A Complexidade do Conceito de Doença

Por que o conceito de doença é importante para um clínico? Normalmente, os médicos não estão preocupados se o conceito de doença que utilizam é ontológico ou fisiológico, normativo ou descritivo. O que é importante e o que tem sido amplamente discutido é o bombardeio de questões provenientes de pacientes, da mídia, de setores da medicina alternativa e até de outros médicos sobre as bases do raciocínio clínico - cujo ponto de partida é o conceito de saúde e de doença. A crítica principal normalmente gira em torno da medicalização da Medicina e a sua contrapartida teórica: a patologização do curável, nos quais o conceito contemporâneo de doença é altamente implicado.

Sobre isso, segue um excerto do trabalho de Bjorn Hofmann (para o texto completo clique aqui):

"I have argued here that the debate on the concept of disease is complex, and that this complexity can be recognised in the theoretical frameworks of the debate. The profound philosophical issues underlying the debate illustrate the complexity of the concept. That is, the complexity of the concept is displayed by the complexity of the categories of the debate. There is something outstanding to the concept of disease generating logical, ontological, epistemological and normative challenges. The concept appears to be irreducible to a particular perspective or a monistic conception. Even if we could answer the question of the ontological status of instances of disease, its classificatory and normative issues would not be resolved. Correspondingly, if we cleared the evaluative status of disease, the ontological, semantical and epistemological issues would still be open. These issues seem not to be inter-reducible. However, is this only a theoretical complexity? People are actually treated in the health care system without there being any reflections of this kind. Are the challenges only of an abstract kind? The complexity in the theoretical frameworks appears to be more than a mere academic issue, and it is reflected in medical practice. Whether pregnancy, excellence, infertility, whiplash, or a general feeling of incompetence are cases of disease are practical issues, and even the status of homosexuality as a disease has been a topic in clinical practice until recently. Furthermore, the classification of disease entities is a great challenge to modern medicine. A strict and consistent concept of disease, be it theoretical or practical, should result in a strict and consistent taxonomy, which obviously is not the case. Disease entities are classified according to symptoms, syndromes, physical signs, paraclinical signs, abnormalities of morphology, physiological aberrations, genetic abnormalities, ultrastructural abnormalities, etiological agents and according to eponymal origin. Hence, the theoretical complexity discussed in this study corresponds to a practical complexity, and as far as the conceptual debate on disease is concerned, the concept should give practical guidance and pave the way to a tidier practice. In this respect it has certainly failed. The reason for this is reflected in the complexity of the theoretical frameworks. My aim has not been to argue that the profound issues revealed in this study are final and absolute for the debate on the concept of disease. A conceptual debate of human disease may follow other lines of thought. The presentation has been one attempt to structure the categories of the debate. However, I would argue that any investigation of these categories has to take into account the theoretical complexity. The profound philosophical distinctions of the debate show that the concept of disease involves fundamentally different issues. Disease is basically an issue that is so complex that it appears extremely difficult to encompass it by a single monistic theory."