To have your condition labelled as a disease may bring considerable benefit. Immediately you are likely to enjoy sympathy rather than blame. You may be exempted from many commitments, including work. Children learn very young that saying you have a headache will bring sympathy and a hug, whereas saying, “I can't be bothered to go to school” will bring anger and punishment. Having a disease may also entitle you to benefits such as sick pay, free prescriptions, insurance payments, and access to facilities denied to healthy people. You may also feel that you have an explanation for your suffering.
“I don't know why you say that making a diagnosis is the most important thing a doctor does. As a general practitioner I hardly ever make a diagnosis.”
General practitionernorth London
But the diagnosis of a disease may also create many problems. It may allow the authorities to lock you up or invade your body. You may be denied insurance, a mortgage, and employment. You are forever labelled. You are a victim. You are not just a person but an asthmatic, a schizophrenic, a leper, an epileptic. Some diseases carry an inescapable stigma, which may create many more problems than the condition itself. Worst of all, the diagnosis of a disease may lead you to regard yourself as forever flawed and incapable of “rising above” your problem.
Consider the case of alcoholism, a hotly disputed diagnosis. Better perhaps to be “an alcoholic” than a morally reprehensible drunk. But is it helpful to think of yourself as “powerless over alcohol,” with your problem explained by faults in your genes or body chemistry? It may lead you to a learned and licensed helplessness.
Illich puts it like this this6:
“In a morbid society the belief prevails that defined and diagnosed ill-health is infinitely preferable to any other form of negative label or to no label at all. It is better than criminal or political deviance, better than laziness, better than self-chosen absence from work. More and more people subconsciously know that they are sick and tired of their jobs and of their leisure passivities, but they want to hear the lie that physical illness relieves them of social and political responsibilities. They want their doctor to act as lawyer and priest. As a lawyer, the doctor exempts the patient from his normal duties and enables him to cash in on the insurance fund he was forced to build. As a priest, he becomes the patient's accomplice in creating the myth that he is an innocent victim of biological mechanisms rather than lazy, greedy, or envious deserter of a social struggle over the tools of production. Social life becomes a giving and receiving of therapy: medical, psychiatric, pedagogic, or geriatric. Claiming access to treatment becomes a political duty, and medical certification a powerful device for social control.”