Disease, Illness, Sickness

I finally feel I can say I'm recovering from my New Year's flu or pneumonia or death or whatever you want to call it. For over a week I've been coughing and sneezing and achy and.... miserable. I'm only grateful that it wasn't this nasty stomach virus that has been going around. My stomach is almost always the one thing one me that doesn't hurt when I get sick. Even when I have food poisoning, I always manage to throw up, feel better, and immediately begin thinking about food. But this stomach bug has been serious business here. Over a million suspected cases this winter, and it's not even half over yet. I'm planning on staying away from computer labs and hospitals, which is apparently where it likes to spread.

My sickness, on the other hand, allowed me plenty of time to contemplate what it means to actually be sick. This stems back to a medical anthropology class I took as an undergraduate. Interesting class, but not nearly as interesting as it should have been. But I did learn some interesting concepts, notably those of disease, illness, and sickness. From an anthropological standpoint, these things are all very different (in American culture, we use all three interchangeably, more or less, to refer to the state of being not-well). I hate for this to turn into an academic lesson in anthropological terminology, but here-goes. Disease, from this particular scientific standpoint, refers to an actual virus or bacteria or cancer or anything along those lines that causes malfunctions in the body. Illness, then, is the cultural recognition of either a disease or a malfunction of the body, which may or may not be caused by a disease. Sickness is the role someone with an illness plays within the constructs of a culture, what is expected of someone who is ill.

Confused? Well, let's use an example. In the US, someone who has cancer has a disease. It is recognized as such by everybody, and there are certain medical terms which we apply to people who have cancer. That recognition of cancer as a problem is the illness. Now, there are also certain protocols to be followed when one has cancer; notably, friends and family are supportive and sympathetic, and the ill person is expected to A) undergo a series of unpleasant treatments in order to rid themselves of the disease, or B) squander all their money on all the adventures they have always wanted to do in a very Hollywood plot line. Those choices, A and B, become the sickness, how that person is supposed to act in the event of an illness, this particular one caused by an actual disease (cancer).

Illnesses, however, can also be recognized without there being a disease to cause it. For example, in some early Puritan communities, red hair was considered a sign of possession or witchcraft. There is no disease associated with red hair, medically speaking, but there is an illness in the Puritan culture: being in league with the Devil. All very dramatic, I know, but there ARE the Puritans we're talking about. The sickness, the proscribed was a person with the illness of red hair was supposed to act, usually followed a path of persecution (often, both for the mother and child), repentance and/or execution. A person with such an affliction was expected to say and do certain things in order to either give up his or her pact with the Devil or be subject to various inhuman tortures upon denying the connection.

In addition, just to make things a bit more confusing, there can also be a disease present that has no illness or sickness associated with it. The Masai in eastern Africa, for example, are often afflicted with a certain kind of bladder infection that most often only affects males (this is actually due to the gender-differences in work and play expectations which takes boys into a different sphere than girls, and within that sphere is where these particular bacteria live, hence the reason that women most often do not contract this type of bladder infection). The disease is present, as evidenced by the blood in the urine of most boys beginning at around puberty. However, within the Masai, the sign of blood in the urine as a result of this infection is not seen as an illness; on the contrary, this symptom is a sign that the boy has reached puberty and is ready to be inducted into the realm of men. Therefore, there is no sickness, no proscribed was for one with an illness to be acting because there is no illness. In their rituals, there is nothing negative about blood in the urine.

Quite fascinating, really. And it is interesting what you can learn about a culture while observing their diseases, illnesses, and sicknesses. In my case, I have some kind of disease (like I said, the flu, pneumonia, death, whatever). It is recognized that I have some sort of illness, but here, probably due to the crappy weather, it is an illness far less urgent and serious that it would be in States. Here, my coughing is drowned out by the coughs of a dozen people near me, the snuffles and nose blowing of half the students in my classrooms. When I inform people that I am sick, they do not shy away from me as many would do in the States; they simply nod knowingly and say, "Yes, 'tis the season. And so for a sickness, it is not expected that I change my routine at all, but instead find a selection of non-drowsy (which here means they add all kinds of caffeine to keep you up, which is really quite miserable) cough syrups and decongestants and push through until spring, when, I have been informed, it will finally go away after months of plaguing my mental well-being. I feel that this attitude helps to explain why there are a million cases of that stomach virus in the UK.