Table 2

Implications of alternative viewpoints regarding accepting or rejecting states of being as diseases

Categories of states of being
Disease?ConceptualisationImplications for actionPotential negative consequences/ramifications
Addictions or possible addictions
 Drug addiction
 Gambling addiction
YesBiological health disorderHarm reduction
Public funding
Medical treatment
Focus on individuals and treatments may cause social and moral aspects to be ignored8 43 44 47
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, increased suffering for the population40 42–44 46 48
Social problemPreventive social solutions:
income redistribution, poverty reduction, education, social marketing
Effective medical treatment underused42 43
Medical diagnoses with uncertain biological/psychosocial basis
 Chronic fatigue syndrome
 Irritable bowel syndrome
 Panic disorder
 Personality disorder
YesSpecific biological problemDiagnose and treat, possibly with drugsOverdiagnosis and overtreatment with drugs, undertreatment with behavioural approaches11 15 16 31
NoSocially mediated adjustment problemBehavioural therapy
Modify environment
Patients may feel stigmatised
Effective medical treatment may be underused11 16 49
Diminished function or altered appearance, often age-related
 Age-related muscle loss
 Erectile dysfunction
 Lack of sexual desire
YesBiological health disorderDiagnose and treat, possibly with drugs
Public funding
Overdiagnosis and overtreatment
Medicalisation of society, with increased self-perception of illness and poorer coping with suffering that is part of life11 15–17 49
NoNormal consequence of livingAccept and adjust
Responsibility on individual
Neglect of treatments that may reduce suffering and improve function11 16 49
Patterns of behaviour
YesBiological health disorderDiagnose and treat, possibly with drugs
Negative social stigma
Adverse judgment and resulting stigma and discrimination53
NoLifestyle choiceRespect person's choicePermissive attitude encourages self-destructive or morally reprehensible behaviour*43
Underuse of effective treatment*34
NoMoral failingAbstinence/modification of behaviour through individual choice/self-discipline
Punitive strategies
Stigma and discrimination53
Syndromes or constellation of patterns of symptoms of unclear basis
 Attention deficit hyperactivity disorder
Overactive urinary bladder
Panic disorder
YesEssentialist: specific biological disorderLabel all patients with specific category and treat uniformlyFailure to recognise diversity of illness, excessively uniform management, stifle research that could deepen understanding2 5 51
NoNominalist: collection of symptoms, signs, behaviours, label of convenienceAcknowledge syndromes as convenient constructions, seek underlying causes, don't attempt to pigeon-hole unusual presentationsAcknowledgement of complexity may lead to inefficiency, paralysis2 5 51
  • *Negative consequences listed here refer particularly to smoking and obesity not to homosexuality and transexualism.