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But health is not merely understood in biological terms, external influences can
severely influence the well-being including “the physical topography of the coun-
try, cultural institutions, basic assets, and its economic conditions” [9, p. 109]. Ill
health is not restricted to functional inability and might be produced by a wide range
of external influences.
Rather than taking the empirical category of the disease as the starting point, Nor-
denfelt starts with the personal illness experience. Illness takes on epistemological
primacy vis-à-vis disease. It is through the experience of ill health that people start
looking for what is common to the different forms of these states. In this first phase
illnesses are identified, recognized and communicated, without knowing the under-
lying disease causing the illness. In the second step, the sick are seeking experts
for assistance. Communicating in the illness-language, they explain their ill health.
The physicians in turn are then searching for the causes of the illnesses. Finally, the
medical profession finds these causes and calls them “diseases”. Such an account is
applicable for the historical genesis of the medical profession and the understanding
of the particular diseases; but they are repeated in each illness episode. It empha-
sizes the subjective suffering perspective vis-à-vis the objective empirical functional
limitation.
From the perspective of this debate, health is thus understood on the one side as
the function of an internal process, as Boorse does, or on the other side as the ability
to reach vital goals in the case of Nordenfelt; it might be defined in biological and
statistical terms, or with reference to personal and cultural norms. Finally, it might
be the opposite of diseases or the two terms are not mutually exclusive. This unset-
tled dispute mirrors the debate whether medicine is an art or a science. This issue
also touches upon the question of the place of natural science in medicine. Even the
either-or-logic of these debates is refuted, questions still are raised about the local-
ization of health and disease as key terms of medicine in the scientific coordinates.
The definition of health and disease is also relative to the perspective: Medicine
and psychotherapy will provide different answers, but so will different disciplines
within medicine. Palliative care, cardiology, psychiatry, and internal medicine will
have different concepts of the human body and accordingly also different concepts
of what it means to be healthy. This leads to the point of certain relativity inherent
in the debate. “A definition of health cannot be false in the strong sense but merely
inadequate to serve its purpose.” [15, p. 12] Within the broad field stretched be-
tween these two authors, a large number of different definitions of health disease
are placed.
6.3
The Readjustment of the Coordinates - Disease, Illness
and Health
This controversy about the understanding of disease and the consequent lack of
consistency in the medical ethical discussion about health and disease asks for con-
ceptual clarity. It is “the source of a semantic chaos that has rendered the philosophy
of health and disease an academic palaver preventing any progress” ([14], p. 112).
 
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