title: [The cultural history of disease].
abstract: In this essay the concept of Cultural History of Disease (CHD) is proposed as an alternative to Natural History of Disease (NHD). A brief historic recapitulation of the concept of disease is made, and the present idea is given a detailed account which is the basis of the nosological theory of the health/disease paradigm. The main aspects of the NHD are specified, its limitations and restrictive consequences in health care are highlighted. It is proposed the idea of disease as particular and differential ways of being from human beings. It is showed how culture (everything that make us human) "takes the reins of evolution" in our species and determines, in every period, our ways of being, of living, and getting sick. Some distinctive qualities of life are showed to take a distance from the idea of machine and the dominant mechanism of health care in our time. The concept of CHD is developed as a proposal that "lightens" aspects ignored by NHD. An account is made of how, by cultural effect, a number of diseases no longer exist; others have appeared or increased their presence, have changed their features or varied their distribution. The every time more and more unsupported congenital/acquired dichotomy is discussed. It is showed how the epigenetic inheritance is a strong evidence against the separation between genetic and environmental. The mechanist causality, in its different characteristics, proper of the health/disease paradigm and of NHD, is contrasted to contextual causality proper of CHD. The implications of CHD in the way of approaching to diseases, in restating the patients', physicians' and health care institutions' role are discussed. As well as in recognizing that health care has no sense without life care in its different manifestations, from which derives the need to fight for more proper conditions and circumstances for a dignified, satisfactory, serene, fraternal life in including societies.
authors.affiliation: Unidad de Investigación Educativa, Centro Médico Nacional Siglo XXI, IMSS, México DF. leonardo.viniegra@imss.gob.mx
authors.forename: Leonardo
authors.initials: L
authors.lastname: Viniegra-Velázquez
mesh_terms: D001294:Attitude to Health; D005075:Biological Evolution; D015984:Causality; D003469:Culture; D004194:Disease / Q000266:history*; D044127:Epigenesis, Genetic; D030342:Genetic Diseases, Inborn / Q000235:genetics; D006262:Health; D049673:History, 20th Century; D049690:History, Ancient; D006801:Humans; D019369:Life; D019365:Metaphor; D010361:Patients / Q000523:psychology; D012380:Role; D019366:Western World / Q000266:history