Disease is a fluid concept influenced by societal and cultural attitudes thatchange diachr

Disease is a fluid concept influenced by societal and cultural attitudes that

change diachronically in response to new scientific and medical discoveries.

Historically, doctors defined a disease according to a cluster of symptoms, and

as their clinical descriptions became more sophisticated, they started to classify

(5) diseases into separate groups, so that from this medical taxonomy came new

insights into disease etiology. Before the 20th century, schizophrenia and

syphilitic insanity were treated as the same disease, but by early 1900 it became

evident that psychoses without associated dementia represented a separate

disease for which the term schizophrenia was then coined. The definition of

(10) schizophrenia continues to evolve from the psychiatric disease of the 1960s to an

illness with a suspected genetic etiology, though the existence of such an

etiology remains uncertain. While an optimistic hunt is still on for the genes

involved, we must continue to define schizophrenia in terms of the presence or

absence of "positive" and "negative" symptoms.

(15) Labeling someone as diseased, however, has enormous individual, social,

financial, and physical implications, for irrespective of disease symptoms, the

label itself may lead to significant distress. Individuals with asymptomatic

conditions, including genetic variations, may be perceived by themselves or

others as having a disease. It is not that labeling someone as diseased is always

(20) positive—it does have severe ramifications, affecting decisions to have children

or resulting in unjust treatment by life, medical, and disability insurers--but it

can be beneficial, legitimizing symptoms, clarifying issues of personal

responsibility, and improving accessibility to health care. Nevertheless,

deviations from normal that are not associated with risk should not be

(25) considered synonymous with disease. Two schools—nominalist and essentialist

or reductionist—have debated the clinical criteria used to label a patient as

diseased. Nominalists label symptoms with a disease name, such as

schizophrenia, and do not offer an explanation of the underlying etiology, while

essentialists contend that for every disease there is an underlying pathological

(30) etiology, and now argue that the essential lesion defining the disease state is a

genetic abnormality.

It has been suggested that diseases defined according to the essentialist

tradition may be precisely wrong, whereas those defined in the nominalist

traditional may be roughly accurate. But in labeling a disease state, we must

(35) consider both the phenotype (symptoms) or the genotype (genetic

abnormality), for the former describes a state that places individuals at some

definable risk of adverse consequences, while the latter helps suggest specific

genetic or pharmacologic therapies. Thus, both clinical criteria and genetic

abnormalities should be used to define a disease state, and the choice of a

(40) disease definition will vary according to what one wishes to achieve, the genetic

counseling of family members or the effective treatment of the patient.

The author of the passage is primarily concerned with

A．revealing a commonly ignored distinction

B．proposing a return to a traditional taxonomical system

C．describing an way to resolve a taxonomical dilemma

D．assessing the success of a new taxonomical method

E．predicting a change in future taxonomy