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June 9, 1989

The Nature of Disease

Author Affiliations

University of California at Los Angeles School of Medicine

University of California at Los Angeles School of Medicine

JAMA. 1989;261(22):3314. doi:10.1001/jama.1989.03420220128044

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This book addresses the philosophical question: "Do we invent diseases or do we discover them?" Not only is this far from easy to answer, but a thousand years of discussion on this and related subjects have failed to result in a consensus.

The author finds an acceptable and straightforward answer to the first part of the question: essentially, the concept of disease is normative in that we make value judgments about what constitutes normal and abnormal behavior. Homosexuality, for example, may or may not be normative depending on the judgment one brings to the behavior. In this sense, we invent diseases. And, in this sense, the fact that different cultures have different views of disease is understandable, as is the generally held view that mental retardation is a disease but genius is not.

Whether or not we discover diseases is a far more complex issue, primarily because one implication of