Regular Episode
#183 – MONSTROUS MEDICINE: DISEASE
Fair warning: the conversation touches on human sexuality, historical medical abuses, and some genuinely disturbing corners of medical history. No explicit tag, but parents may want to preview first.
🔬 What Actually Makes Something a Disease?
Mike argues that the concept of disease is far less objective than most of us assume. Two major authorities do the official sorting: the Diagnostic and Statistical Manual of Mental Disorders (DSM) for mental health and the International Classification of Diseases (ICD) for everything else — both periodically revised by committees of experts. The ICD-11, for instance, newly classified gaming disorder as a bona fide condition. But behind those committee decisions lies a messier philosophical substrate.
Mike identifies three interlocking criteria that have historically governed whether something gets called a disease:
– Biological difference from an assumed norm.
– That difference must interfere with a person’s social or functional responsibilities.
– Crucially, the condition must not be perceived as the person’s own fault — volition and culpability are baked into the concept from the start.
⚗️ Hysteria, Neurasthenia, and “Americanitis”
History is littered with diseases that evaporated once cultural expectations shifted. Female hysteria — rooted in the ancient Greek belief that the uterus could migrate through the body and cause behavioral disruption — persisted as a fashionable diagnosis from antiquity well into the 19th century, sometimes resulting in hysterectomies for women who simply weren’t behaving as expected.
Neurasthenia was the 19th century’s catch-all for anxiety, depression, headaches, impotence, loss of appetite — essentially anything a nervous system could do wrong. It was framed around an early hydraulic model of the nervous system: sufferers were simply “low on nervous fluid.” The prescribed cure diverged neatly along gender lines: bed rest in a darkened room for women; heading out West to experience untamed nature for men. The condition became so associated with the pace of American life that it acquired the nickname Americanitis — a term Mike notes still resonates, given ongoing debates about how modern life strains human biology.
🏳️🌈 Morality, Medicine, and Homosexuality
Mike describes disease as, at its heart, a moral concept — and homosexuality is the case study that makes the argument most sharply. It moved from sin to disease (framed as a biological abnormality deserving pity rather than punishment) before advocates, beginning in the early 1970s, successfully pushed for its removal from the DSM. Blake and Karen reference a This American Life episode documenting that contentious removal process. Mike notes that the “benevolent” disease framing was never truly kinder: as he puts it, if Oscar Wilde had been diagnosed rather than prosecuted, the likely outcome would have been an asylum rather than prison — the authority still taking control of the variation it deemed unacceptable.
✍️ Left-Handedness and the Sinister Variation
Left-handedness offers a compact illustration of the sin-to-disorder pipeline. Blake traces the etymology: sinister derives from the Latin for “left,” while dexter — the root of “dexterity” — means “right.” Within living memory, left-handed children were subjected to physical and psychological coercion by teachers, parents, and doctors to force a switch. Mike observes that “benevolent” reframing (it’s not your fault, it’s a disorder) changed almost nothing in practice: the judgment of wrongness, and the effort to correct it, persisted.
🦠 The Germ Theory Pivot and Science-Based Medicine’s Blind Spots
The 19th-century discovery of germ theory — bacteria, pathogens, and eventually antibiotics — transformed medicine and gave it enormous credibility. Doctors adopted the white lab coat to signal scientific identity, not merely medical status. But Mike argues this success came with a cost: it entrenched the expectation that a disease must have a detectable organic cause. Conditions like chronic fatigue syndrome paid the price for decades, with sufferers told they were simply lazy because nothing measurable was visibly broken.
📊 Big Data, Medical Privacy, and Who Owns Your Story
The conversation takes a contemporary turn when Karen mentions opting out of Australia’s My Health Record centralized database. Mike points out that a medical history isn’t just clinical data — it’s a moral history. Records of past abortions, drug addictions, or STIs carry social stigma, and centralizing them raises questions well beyond cybersecurity: Who holds authority over that data? What happens when governments change? Blake, speaking from his IT background, notes the tension between the genuine scientific value of large medical datasets — particularly for emerging fields like gut microflora research and personalized medicine — and the long-term risks of concentrated, persistent personal data.
🔭 The Future of Disease as a Concept
Mike’s tentative forecast: the monolithic disease model may not survive another generation intact. Conditions like autism spectrum disorder and schizophrenia are already fragmenting into finer-grained categories as genomic and microbiome data accumulate. Whether obesity is a disease is contested in headlines almost weekly. The direction of travel, Mike suggests, is toward individualized assessment — genes, microflora, personal history, and self-reported suffering — rather than lookup tables of named diseases. The ICD’s ever-multiplying codes may eventually become too granular to be useful, pointing toward a different kind of medicine altogether.
📚 Further Reading
– 📚 Unwell: What Makes a Disease a Disease? 💵 by Mike McRae (available via Booktopia for international orders)
– 📚 Tribal Science 💵 by Mike McRae
🔗 Related Links
– Diagnostic and Statistical Manual of Mental Disorders (DSM)
– ICD-11: International Classification of Diseases, 11th Revision
– Female Hysteria (Wikipedia)
– Neurasthenia (Wikipedia)
– Homosexuality and Psychology — DSM removal history
– Germ Theory of Disease
– My Health Record (Australia)
– Science Alert
Note: ads inserted into the distributed audio alter the timestamps in unpredictable ways, so timing references in these notes are approximate.
What is a disease? We’re joined by science writer Mike McRae, author of Unwell: What Makes a Disease a Disease? to discuss the history of the whole concept of diseases which turn out to have a large, often hidden, social component. For US audiences, be advised that Mike’s book is not available directly in the US. You’ll need to order it through an International bookseller like Booktopia (link above).
Mentioned in the episode
- This American Life (episode about homosexuality and the DSM)
Music
- Monstertalk Theme: Monster by Peach Stealing Monkeys
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