Table 2

Implications of alternative viewpoints for states of being if accepted or rejected as diseases

Categories of states of being
Examples
DiseaseConceptualisationImplications for actionPotential negative consequences/ramifications
Addictions or possible addictions
Alcoholism
Drug addiction
Gambling addiction
YesBiological health disorderHarm reduction24
Public funding
Medical treatment
Focus on individuals and treatments may cause social and moral aspects to be ignored10 25–27
NoLack of self-control
Moral failing
Abstinence through individual choice and self-discipline
Punitive management strategies
Stigma and discrimination, neglect of harm reduction, neglect of social causes and increased suffering for the population25 26 41–43
Social problemPreventive social solutions: income redistribution, poverty reduction, education and social marketingEffective medical treatment underused26 43
Medical diagnoses with uncertain biological/psychosocial basis
Attention deficit hyperactivity disorder
Panic disorder
Personality disorder
YesSpecific biological disorderLabel patients with a specific category. Diagnose and treat uniformly, possibly with drugsOverdiagnosis and overtreatment with drugs, undertreatment with behavioural approaches4 20 28–30
Failure to recognise the diversity of illness19 44 45
NoSocially mediated adjustment problemSeek underlying causes, modify environment
Behavioural therapy
Don’t attempt to pigeon-hole unusual presentations
Patients may feel stigmatised
Effective medical treatment may be underused29 30
Acknowledgement of complexity may lead to inefficiency19 44 45
Diminished function, often age-related
Lack of sexual desire
YesBiological health disorderDiagnose and treat, possibly with drugs
Public funding
Overdiagnosis and medicalisation of society, with increased self-perception of illness and poorer coping with suffering that is part of life20 29–31
NoNormal consequence of livingAccept and adjust
Responsibility on individual
Neglect of treatments that may reduce suffering and improve function29 30
Patterns of behaviour
Homosexuality
Transsexualism
YesBiological health disorderDiagnose and treat, possibly with drugs
Negative social stigma
Adverse judgement and resulting stigma and discrimination46
NoHuman diversityNo medical intervention
NoMoral failingAbstinence/modification of behaviour through individual choice/self-discipline
Punitive strategies
Stigma and discrimination46