Article Text

Download PDFPDF

The illness-disease dichotomy and the biological-clinical splitting of medicine
  1. Luigi Tesio1,2,
  2. Marco Buzzoni3
  1. 1Department of Biomedical Sciences for Health, Università degli Studi di Milano, Milano, Italy
  2. 2Department of Neurorehabilitation Sciences, Istituto Auxologico Italiano, IRCCS, Milano, Italy
  3. 3Dipartimento di Studi Umanistici, Università degli Studi di Macerata, Macerata, Italy
  1. Correspondence to Prof. Luigi Tesio, Department of Neurorehabilitation Sciences, Istituto Auxologico Italiano, IRCCS, Milano 20122, Italy; luigi.tesio{at}


In a recent paper, Sharpe and Greco (2019) argue that some clinical conditions, such as chronic fatigue syndrome (sometimes called myalgic encephalomyelitis), should be treated by altering the patient's experience and response to symptoms without necessarily searching for an underlying cause. As a result, we should allow for the existence of ‘illnesses without (underlying) diseases’. Wilshire and Ward (2019) reply that this possibility requires unwarranted causal assumptions about the psychosocial origins of conditions not predicted by a disease model. In so doing, it is argued that Sharpe and Greco introduce epistemological and methodological problems with serious medical consequences, for example, patients feel guilt for seeking treatment for illnesses that only exist ‘all in the mind’, and medical researchers are discouraged from looking for more effective treatments of such conditions. We propose a view that integrates the insights of both papers. We abandon both the strict distinction between disease and illness and the naïve unidirectional account of causality that accompanies it. This, we claim, is a step towards overcoming the current harmful tendencies to conceptually separate (1) Symptom management and disease-modifying treatments. (2) Rehabilitative-palliative care and ‘causal’ curing. (3) Most importantly, biomedicine and clinical medicine, where the latter is currently at risk of losing its status as scientific.

  • medical humanities
  • philosophy of medicine/health care
  • medical education

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See:

Statistics from


  • Contributors LT had the idea to realise this manuscript, given its relevance to the medical profession and education. Both authors provided equal contribution to the manuscript writing.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.