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By Professor Omar Hasan Kasule Sr.
Learning Objectives
- Definition of disease and illness
- Classification of Disease
- Nature of Disease
- Causes of Disease
Key Words and Key Terms
- Definition of disease
- Diseases as deviation from the normal
- Relativity in disease definition
- Multi-dimensional definition of disease:
- Natural history of disease
- Pathology
- Symptoms and signs
- Diagnosis:
- Treatment
- Prognosis:
- Diseases of the heart, amradh al qalb
- Diseases of the body, amradh al badan
- Superstitions and disease
- Classification of disease
- Disease as reaction and adjustment:
- Benefits of disease:
- Disease as a trial
- Disease as punishment:
- Disease as an exemption from obligations:
- Causality, sababiyyat
- Sufficient cause of disease:
- Necessary cause:
- Multifactorial causation of disease:
- Pre-determination
- Endogenous and exogenous causes of disease:
UNIT OUTLINE
1.0 CONCEPTS OF DISEASE
A. Definition of Disease
B. Natural History of Disease
C. Diseases of the Heart and Disease of the Body
D. Disease in the Qur’an:
E. Superstitions and Disease:
2.0 BASIS OF CLASSIFICATION OF DISEASE
A. Duration:
B. Moral Criteria:
C. Physical Cause:
D. Mental Cause:
E. Site or Organ Affected:
3.0 NATURE OF DISEASE
A. Reaction and Adjustment:
B. Benefits of Disease:
C. Disease as a Trial
D. Disease as Punishment:
E. Disease as an Exemption from Obligations:
4.0 CAUSES OF DISEASE
A. Concept of Cause
B. Environment
C. Malnutrition
D. Genetic and Immunological
E. Neoplastic and Degenerative Change
UNIT SYNOPSIS
1.0 CONCEPTS OF DISEASE
Disease is divergence from the normal, gaussian mean, but not all deviation is disease because of the reserve capacity and ability of the body to adjust to variations. The demarcation between pathology and normal physiological variation can be fine. The definition of disease is very relative being affected by age, gender, culture, beliefs, socio-economic status, attitudes, and prevalence of diseases. Definition of disease considers several dimensions that may operate singly or in combination: moral or spiritual, biological or pathological, psychosocial, or normative statistical. Overall disease is a state of dis-equilibrium, khuruuj al badan ‘an al i’itidaal. A distinction must be made between disease as a pathological manifestation and illness that is a subjective feeling. Symptomatology is perhaps a better indication of disease severity because it includes the personality of the patient and reactions. Thus the same pathology does not produce the same symptomatology in all patients. Those with strong iman may complain less about pain than others. Prognosis is an empirical estimate of the future course of the disease based on available data and is not definitive because the final outcome is part of the knowledge of the unseen, ‘ilm al ghaib. The physician does not have the privilege to say anything definitive about the future prognosis. There is a 2-way interaction between diseases of the heart, amradh al qalb, and diseases of the body, amradh al badan. The Islamic position is to approach most diseases empirically and to be guided by experimental science. Islam rejects superstitious beliefs and practices in all their various forms and manifestations.
2.0 BASIS OF CLASSIFICATION OF DISEASE
Diseases may be classified by their duration as acute or chronic, by cause as diseases of the heart, amradh al qalb, (2:10 & 74:31) and diseases of the body, amradh al badan, by life-stage as congenital or acquired, by nature as mental or organic, as local or systematic, and by organs afflicted. The physical environmental causes of disease are: infection, physical energy, degeneration, and breakdown of homeostatic control. Most disease processes are actually attempts by the body to repair damage. Some diseases are gender-specific because of the organ that is affected.
3.0 NATURE OF DISEASE
Disease is a pathophysiological disturbance is normally a response to a biological, physical, or chemical insult or injury to the body. Thus most disease manifestations including their symptoms and signs are a reaction to the injury and an attempt to re-adjust. In an Islamic context, disease does not always connote a negative or bad event. There are indeed many situations when what is a disease situation is actually beneficial. It forces us to rest, its pain teaches patience and forbearance, it is an opportunity for expiation/atonement for previous sins, al maradh kaffaarat ‘an ba’adhi al dhunuubi. The trials that one goes through and the eventual patience can be rewarded by Allah’s forgiveness. Some diseases are due to disobedience. Acts of disobedience may be followed by epidemic disease or by disease in an individual. The disease may be directly related to the sin such as liver cirrhosis due to chronic alcohol consumption or there may be no direct relationship. The prophet taught that when communities commit inequities, Allah sends them diseases unknown in their ancestors. Many of the diseases of industrialized societies are related to lifestyle and may be Allah’s punishment for various transgressions. Allah in recognition of the burden of disease and the need to give the body a chance to recuperate excused the sick from some physical religious obligations (2:10 & 73:20).
4.0 CAUSES OF DISEASE
According to the Islamic perspective every phenomenon in life has an immediate cause, sabab that humans can search for and find. However behind all these causes is the power and majesty of Allah who alone is the source of all causes, musabbib al asbaab. When all the factors that produce a certain pathological condition exist, we say that there is a sufficient cause of disease. There are empirical factors that must operate for a certain pathological condition to occur. These are referred to as necessary causes. Denying their existence is denying the cardinal principle of sunan Allah fi al kawn and is akin to superstitious belief. Human diseases, like the human organism, are complicated and usually several factors are involved in their causation. Humans may know some of the factors and ignore others. It is not necessary to know all the factors in order to treat a disease. Since the factors usually act in sequence, knowledge of only one may be sufficient to interrupt the causal pathway. The causation, progression, and resolution of disease are in the hands of Allah and are part of qadar. It is Allah’s pre-determination that a person falls sick. Humans try to understand disease processes in order to reverse them. This is not contradicting or opposing Allah’s will. All what a physician does is with Allah’s permission and is therefore part of pre-determination. Treatment and prevention of disease are not against qadar but are subsumed under the principle that qadar can reverse another qadar, radd al qadar bi al qadar. In the end all cure is from Allah and not the human.