Causal concepts of disease

I’ve emphasised before (eg. see previous post) how medicine changed in the nineteenth century. K. Codell Carter in his book The rise of causal concepts of disease (2003) mentions how James L. Bardsley, a prominent British physician, in 1845 thought that diabetes ‘has been traced by some patients to sleeping out the whole of the night in a state of intoxication’. This shows how much our ideas of disease before our modern anatomoclinical understanding were influenced by patients’ opinions themselves.

Codell Carter describes the development of what Robert Koch called the aetiological standpoint which understood disease as having natural, universal and necessary causes. He also suggests in the last chapter of the book that how we characterise disease may change in the future. 

The domination of medical thought by the aetiological standpoint has prevented the proper understanding of functional mental illness. Psychiatry’s credibility is wrongly dependent on a biological aetiology of mental illnes, despite brain abnormality not being a sufficient explanation of functional mental illness. Psychiatry’s still stuck in the nineteenth century in its search for natural, universal and necessary causes of mental illness.