The Rise of Chronic Illness: A Paradigm Shift in Healthcare

From the 1950s onwards, medical advancements, improved hygiene, and the rise of preventative medicine have significantly increased life expectancy. This progress has brought into sharp focus a phenomenon that had long remained secondary: chronic and degenerative diseases.

Historically, illness was primarily defined as an acute state of physical and psychological suffering. The physician, through their expertise, aimed to restore the patient to their previous state of health, enabling a transition from the status of "ill" to "cured." The medical paradigm operated largely on a binary: disease or absence of disease, following the traditional sequence of symptoms-diagnosis-treatment-cure or death (Baszinger, 1986).

The shift from acute to chronic diseases is largely attributable to the advent of vaccines. Public health vaccination campaigns have dramatically reduced the prevalence of pathologies now more commonly seen in developing countries, such as tetanus, diphtheria, and polio. The development of antibiotics has also contributed to the decline in infectious diseases. It's also worth noting the possibility of spontaneous regression of fatal infections, as documented in medical literature.

However, with the emergence of chronic illness, the patient's previous state of health is often unattainable. The defining characteristic of a chronic disease is its persistence over many months, if not a lifetime. Patients must learn to live with their condition and adapt their lives accordingly, presenting them with a dual challenge. In addition to being "burdened" by the illness, they also face disruptions in their social connections, employment, and daily routines. Furthermore, chronic disease is not always compatible with maintaining a "normal" social life. Georges Canguilhem (1904-1995) defined the physician's role as encompassing two key aspects: combating the disease and caring for the patient. To effectively care for their patient on a human level, physicians must move beyond purely objective medical approaches and acknowledge the patient's emotional and psychological needs.

Consequently, the traditional "sick role" concept, as described by Parsons, is challenged. Even with strict adherence to medical treatment, patients with chronic conditions can no longer necessarily expect to be "cured." The patient-physician relationship shifts from a focus on cure to one of disease management (Herzlich & Pierret, 1991).

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Footnotes:

13. Baszinger, H. (1986). Le corps, la maladie, la guérison. Editions du Seuil.

14. Herzlich, C., & Pierret, J. (1991). Malades d'hier, malades d'aujourd'hui: de la mort à la naissance. Editions Payot