Wednesday 21 January 2015

What is disease? Identifying the major epidemic pathology of modernity (or, some un-noted consequences of the biological definition of disease)

I think there are two plausible definitions of disease (aka pathology):

1. A condition which reduces probable reproductive success - this is an objective, albeit probabilistic, biological definition.

2. A condition which causes pain, suffering, distress - this is a subjective, personal and to some extent social definition.


So that lung cancer, or coronary heart disease, or pneumococcal pneumonia are biologically diseases because they threaten life, reduce the prospects of reproduction and the ability to assist in guarding life and assisting the reproduction of the family and group.

While most forms of pain - such as headache and backache, fever, vomiting and diarrhoea, also psychological symptoms such as depression and anxiety, and probably even deformity and disfigurement, are 'diseases' mainly because they cause suffering. In fact they are usually called 'symptoms' rather than diseases - and they are the kind of things that lead the sufferer to seek treatment.

(A 'symptom' is something the patient 'complains of' in the terminology - as contrasted with a 'sign' which is observed by the doctor. A sign would be a heart irregularity or lung crackles heard with a stethoscope, or a deep abdominal swelling palpated with the hands.)

In fact, many of the subjective symptoms reduce to the biological definition because the personal suffering leads to impairment of functioning. For example a severe headache leads to stopping work and becoming - for a while - dependent and less able or willing to preserve life and pursue reproductive success; and also less able to contribute to social function.


But, by the biological definition, disease has a larger scope than usually noticed. It includes everything which impairs potential and probable reproductive success. 

By this interpretation 'disease' includes many almost universal features of modern life. For example, any personal motivation or sexual preference which impairs reproductive success.

Because it is characteristic and indeed universal of modernized societies (The West) that by personal decision, almost all people - on average, en masse - have chosen, that is are motivated to choose, significantly sub-replacement reproduction.


This chosen sub-fertility is therefore - in its many causes and justifications - objectively a disease state.

It is indeed an epidemic disease state.

And this is not a matter of subjective opinion - but a plain and obvious biological fact,



A.B. Prosper said...

Professor, I think the flaw in your thinking is that you forget that low fertility rates are inherent to modern technology and urbanization.

After all they've been declining for centuries and as the developed world is massively urban it follows that fertility rates would be lower.

Gallup notes that nearly half of Europeans of peak reproductive age 15-29 which encompasses nearly all the peak fertile years are unemployed or underemployed, that is wanting full time work but do not have it.

This doesn't included people who are noted as being full time employed but have wages too low to afford say proper housing either,

How on Earth are they supposed to afford children?

In the past the elite of society counted on religious and community pressure as well as necessity to ensure people parenting even when it wasn't their best interest to do so

Now non dysgenic people are free to behave rationally and ethically and reduce the number of children they have and are doing so.

In fact fact I'd argue that given birth rates in Europe among Europeans are as high as they are many people actually want children

As such stable employment, decent income during those peak fertile years along with a pro-natal ideology either Sate or by restoration of faith (any will do so long as its natal) should easily restore birth rates.

Wm Jas said...

Surely "everything which impairs potential and probable reproductive success" is too broad a definition. Is it a disease to be unattractive? To live in a small town with few singles? To be an average man in a polygynous society? Is Catholic priesthood a disease? Or Chinese citizenship?

Bruce Charlton said...

@WmJas - You will never eliminate grey areas from even the simplest and clearest definitions.

To be 'unattractive' has always, in *extreme* instances (e.g. some obvious disfigurements and deformities), been regarded as a disease.

Or it may be the society that is pathological when an individual is healthy.