ABSTRACT
The notion of disease is typically based on two interconnected judgments. In assessing whether a disease exists, the first rule is to identify evidence of pathology or dysfunction, indications that body processes deviate in some way from how they should perform (Wakefield 1992a, 1992b). In many cases we have objective biological markers, but in others the assessment is made on an experiential basis. Second, an assessment is made as to the consequences of such deviations in terms of a particular set of values. Typically, we concern ourselves with deviations that imply likely future risks of pain, disability, and reduced longevity, and these criteria are for the most part widely agreed upon. Yet individuals have differing perspectives on these consequences and may be willing to trade some increment of life, pain, and risk for other valued goals and priorities. People may put greater priority at various points in their life trajectories on economic advancement, a sense of excitement, prestige, commitment to one’s family or group, or even loyalty to nation. In everyday life, judgments of consequences are influenced profoundly by local cultures and prevailing values.
