Insomnia is a common symptom resulting from many disease processes.
The Disease Perspective
The attribution of illness to an abnormality in the structure or function of a bodily part is essential to disease reasoning. The disease model perspective assumes that people share certain illness symptoms, signs, and clinical course characteristics because they share the same underlying physical problem. Clearly, this type of reasoning represents the backbone of contemporary medical science and clinical practice.
The disease model ultimately is a stepwise process; it begins with observing, then categorizing findings, and finally explaining clinical phenomena. Similar clinical presentations, including the course, signs, and symptoms, may be described as syndromes. This should stimulate attempts at explanation, typically through the recognition of similar underlying pathological conditions. The ultimate goal is the identification of one or more specific etiological processes responsible for the pathology. McHugh and Slavney (1998) emphasize this relationship of the clinical syndrome, pathological process, and etiology. They offer congestive heart failure as an example of a general medical syndrome, which has several potential types of associated pathology, including myocardial infarction, valvular stenosis, hyperthyroidism, and constriction of the pericardial lining. Constrictive pericarditis, in turn, may have the specific etiology of a tubercular infection.
In the realm of psychiatry, dementia is a well-defined syndrome characterized by a global decline in mental functioning. Dementia is a clinical diagnosis based on psychological features and the course of the symptoms. However, various pathological processes can lead to the typical presentation of dementia. Alzheimer disease, multiple infarcts, severe major depression, and pernicious anemia are among the possible underlying pathological entities. Vitamin B 12 deficiency may be the etiology of the pernicious anemia, just as a genetic defect may be established as the cause of Alzheimer disease.
Schizophrenia also may be viewed as a syndrome with characteristic positive and negative symptoms and, generally, a chronic course. However, there often is considerable variation in the clinical presentation. The range of patients diagnosable with this disorder makes it a rather disjunctive syndrome category. Some have suggested that schizophrenia is best considered as a group of disorders. Of course, evidence of definitive pathology would help greatly in diagnosing psychotic patients. While various avenues of investigation, such as neuroimaging and pharmacological studies, are very promising, pathological processes and etiological agents are not yet firmly proclaimed. The current state of our science, however, does not disqualify schizophrenia from the disease model; we simply remain frustrated at the syndrome level. Ultimately, new data will promote new categorization and explanation and, it is hoped, new treatment approaches. The disease model has enormous strength and value. It is a familiar mode of thought; the inherent formation and testing of a scientific hypothesis typically is automatic in clinical practice. This approach promotes the accumulation of knowledge that helps explain not just pathology but also normal functioning. The effective recognition of causes leads to rational treatments and preventive measures. However, the disease perspective does deemphasize the role of individuals and their unique vulnerabilities in contributing to their clinical presentations. Further, there is a risk of overapplication of disease reasoning. McHugh and Slavney warn against the potential imperialism of assuming brain pathology for all mental symptoms. They note that some features, such as emotional responses and temperament, are better appreciated with alternative explanatory models.
Source: David N. Neubauer, “Understanding Sleeplessness: Perspectives on Insomnia,” The Johns Hopkins University Press, Baltimore 2003
Republished by Health Care Programs