Healthy/Sick Dichotomy

What we mean by the culture of bio-medicine is that bio-medicine, while claiming to be free of cultural bias is actually a culturally influenced institution. In most cases, bio-medicine is associated with western culture, and is sometimes referred to as western medicine. It is important to realize that bio-medicine is culturally influenced because there have been many cases where bio-medicine is used as ‘proof’ to rationalize or justify one group or another’s action. The most prominent example of this is eugenics, which essentially legitimized racist beliefs by providing scientific ‘proof’ of inferiority.

I think that the difference between being healthy versus being sick from a biomedical standpoint is not always clear. Specifically, I believe that the pharmaceutical industry has pushed our medical system to prescribe more medication, whether or not medication is the best answer. The first example that pops into my mind is ADHD. I believe that ADHD and its corresponding medication to be over diagnosed and over-prescribed, respectively. I also do not agree with the way that children are targeted for ADHD medication, or with the way that parents can be led to believe that it will solve all their child’s school performance problems. While I’m sure some people actually need the medication and benefit from it, I think that ADHD for the most part is culture-bound.

I am not entirely sure where my beliefs on the dichotomy on being healthy versus being sick originated. While I believe that pharmaceuticals can be extremely useful, I dislike the way in which we jump to straight to prescriptions to solve all our problems. I believe that prescriptions should be used as a last resort, and that lifestyle changes should be the first attempt at improving health. In line with that train of thought, I believe that many of the variations in an individual’s health we consider to be a disease are caused by that individual’s lifestyle, and can be corrected with changes to their lifestyle. If a condition is caused by a person’s lifestyle and can be easily corrected by changes to their lifestyle, I do not see why that condition should be considered an illness or warrant a prescription medication. The problem with this ideal is that individuals are not always in control of their lifestyle or fully understand the cause-effect relationship between their lifestyle and their illness. Once again, I am not entirely sure where my personal views on this dichotomy originated.

4 thoughts on “Healthy/Sick Dichotomy

  1. The healthy and sick dichotomy is one that is used very frequently in western culture. But what does it really mean when someone says they are sick? And why is calling in “sick” to work something that is accepted as normal? Although this dichotomy is accepted in western culture, it is very important for clinicians to understand the implications behind it. To be healthy or unhealthy is an extremely multidimensional approach that cannot be simply summed up by one word. Health should be viewed on a spectrum that is personalized to each individual. For example, one may be mentally ill but physically healthy, or one may have cancer but be mentally sound. A clinician should be aware of the many dimensions of illness and understand its individualistic tendencies. By simply measuring ones physical health (blood pressure/reflexes/vision) the clinician may see a patient as completely healthy, however they must not fail to understand the spectrum of health and approach it at a more individual level, based on the patients perceptions. Instead of viewing this dichotomy as a truth, clinicians should find an alternate way to conceptualize and understand health and sickness. Instead of using only medical instruments and symptoms to understand if one is “healthy”, a more personal approach should be taken. Biomedicine is often criticized for being too impersonal, which goes against my alternative approach. It is much easier for a doctor to just use his medical instruments and diagnose, than to play the role of therapist as well. While this approach would be more holistic, it would be much more time consuming and take a lot more training for doctors.

  2. This is a very important dichotomy for clinicians to understand for a number of reasons. In western society many individuals hold this notion as an engraved conception of health. They either believe they are sick or healthy, not in-between. If a clinician does not understand the perception of the patient then they could make a mistake not only in their diagnosis, but the treatment as well. They need to understand the patient’s view, starting position and ultimate goal. If they do not comprehend this concept they will not be able to provide the most effective care for the patient, and in doing so, jeopardize their health. An alternative way to approach this dichotomy would be to not think of it as two extreme options, but rather a range with these two as the end points. This way a physician can more effectively assess a patient and pick a point along the range of where they are. They can correctly identify where the patient sees himself and where on the range is the most reasonable target, hopefully full optimal health, but for some with underlying conditions optimal health will never be fully attainable so they will have to suffice with somewhere close to it on the range.

  3. The dichotomy of healthy/sick is one that clinicians need to pay close attention to. This dichotomy is used in western medicine a lot and is referred to a lot by people other than clinicians too. What clinicians need to realize is that healthy and sick can have very different meanings depending on the patient’s views. In some cultures people don’t even address depression as a sickness, so if this person were to come in the western world they would not think they were sick even if a clinician told them they thought they were depressed. I know that the doctor’s office that I go to has a scale that rates your pain from 1-10 with corresponding faces on it. So instead of using healthy/sick, they use pain to determine the illness in some cases. Physicians can check for the physical symptoms that patients may have, and say that they are healthy, but there are more internal problems or ones that we don’t address in the western world to think about. An alternative way to conceptualize this dichotomy is to not think of it as the truth, and try to learn more about a patient to really and truly understand the patient’s views and culture. This would help the patient trust the physician more and for the physician to make a better diagnosis.

  4. This dichotomy, as with most, is very hard to classify. Firstly, they vary across cultures, so what is considered an illness in one society may not be elsewhere. Secondly, they are dependent on ones personal views and beliefs. What one might consider healthy, may be completely different from another, in fact someone else may consider them sick. Also, it is dependent on how health or illness(sick) are or are not being defined. Is it purely physical? Mental? Both? Neither? Or simply some aspect of it all ( I’m a diagnosed epileptic but have no seizures since having surgery 3yrs ago, and typically have perfect checkups at the doctor, am I still sick? Or would I be considered healthy?)
    I agree with you that our society has become highly over medicated, largely in part because of the pharmaceutical industry. And that although some people truly do need, and benefit from these medications, they are too easily prescribed to ‘healthy’ patients, particularly ADHD (even birth control for PMDD as in the lecture). This is a valid reason for clinicians to understand the dichotomy of healthy vs. sick, as confusing as it can be. However, its also important that they understand this, because of how unclear it can be, and how much it can vary from case to case. A patient could have a serious condition but show no symptoms, or be very good at hiding them. Another patient could show multiple symptoms, possibly to multiple problems, but be perfectly healthy. A doctor needs to be able to distinguish which is which, and so forth. Also, some people’s idea of health varies depending on how they feel, and this needs to be taken in to account. The best way for this to be done, and its not easy or even common in our society is to have an excellent report and bedside manner with ones patients. To spend that extra minute asking the little questions, and put in that little extra effort could go a very long way in these regards.

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