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The issue of a lack of trust in the modern medical profession has been addressed
from different perspectives; and the question indeed might be raised whether it is
the complementary to the raise of autonomy as a bioethical principle ([11]). Klein-
man raised the question already in the 1970s and linked it to the lack of the medical
profession to take the illness narratives of the patients seriously. Without disre-
garding the importance of biomedical research, the solution to many of the current
medical problems is not seen in further research into the causes of disease - but
rather a better grasp of the clinical encounter especially the notion of illness expe-
rience. The distinction between illness and disease is crucial for the entire field of
medical anthropology. In a constructivist vein, he states that disease and illness are
two different explanatory models; as well as there are different partly conflicting ex-
planatory models in medicine. The differences might be between different medical
disciplines or even within one and the same [7, pp. 119ff]. Without disregarding the
importance of the explanatory model of disease so successful in Western medicine,
Kleinman puts his focus on the illness narrative: “Illness is shaped by cultural fac-
tors governing perception, labeling, explanation, and valuation of the discomforting
experience, processes embedded in a complex family, social, and cultural nexus.”
[6, p. 141] Taking the cultural construction of the illness narrative serious, however,
should not lead to a culturalization of illness as such. The reification of the cultural
explanation can easily obstruct the clinical encounter, as Kleinman is well aware
of ([5]). The cultural construction of the illness experience is acknowledged by
Sadegh-Zadeh without falling into the trap of an essentialist concept of culture. He
rightly points to linguistic framing of illness episodes and the way their experience
is shaped. It makes a difference whether you understand it as “you are in pain” or
“you are under demonic attack”.
However, the disentanglement of illness and disease is taken one step further
by the conceptual framework of medical anthropology. Illness and disease are two
distinct explanatory models, taking on the phenomenon from different sides. One
main problem of clinical practice, in Kleinman's perspective, is that the illness ex-
perience is disregarded in search of the disease; the reason being the tremendous
progress in terms of technological intervention battling diseases. The consequences
of such disregard of illness, however, are severe: Patient noncompliance, dissatis-
faction with the medical treatment and insufficient medical care might follow. The
exploration of the illness is in many cases tantamount for being able to bring about
a successful treatment. There is strong communicative task at hand for the physi-
cian to negotiate towards a model of illness/disease shared by physician and patient.
This leads to stark claims demanding for equal attention paid to both explanatory
models: “Where only disease is treated, care will be less satisfactory to the patient
and less clinically effective than where both disease and illness are treated together”
[6, p. 146].
This communicative task towards the exploration of the illness is rather underval-
ued in the Sadegh-Zadeh's Handbook. This already becomes visible by the space
given to the two concepts; disease takes ten times more space than illness in the
Handbook. The paragraph discussing pathology vs. nosology in a historical per-
spective gets the closest to make space for the illness narrative as a complimentary
