A medical definition

 A medical definition
Professor Marshall Marinker, a general practitioner, suggested over twenty years ago a helpful way of distinguishing between disease, illness and sickness. He characterises these “three modes of unhealth’”as follows.

“Disease … is a pathological process, most often physical as in throat infection, or cancer of the bronchus, sometimes undetermined in origin, as in schizophrenia. The quality which identifies disease is some deviation from a biological norm. There is an objectivity about disease which doctors are able to see, touch, measure, smell. Diseases are valued as the central facts in the medical view…

“Illness … is a feeling, an experience of unhealth which is entirely personal, interior to the person of the patient. Often it accompanies disease, but the disease may be undeclared, as in the early stages of cancer or tuberculosis or diabetes. Sometimes illness exists where no disease can be found. Traditional medical education has made the deafening silence of illness-in-the-absence-of-disease unbearable to the clinician. The patient can offer the doctor nothing to satisfy his senses…

“Sickness … is the external and public mode of unhealth. Sickness is a social role, a status, a negotiated position in the world, a bargain struck between the person henceforward called ‘sick’, and a society which is prepared to recognise and sustain him. The security of this role depends on a number of factors, not least the possession of that much treasured gift, the disease. Sickness based on illness alone is a most uncertain status. But even the possession of disease does not guarantee equity in sickness. Those with a chronic disease are much less secure than those with an acute one; those with a psychiatric disease than those with a surgical one … . Best is an acute physical disease in a young man quickly determined by recovery or death—either will do, both are equally regarded.”2

Disease then, is the pathological process, deviation from a biological norm. Illness is the patient's experience of ill health, sometimes when no disease can be found. Sickness is the role negotiated with society. Marinker goes on to observe that a sizeable minority of patients who regularly consult general practitioners, particularly for repeat prescriptions, suffer from none of these modes of ill health. They appear, rather, to be seeking “to establish a healing relationship with another who articulates society's willingness and capability to help”. So a “patient”, in the sense of someone actively consulting a doctor rather than just being on the books, does not necessarily mean someone who has a disease, feels ill, or is recognised to be sick; and of course there are other more mundane reasons, short of wanting to establish a healing relationship, why a patient may consult a doctor—to be vaccinated before travelling abroad for example. Most patients most of the time however, probably can be classified as having a disease, or feeling ill, or being recognised as sick