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Whether progress is genuinely attainable in a discipline that spent the last two and a
half millennia in assembling footnotes to the founder of the Western philosophical
tradition, as the famous word of Alfred North Whitehead goes, might be arguable.
However, conceptual clarity might nevertheless be an important goal to avoid mis-
understanding and reach a genuine discourse worth its name.
Sadegh-Zadeh's epistemological starting point in the exploration of health, ill-
ness and disease is the last of these three terms. “Medicine is concerned with hu-
man suffering only if it is a facet of illness. Illness [...] may be engendered by
a variety of causes. Among them is a cause of a particular type called disease.”
[13, p. 151] Disease is the crucial category because the knowledge of disease
only enables the physician to provide his professional help. The explicit concern
of Sadegh-Zadeh is to provide clarity in how the concept of the disease actually
works. It is partly a Wittgensteinian task to show the confusion generated by an
erroneous use of language - and to show “the fly the way out of the fly-bottle”
[16, § 309]. His contribution to the existing discourse on the concept of health and
disease can be summarized in three main points: First, a conceptual clarification to
better grasp what we actually discuss with the term of disease; second, an account of
the concept of disease with Wittgenstein grasping the concept of disease precisely
in its fuzziness (the prototype resemblance theory of disease), and finally, a norma-
tive turn not only understanding disease as a deontic concept, but also medicine as
a deontic discipline.
The conceptual clarification consists in a distinction of different understandings
of disease - the general category often is confused with individual diseases and/or
with the disease state of an individual patient. The approach differentiates on the one
hand between the general category of disease and the particular types such as dia-
betes, alcoholism and ADHD. Token diseases in turn are disease state of a particular
patient; while type diseases refer to particular diseases such as diabetes, heart attack
or schizophrenia. Clarity is created if there is a clear boundary drawn between di-
agnostics on the one hand that deals with the particular disease of a concrete patient
(token disease) and the nosology - serving as a background - which comes up with
the classification of all types of disease. This first clarification is rather straightfor-
ward, although it has to be noted that these categories are sometimes confused in
the literature.
However, the term disease is as most concepts not a simple straightforward con-
cept. It is not a classical concept like a square. While instances of a classical
concept have a common nature, a non-classical is fuzzy in nature. There is no clear
set of features that serves as the distinguishing marker for all members of a non-
classical concept. Examples are concepts like birds, vegetables or diseases, which
do not share a common set of features, rather the features are partly overlapping.
Wittgenstein's notion of the family resemblance serves as the model for this theory.
In a famous paragraph of this Philosophical Investigations, Wittgenstein points out
the working of concepts such as “game” - “board-games, card-games, ball-games,
Olympic games, and so on.” [16, §66] Wittgenstein reminds us not simply to assume
that they must have something in common, but rather to observe the way these con-
cepts work more closely. They have many things in common - but no single feature
