Band 18 : Was ist Gesundheit? : interdisziplinäre Perspektiven aus Medizin, Geschichte und Kultur
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Controversies Over the Concept of Mental Disorders. Just like persons suffering from somatic diseases, those experiencing mental disorders, maladies, or diseases should be provided with care and protection from certain social demands. Yet, any disease concept should be precise enough to avoid classification of behavior as pathological while it is merely socially undesirable in the current political system. This paper reviews various conflicting concepts of disease, illness and sickness. In addition, it provides a narrower definition of a so-called clinically relevant mental malady. This definition is characterized by a) an impairment of mental functions relevant for human life (the disease aspect of a mental malady) and b) personal harm either due to suffering (the illness aspect) or impaired activities of daily living that severely limit social participation (the sickness aspect). This chapter claims that any definition of disease-relevant mental dysfunctions should be critically reflected regarding its philosophical and anthropological foundation and ethical consequences. Criteria of disease, illness and sickness should no longer be defined by groups of professionals selected by the WHO or other institutions, but instead require public debates that include organizations of patients and relatives.
Health Data as a Public Good. Routine health data, which are collected by health insurers and other agencies in the health care system, offer enormous potential for health monitoring and research. Germany has been slow to make such data available for socially beneficial purposes, partly due to concerns about privacy and data protection. Against this background, we discuss some of the most important potential uses of routine health data and call for a broader societal debate about the benefits, risks, and appropriate regulation of routine health data usage.We then review theWestern Australian Data Linkage System as an example of a data infrastructure that is characterized by high levels of stakeholder and patient involvement and a sophisticated method of privacy protection. While Germany does not need to copy this approach, we hope that the experiences of Western Australia and other countries will stimulate and inform the overdue debate about a modern, responsible, and sustainable approach to socially beneficial health data usage in Germany.
Taming the European Leviathan: Health as Politics. A Research Project. This article outlines the research project „Taming the European Leviathan: The Legacy of Post-War Medicine and the Common Good“. It is funded by a Synergy Grant of the European Research Council and unites European researchers comparing health policies (from drug research to prevention) in West- and East-European countries, e.g., Bulgaria, Germany, France, Czechoslovakia, Hungary, and the United Kingdom. The common goal is to provide a different perspective on post-war Europe, a perspective that emphasizes commonalities rather than differences.
The Feeling of Being Healthy: New Perspectives on Modern Medicine. „Well-being“ and mental health have become increasingly important in the definitions of health since 1945. Has this also changed the feeling of being healthy? The chapter demonstrates that the intuitive feeling of being healthy when the body does not cause any discomfort has been increasingly delegitimized in the last hundred years. It identifies three developments as responsible for this shift: the establishment of the risk factor model, the reconceptualization of health as result of a constant process of rebalancing health and illness, and the emphasis on the subjective component of health.
Concepts of Health in Psychiatry. In talking about concepts of health in psychiatry,we are not talking about an essentialist concept of health, where there is some essential thing that health might be. There is a straightforward sense in which psychiatric „health“ simply means the absence of psychiatric disease. Marking out our concepts of health in psychiatry would then involve marking out the boundaries between normal and abnormal psychic phenomena. However, there is no single, neat concept of health in psychiatry; nor are there concepts of health that neatly cohere into one overarching theory of health. This is not because psychiatry is vague. It is because psychiatry reflects the complexity of the whole person.
Health in Judaism: An Intercultural Discourse on Lack of Understanding and Misunderstanding in the Past and Present. Hardly any other religion pays as much attention to physical health as Judaism. Beginning with the Torah, the contrast between „healthy“ and „sick“ is already conceptualized and associated with the will of God and his plan of creation. In addition to the stereotype that Jews are sicker than their fellow human beings, there is an early claim that their state of health is better than that of other peoples. The religious writings of Judaism contain a large number of regulations that show how much the Greco- Roman doctrine of dietetics has been internalized, expanded and adapted to one’s own spiritual needs. There is broad consensus among today’s rabbis that health care, as described above all in the Talmud, was time-related and therefore should be based on today’s standards and findings while remaining in compliance with religious laws.
Local Concepts of Health and Illness in Transition: Examples from Papua New Guinea. Papua New Guinea societies integrate traditional medicine, biomedicine, shamanic practices, and Christian healing techniques into herbal therapies. During an episode of illness, patients pragmatically apply different diagnostic and therapeutic procedures. Concepts of person and body are central to indigenous illness etiologies and therapeutic practices. This contribution offers an insight into local concepts of health in Papua New Guinea, shows interfaces of local medical systems with biomedical approaches, and addresses the constant change to which medical systems are subject.
The World Health Organization (WHO), Pandemics, and COVID-19: How to Proceed With a Multilateral Concept of Global Health? The WHO grew to 194 member states, and with globalization, geopolitical shifts, and internal reorganizations, the lines of influence have become more complex. In 2020, the United States severely endangered multilateralism in health. Recently, the Biden administration has revived US commitment as a major global health player. Yet, the lack of coherence in supporting collective action on global health remains a problem. Global health geopolitics are shifting and China and India have acquired enough power to shape the global health agenda. At the instigation of Germany, health has become a regular topic at Group of Twenty (G20) and G7 meetings – a critical factor during the COVID-19 pandemic. The WHO’s director general frequently states that health is a political choice. Many countries made unfortunate, if not questionable political choices in their responses to COVID-19. But as a matter of fact, they took the wrong turn much earlier when they neglected investments in pandemic preparedness and in the WHO. Countries have the political choice right now to seriously strengthen the WHO, its funding, and its legal power, or to weaken or even destroy one of the most important agencies in the UN system.
The Normative Practice of Health and Disease. „Health“ and „disease“ are frequently used terms with a high relevance for our everyday lives. Their spectrum of meaning is very extensive, but also ambivalent, because they are not adequately captured by a purely medical-scientific approach. The forms of knowledge associated with „disease“ and „health“ are rather diverse and allow different ways of looking at them side by side in a justified manner. Against this background, the relationship between scientific and life world approaches to these phenomena is of central importance, because this results in very different claims to an interpretative sovereignty of „health“ and „disease“. For these states not merely have an associated dimension, but an essentially practical-normative one, so that they cannot simply be reduced to a biological function or dysfunction. This becomes especially clear when the assignment of dysfunctional conditions to the concept of disease results in immediate options for action that are not simply limited to a chapter expansion of medical textbooks, but may lead to fundamental personal and social changes. For this side of „disease“ and „health“ reflects not only medical developments, but also normative attitudes in science and society. These in turn are also decisive for the communicative structure in the doctorpatient relationship.
The Emergence of Modern Medicine and a New Understanding of Health and Disease: Rudolf Virchow and the Berlin Medical Society. At the beginning of the 19th century, the most important cities for medicine were Paris and Vienna. Berlin had less than 200,000 inhabitants and no university.Within a short period of time, this changed dramatically – and progress in medicine was a main catalyst. At the end of the 19th century, around two million people lived in Berlin and the city had become the world metropolis of modern medicine. This article examines the main causes and the central figures of this astonishing development. The driving force behind this advance was the rise of a new sort of medicine, i. e., a medicine based on evidence and science. Here, the Berlin Medical Society and its long-time president Rudolf Virchow played a central role. His concept of cellular pathology changed the definitions, methods and understanding of health and disease. Thus, it is no exaggeration to state that Virchow served as one of the most important founding fathers of modern medicine.