In a course I’m taking on the sociology of medicine—Sociology 190, taught by Nicholas Christakis—we’ve spent a lot of time investigating “what is a disease?” The desired conclusion seems to be that Disease Is Socially Constructed; also, that Isn’t It Terrible How We Keep Socially Constructing New Diseases That Aren’t “Real Diseases”, Society Is Going Down The Tubes, Alas And Alack! I think this is an unfortunate attitude and these debates are pretty silly. As far as I know, nobody actually disagrees about facts; we’re just arguing about connotations.
A few weeks ago, Prof. Christakis gave us all a survey in which he listed a number of things (cancer, short stature, large nose, homosexuality, nuclear war, etc.) and asked for each “is this a disease?” and “is this a concern of doctors?” For many conditions, students’ opinions on the two questions differed wildly. This is good evidence that we’re focusing on the wrong thing. Whether or not we decide something “is a disease” has few material consequences separate from whether it’s a concern of doctors. And the latter issue is much easier to debate, because we can ask concrete questions (if doctors know about this condition, will patients have better health outcomes? could doctors’ concern for this one have bad side effects for e.g. privacy?) rather than arguing about definitions with no motivation behind them.
In a recent discussion section, we spent a long time arguing whether internet addiction should count as a disease. During the entire debate, we didn’t manage to isolate a single point of difference in anyone’s concrete beliefs. The hidden question we were actually debating was, “is internet addiction sufficiently serious/natural/damaging/whatever that it deserves the connotations it gets from the word, ‘disease’?” The problem is that those connotations vary wildly from person to person, and anyway, arguing about them doesn’t get you anywhere—you gain nothing from knowing whether “internet addiction is a disease” separately from knowing that “internet addiction afflicts 10% of college students in China”1 or “internet addiction is associated with neural activity patterns similar to those of physiological addictions to e.g. drugs”2.
This isn’t just a semantics problem, either. By reinforcing the idea that being a “disease”, rather than a concern of doctors, is relevant, Sociology 190 causes confusion and can give students an unwarrantedly poor opinion of the medical establishment. Now, I agree with the primary thrust of Prof. Christakis’ thesis, which is that doctors are fallible, and so as a society we should try to avoid medicalizing too many things because of the risk of iatrogenesis.3 But when we think in terms of “diseases” being “socially constructed”, people come away with the message that almost any newly-defined disease is illegitimate, which is downright harmful. I don’t care whether people call internet addiction a disease, but when the average South Korean high schooler spends 23 hours a week gaming, doctors (or at least health officials) had better be concerned.
This pattern—sneaking value arguments into things that sound factual—actually comes up quite a bit. When people debate about “what is art?", they’re doing a similar thing, arguing about what exactly deserves the halo it gets from being called art. That’s not a very productive argument to have. Similarly with most other words with strong connotations or halo effects, like “love”, “freedom”, etc. These are great examples of when it’s helpful to taboo whatever word you’re arguing about and try to rephrase in lower-level terms.