Introduction

HEALTH, AND ITS NEGATIVE, illness, have probably been major human subjects of preoccupation and concern as long as anything like human society has existed. Some kind of illness has been very prevalent in diverse nonliterate societies, such as those of Central Africa ¹ or the Navaho of the American Southwest.² The main tradition of the conception of and concern with health that has dominated Western civilization, however, has its roots more in Greek culture than in any other single source. The earliest connected literary remains of this tradition are usually called the body of the Hippocratic writings, which date from the fifth century B.C.

The Hippocratic writings contained an exceedingly important formula that has survived ever since, mainly in its Latin form. This is what has been called the vis medicatrix naturae (i.e., the healing power of nature). This formula seems appropriate to provide a major point of reference for the present analysis. It will be interpreted in terms of possible relevance to thesocial and action contexts that are stressed in the title of the present article. Vis medicatrix may be thought of as a property of living systems, in the first instance, individual organisms, by virtue of which such systems have the capacity to cope, often without outside intervention, with disturbances to health or cases of illness, that is, cases not so severe as to exceed certainlimits. It was one of the primary tenets of Hippocratic medicine that the physician should take account of the inbuilt capacity of his patients to recover from illness and work along with such capacities, rather than to intervene arbitrarily without reference to such capacities.³

* The term "action" in the subtitle of this article does not refer to practical effectiveness, but to the theoretical scheme called the “Theory of Action" with which I and a variety of colleagues have been working for a number of years.

¹ Renee C. Fox and Willy De Craemer, The Emerging Physician: A Sociological Approach to the Development of a Congolese Medical Profession (Stanford, Calif.: Hoover Institution on War, Revolution and Peace, 1968).

² Clyde Kluckholn and Dorothea Leighton, The Navaho (Cambridge, Mass.: Harvard University Press, 1946).

Revised version of the article appearing in the Encyclopedia of Bioethics, Warren T. Reich, ed. (New York: Free Press, 1978). Copyright © 1978 by Georgetown University. Used by permission of the Publisher.

We share the view, which has been prevalent almost throughout the history of Western medical thinking, that the primary focus of the problems of health and illness lies in the state of the organism, that is, as a living biological system. The task of the present article, however, is to put this biological aspect of the problem in a somewhat larger setting. Of all living species, man is predominantly characterized by being, to paraphase Aristotle, in the first instance a "social animal" and in the second instance a bearer of symbolically organized cultural traditions. In the usual senses of the history of science, then, man - though very obviously an organism in the biological sense - is more than an organism. He is a behaving system, a personality, a member of structured social systems, and a participant in cultural systems and patterns of meaning of what is sometimes called "the human condition." Though there are obviously many continuities between the problems of health and illness at non-human levels and the human problems, our primary concern is with certain features of the health-illness complex that are most specifically human.

Health as a central feature of the state of the living organism is quite clearly one of the most important aspects of the human condition for problems of bioethics. We shall argue in the next section that problems of health should not be regarded as only organic even though they are"rooted" in the state of the organism; yet, we do not negate the importance of the organic reference. Furthermore, we wish to stress that we regard health as a state of the human individual, not of collectivities such as populations or species or, in more concretely human terms, groups of societies.

In empirical human experience, after all, the life of the individual is bounded by birth - whatever the interpretation of states between conception and birth - and by death - however organic death be defined. In any case, problems of health are intimately intertwined with those of both birth and death, perhaps especially the latter. It is clearly no accident that birth and death have constituted primary foci of meaning for every known human religion. Such problems seem to be at the very center of the ethical problems of the human condition.

³ Bernard Barber (ed.), L. J. Henderson On the Social System: Selected Writings (Heritage of Sociology Series) (Chicago: University of Chicago Press, 1970).

68 SOCIOLOGY OF HEALTH AND ILLNESS

If this be true of the beginning and the end of the life cycle of the human individual, it is clearly also true of what happens to such individuals in between. If we must recognize the existence and importance of mental as well as organic health, as I think we must, the focal religious category of suffering can surely have an organic reference - though presumably notin the strict sense physical; a stone presumably does not feel pain when it is hit with a sledgehammer - but there seems to be no reason to limit the concept of suffering to the organic level. Thus, mental or spiritual pain and anguish seem very real as not mere epiphenomena of organic events. Insofar as there is mental health or illness it is clearly intertwined with these.

Finally, another classic field of religio-ethical concern, the "problem of evil," seems to stand on a different level, relatively dissociated from the state of the organism. It articulates with the problem of justice precisely, in the sense of what happens to individuals. Since injustices, objectively suffered or subjectively felt, affect the whole person, they can scarcely fail to interact with the problems of health.

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