Disease vs. Illness: How Culture Teaches Us to Be Sick
"Disease is a biomedical worldview. Illness, by contrast, is how your culture teaches you to be sick."
I remember reading this quote by Terry Tafoya at the beginning of a course module, and it stopped me in my tracks. It perfectly encapsulates a distinction that is often lost in modern mental healthcare. Unlike a broken bone or a viral infection, you cannot draw blood or take an x-ray to determine if someone has a specific mental disorder.
This quote led me to a deep exploration of the Power Threat Meaning Framework, which argues that mental health issues are often products of social constructs rather than fixed biological facts.
The Trap of Language
One of the key premises I studied is that diagnoses—like those in the DSM—are linguistic constructs. They are created out of language and social agreement, not universal laws.
Reflecting on this, I thought about how language varies so wildly from culture to culture. We often hear about the frustration of not being able to translate a specific feeling or concept into another language because the word simply doesn't exist there. If language defines our reality, then the way one culture expresses and defines "schizophrenia," for example, might be completely different from another.
It begs the question: Why doesn't the DSM have different versions for different regions? By imposing one linguistic framework on the whole world, are we missing the full picture of the human experience?
Diagnosis is Fluid, Not Fixed
Another major takeaway was that diagnostic categories are always subject to change. We can look at history for proof: the DSM once listed homosexuality as a disorder, and "hysteria" was a common diagnosis that is rarely heard of today.
As a therapist, I see this fluidity as the norm. Diagnoses aren't fixed truths; they are snapshots of cultural norms at a specific point in time. Realizing this is crucial because it helps us emphasize that mental illnesses are not permanent, unchangeable labels attached to a person's identity.
The Power of the Constructivist Approach
I believe using this constructivist approach—viewing illness as a social construction—is incredibly beneficial for healing.
It normalizes the fluidity of our experiences. If clients can understand that their mental illness is often a byproduct of their environment, their culture, and the times they live in, it creates space for change. It helps them realize that their condition isn't a fixed defect, but a fluid response to the world around them. This shift in perspective makes the ability to progress and make new meaning of their lives much easier.
References
Johnstone, L. & Boyle, M. with Cromby, J., Dillon, J., Harper, D., Kinderman, P., Longden, E., Pilgrim, D. & Read, J. (2018). The power threat meaning framework: Towards the identification of patterns in emotional distress, unusual experiences and troubled or troubling behavior, as an alternative to functional psychiatric diagnosis. Leicester: British Psychological Society.
