Experiments in Dealing with Epidemics in Seventeenth-Century Siam

This article uses a study of two epidemic outbreaks of smallpox in late seventeenth-century Siam to interrogate the developing “social meaning” of the disease in Thai society at the time. Through this case study the article examines the problems of translation and the limitations of our source bases for understanding premodern approaches to epidemic management. It suggests ways of reading across various sources to reconstruct how intercultural learning, exchange, and experiment among communities who suffered epidemic disease contributed to global constructions of concepts of disease.

Healing Traditions in Coptic Magical Texts

Within the ‘market of healing’ of Christian Egypt (here broadly considered as the fourth through twelfth centuries CE), ‘magical’ practitioners represent an elusive yet recurrent category. This article explores the evidence for magical healing from three perspectives – first, literary texts which situate ‘magicians’ in competition with medical and ecclesiastical healing; second, the papyrological evidence of Coptic-language magical texts, which provide evidence for concepts of disease, wellness, and their mediation; and finally confronting the question of how these healing traditions might be understood within the methodologically materialistic framework of academic history, using the concepts of placebo and healing as a performance.

The concept of disease in the time of COVID-19

Philosophers of medicine have formulated different accounts of the concept of disease. Which concept of disease one assumes has implications for what conditions count as diseases and, by extension, who may be regarded as having a disease (disease judgements) and for who may be accorded the social privileges and personal responsibilities associated with being sick (sickness judgements). In this article, we consider an ideal diagnostic test for coronavirus disease 2019 (COVID-19) infection with respect to four groups of people—positive and asymptomatic; positive and symptomatic; negative; and untested—and show how different concepts of disease impact on the disease and sickness judgements for these groups. The suggestion is that sickness judgements and social measures akin to those experienced during the current COVID-19 outbreak presuppose a concept of disease containing social (risk of) harm as a component. We indicate the problems that arise when adopting this kind of disease concept beyond a state of emergency.

Subversion

This chapter explores the second stage of the metagnostic narrative arc: subversion. Following the conception of a metagnostic revelation as both recognition and misrecognition, it examines the ways in which the revelation may unsettle labels and categories. First, central concepts of disability studies are introduced and explored, and it is suggested that terms such as disability and impairment are illuminated and interrogated by a metagnostic revelation, as it breaches the expected mapping between body and classification. Indeed, situating a given revelation requires a sudden renegotiation of the ontological balance between biological impairment and socially constructed disability, and also subverts customary narrative strategies for situating disability. Second, the individual’s relationship with a given disease is seen anew and challenged in light of metagnosis, as are concepts of disease, illness, and sickness. This chapter also serves as an introduction to key concepts in disability studies and philosophy of medicine.

When answers are hard to find, change the question: Asking different causal questions can enable progress

This chapter argues that changing the causal questions asked by psychiatric research programmes might facilitate progress in finding the causes of mental disorders. K. Codell Carter’s (2003) The Rise of Causal Concepts of Disease shows that empirical progress sometimes requires a change in the causal questions that researchers ask. The philosophical claim that causal explanation is contrastive implies that projects that seek ‘the causes of disorder’ might pursue this aim in multiple ways. Some causal questions will turn out to be easier to address than others. This means that when research programmes stall, it is worth trying to restart progress through switching the causal questions asked. The chapter considers one type of causal question, ‘Why do some people with condition X find it harmful and others harmless?’, that might plausibly be fruitfully addressed more often than at present.

Concluding remarks

Demographic change and economic constraints are likely to drive change in healthcare systems over the next few decades. It seems inevitable that both the amount and the shape of healthcare systems will be stretched by increasing numbers of old people, even as the definition of ‘old age’ is itself stretched. Concepts of ‘disease’ may need to change; such changes will need to be mirrored in coding systems. As healthcare becomes more specialized, pathways become more complex. This will disadvantage people who lack the cognitive, physical, and financial resources to navigate complex systems. Specialists in healthcare public health will need to adapt their knowledge, skills, and attitudes.

Introduction

This introductory chapter provides a background of how mass immunization programs made vaccination a cornerstone of Chinese public health and China a site of consummate biopower, or power over life. Over the twentieth century, through processes of increasing force, vaccines became medical technologies of governance that bound together the individual and the collective, authorities and citizens, and experts and the uneducated. These programs did not just transform public health in China—they helped shape the history of global health. The material and administrative systems of mass immunization on which these health campaigns relied had a longer history than the People's Republic of China itself. The Chinese Communist Party championed as its own invention and dramatically expanded immunization systems that largely predated 1949 and had originated with public health programs developed in southwestern China during the Second Sino-Japanese War from 1937 to 1945. The nationwide implementation of these systems in the 1950s relied on transformations in research, pharmaceutical manufacturing, and concepts of disease that had begun in the first decades of the twentieth century. These processes spanned multiple regime changes, decades of war, and diverse forms of foreign intervention. Most important, they brought with them new ideas about what it meant to be a citizen of China.

Explanation of basic concepts of medical terminology

People often compare general medicine to psychiatry using false assumptions or incomplete comparative information. Doctors’ role in healthcare relies in part on their sapiental authority, i.e. their knowledge. This sapiental authority relies on developing a medical model to learn and use information. The medical model relies on standardized terminology to aid communication and learning. The medical model allows them to identify problems and recall information on outcomes and treatments. The medical model may also allow explanation of how problems occur and the biopsychosocial model is preferred. Other models of explanation and intervention may also be used and may be superior for certain functions or explanations. The concepts of disease, illness, and health are not clear-cut and often require professional judgements—influenced by culture—based on distress or risk of adverse outcomes to identify examples of, e.g. disease. Condition may be used instead for states that may require medical attention.