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one between clinical practice and clinical research: “Clinical practice is practiced
morality” and “clinical research is normative ethics” [13, p. 775]. The deontic char-
acter shifts the way we should think about medicine. It does not primarily pertain to
truth, but rather to hypotheses and deontic rules. This clarification of the notion of
disease lays the ground for then understanding illness and health in connection to it.
Sadegh-Zadeh avoids simple opposition. The fuzzy notion of disease is not the op-
posite of health; nor of illness. The concept of health is constructed independently.
One might be a patient without suffering a disease, without even being ill - for ex-
ample in the case of consulting the physician because of an insect bite. If health has
an opposed concept at all, it is the one of patienthood. Neither one of these concepts
is classical. Patienthood can be characterized by “a particular degree of discomfort,
pain, endogenously threatened life, loss of autonomy, loss of vitality, and loss of
pleasure” [13, p. 184]. Finally, neither is illness opposed to health. Rather health
is the umbrella term subsuming illness and wellbeing. Illness is one of many states
of health, and it might exist to varying degree, not ill, more or less ill, ill, very ill,
extremely ill, etc.
As briefly sketched out, such an account of disease can overcome the blockage
between the different descriptivists and normativists by focusing on the very work-
ing of the concept of disease. Moreover, it does away with the false expectation to
draw a clear boundary between disease and non-disease. By situating further the
state of health on a meta-level and understanding illness compatible with health,
this account further does away with unproductive opposition (be it the one between
health and disease, or even between health and illness). The productivity of this
account will further be critically examined against the background of the illness and
disease understanding of medical anthropology as conceived by its doyen Arthur
Kleinman.
6.4
Reading Disease and Illness in the Context of Medical
Anthropology (Kleinman)
The implicit task of medical anthropology was to challenge the cultural oblivion of
orthodox medicine and its epistemic framework on the basis of culture. The
Hand-
book
leaves implicitly room for cultural difference: Understanding diseases with
reference to a certain frameworks especially shaped by linguistic framing leaves
room for a factual plurality of disease-understandings. The framing of diseases
through “socionomics” - and the power of discourse - is acknowledged. Culture,
however, is almost exclusively used for the self-identification of the Western cul-
ture, which serves as the framework. What this Western culture exactly is, however,
remains vague. The closing paragraphs about the evolution of medicine towards an
engineering science or even anthropotechnology give an inkling about the classifi-
cation of medicine as “Western”.
Medical anthropology takes its starting point similarly in the paradoxical situa-
tion that in spite of progress in biomedicine there is increasing concern about mald-
istribution of care and moreover a crisis of trust in the health care sector [6, p. 140].
