Tag Archives: flu

The Disease Model Simplified

By Dr David Laing Dawson

“I’m still coughing and sneezing,” one person says. “I caught what’s going around this winter.”

“Yeah,” replies the other. “Everybody in the office got it. And it lingers and lingers.”

It has been a long winter and I have overheard variations of that conversation a dozen times. And I wonder if they know they are applying both the disease model or concept plus some simple epidemiology to their observations of dis-ease, ailment, illness.

Disease model:

Symptoms: “coughing and sneezing”

Natural course: “lingers and lingers”

Same symptoms and course for many leading to assumption of this being the same thing: “I caught what’s going around this winter.”

And probably having the same necessary etiology. “I caught what’s going around.”

And epidemiology:

“Everybody in the office got it.”

It is the same reasoning that John Snow used when he traced the outbreak of Cholera to the Broad Street Pump in Soho, London, in 1854.

But Snow didn’t know much about bacteria let alone viruses, so he would not have said, “I caught what’s going around.” Instead, observing the distribution of the illness, reasoning out the source, all he could conclude was that the cause (hypothesized from this scientific approach to be the same for all sufferers) behaved as if it were a living thing in the water from the Broad Street Pump.

And there we have it. The modern western scientific medical concept of disease. If the symptoms are the same; if the natural course of the illness is the same; if the demographics are similar, then perhaps the cause is the same for each person afflicted. And while we look for that cause, can we see if there is some definable treatment that works for all or most?

It is instructive to know that we can be as ignorant as John Snow was about bacteria and still, applying the disease concept and basic epidemiology, come up with treatments that work ninety percent of the time. For cholera it is sanitation, basic public health measures, clean water, re-hydration and replenishing electrolytes.

Of course to complete the modern medical disease concept, we must then ask the most scientific question of all: “How do we know that to be true?” In the case of treatment this question is framed as “How do we know that it works?” That is, we must test the hypothesis and our otherwise very subjective observations.

For one hundred years psychiatrists have argued about the relevance of the disease model (described above as succinctly as I can) to mental illness. It doesn’t seem to work well with, or help our understanding of, day to day woes on one hand and major social upheavals on the other. But when applied to serious mental illness it is the only concept so far that has lead to treatments that work, and that have been scientifically shown to work.

We are all different. We have different experiences, levels of well-being, social support, education, intelligence, occupations, relationships, resilience. Some, without treatment, quickly die from cholera. Others survive. Yet we know it is the same disease afflicting each and every sufferer.

Same with mental illness. There are hundreds of factors apart from the disease itself, its causes, and our scientific treatment, that affect outcome.

But today, in 2018, why in God’s name would anybody want to throw away the western medical scientific disease concept? It is the one and only concept/model of severe mental illness that has lead to treatment that has been scientifically, objectively, proven to work.

Advertisements