because you could have chosen some other way of dealing with that trauma, but you didn't. In that way, you (your self) are (is) defective. This crucial distinction incriminates mental illness victims at the very core of their being. If society judges the illness detrimental to the society as a whole, it allows for discrimination as well as punishment-usually in the form of incarceration or some form of interdiction by the criminal justice system.

Thus, we have three distinguishing classification characteristics: 1a.) Happens to you (O.K.), 1b.) Happens by you (not O.K.); 2a.) Defective body (O.K.), 2b.) Defective mind (self) (not O.K.); 3a.) Causes harm to society (not O.K.), 3b.) Doesn't cause harm to society (O.K.). The only problem is that mistakes in this societal classification of patients cause actual harm to the victims of these mistakes. This is why it is so drastically important for society, guided by the fields of medicine and science, not to make mistakes in classification. In the past, witches were burned at the stake, epileptics and schizophrenics committed to mental hospitals for life, homosexuals jailed for sodomy. Now, due to better understanding of these conditions, these people can walk the streets free from fear of unreasonable incarceration and discrimination. Only the drug addicts are treated this way today, and it is the function of this book to help rectify this torturous situation.

The essence of the mistaken judgments is the issue of causation and blame by the judging person or people. In other words, did the people do it to themselves or did it happen to them and was it out of their control? Take a well known disease like sickle cell anemia, where a genetic defect in hemoglobin synthesis leads to deformed red blood cells, which clog up capillaries and cause blockage of blood flow to affected areas of the body, pain and dead tissue. Before this disease was understood, victims of the disease were thought to be liars, malingerers and doing the damage to themselves, in other words, hysterical. Now, because we all know about the physiology of this pitiful disease, the victims are no longer judged and stigmatized, although their own bodies are hurting them. We do not judge these people as being self-destructive because we know better. Another disease most of us know about is Lupus, an autoimmune disease where the immune system reacts to one's own tissue and hurts itself. Would we call that self-destructive? Actually, it is the epitome of self-destruction, but because we understand the biology of this problem, we don't judge the victims for their symptoms and problems.

But, when the same sort of disease is in the brain, such as mental illness and addiction, we very readily judge and blame the victims of these diseases for doing it to themselves. Mental diseases that lead to unacceptable behavior are judged severely because they have the appearance of being willed or consciously caused by the person with the abnormal behavior. People who don't have these behaviors can't comprehend how anyone else would do these things unless by their direct will. "Normal" people only act, they believe, via their own conscious will, so, therefore, all people must act via their conscious will. Thus, abnormal behavior must be willed and, therefore, we feel O.K. about placing blame on these weirdoes.

That's how we all view addicts. They must be willing their weird behavior-they are self-destructive. This most abused term, self-destructive, along with its inherent judgment and stigmatization, should be used for all diseases and all abnormalities, or none at all. Is the diabetic self-destructive? What about the stroke victim, the Lupus victim, the sickle cell victim, the hypertensive victim, and the cancer victim? Non-diseased people always think that the victims of some diseases are doing it to themselves until it happens to them, then they don't like the stigmatization. "As long as it doesn't happen to me, do whatever you want to them!" We revel in blaming victims as long as it isn't happening to us. When it happens to us, then and only then, do we look for understanding of the cause outside of us. As science advances, less and less of these crazy diseases are blamed on the victims. Drug addiction and other strange behaviors still meet these criteria for judgments, stigmatization, and blame mostly because we don't understand their physiology. This book hopes to change this circumstance for addictive diseases.

Drug addicts, in the absence of interpersonal crime, need to be reclassified to the same medical disease category as diabetics and cancer victims so that they can avoid self-stigmatization and self-discrimination and, therefore, allow themselves to seek help freely and without fear. Wouldn't we all rise up and protest similar handling of leukemics, epileptics, cancer or stroke victims? Of course, nevertheless we all accept and acquiesce to the abominable treatment of drug addicts, including boot camps, abusive therapeutic communities, and long jail sentences. No longer.