Jennings D, Netsky M G
Vanderbilt University, Nashville, Tenn.
CMAJ. 1991 Apr 15;144(8):973-9.
The concept of disease is of cardinal importance in medical practice. The current definition has developed over more than 200 years. It includes a distinctive natural history and identifiable cellular changes. Pickering proposed a fundamental alteration to the definition when he suggested that essential hypertension is a quantitative disease without causative cellular change distinguishing normal from abnormal. The nature of essential hypertension has been confused from the beginning because of a category error. Injury is conceptually distinguished from disease. Essential hypertension, defined as elevated blood pressure together with its cardiovascular consequences, is found to be neither an injury nor a disease according to current definitions. Instead, essential hypertension refers to a treatment group just as "the fevers" did in an earlier century. One effect on patients of the failure to resolve this diagnostic paradox is the burden of suffering from the label of "disease" rather than from a state that may be substantially due to their own behavior. A theoretical consequence of importance for psychiatric theory is that the disease status of functional disorders can no longer be defended by an appeal to the existence of a quantitative disease of blood pressure.
疾病的概念在医学实践中至关重要。当前的定义已经发展了200多年。它包括独特的自然史和可识别的细胞变化。皮克林对该定义提出了根本性的改变，他认为原发性高血压是一种定量疾病，不存在区分正常与异常的致病性细胞变化。由于分类错误，原发性高血压的本质从一开始就被混淆了。损伤在概念上与疾病有所区别。根据当前定义，原发性高血压被定义为血压升高及其心血管后果，但它既不是一种损伤也不是一种疾病。相反，原发性高血压就像一个世纪前的“发热”一样，指的是一个治疗组。未能解决这一诊断悖论对患者的一个影响是，他们承受着“疾病”标签带来的痛苦负担，而不是来自可能主要归因于自身行为的一种状态。对精神病学理论具有重要意义的一个理论结果是，功能性障碍的疾病状态不能再通过诉诸存在定量的血压疾病来辩护。
