Classification and Disease Diagnosis is all about classification, and classification is a social act. Nature is, writes Eviatar Zerubabel, a continuum, which we need to parcel up into “islands of meaning,” allowing us to generalize about phenomena and experiences. Classification puts items together that have more in common with one another than they do with those things which are in another category. Classifying disease organizes and directs medicine and public health. At an individual level, the clinician will classify the patient complaint, assessing symptoms for characteristics which bring to mind a particular pathology, a previous case, a textbook memory. Collectively, classification of diseases validates, locates, and distributes: designating whether a disease is real, if it is psychological or physical, under what sub-disciplinary jurisdiction it falls, what treatment it requires, how many resources should be assigned to it, and so on. Yet, with each diagnostic act, numerous different classifications are often possible, and not all have the same social consequences. An minor chest injury can be a “contusion, chest wall;” “contusion, breast;” “injury, rib;” “fracture, rib.” A period of psychological distress can be “reactional depression” or “Major depressive disorder, single episode.” A cough, wheeze and fever can be an “upper respiratory infection,” “influenza-like illness,” or “bronchitis, acute.” As Thomas Arnold wrote in the nineteenth century: “We are not to suppose that there are only a certain number of divisions in any subject, and that unless we follow these, we shall divide it wrongly and unsuccessfully: on the contrary every subject is as it were all joints, it will divide wherever we choose to strike it, and therefore according to our particular object at different times we shall see fit to divide it very differently” What are some interesting double-jointed diagnoses you can think of, and what is the rationale for their variable divisions? (see mitpress.mit.edu/books/sorting-things-out)
Posted on: Mon, 04 Nov 2013 18:33:42 +0000
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