1.2: Defining Terms - 'Chronic' and 'Disease'

David Featherston

Defining terms

Definitions and terms associated with the topic of chronic condition self-management differ in meaning depending on their context. The challenge of comparing research studies without standard definitions was acknowledged by Glasgow et al in defining health literacy, self-care, self-management and self-management support.⁽¹⁾

Definitions and terms may hold different meaning for the patient, psychiatrist and carer. This can lead to one, some or all parties not having expectations met and feeling disappointed in outcomes. Focus group feedback obtained during research for this project indicated concern with the use of the term 'chronic' and the use of the term 'disease'.

“The use of the word ‘chronic’ in physical illness is often interpreted as meaning the illness is not as concerning as an acute illness and, therefore, is not considered as a serious problem”

In fact many patients take exception to the term ‘chronic’ and a level of sensitivity should be applied to its use.

“The use of the word ‘disease’ is also problematic. Most people with a mental illness would not consider they have a disease. Chronic depression, for example, may certainly qualify as an illness but could not really be considered a disease, particularly when a person can recover from it.”

The audio recordings below highlight the differences in interpretation and the importance for clarity in meaning of key terminology before embarking on a self-management process.

Patients’ interpretations of the terms 'chronic' and 'disease'

A group of patients and carers were asked to comment on the following two questions:

What is your definition of the term 'chronic'?
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Do you think the term ‘disease’ is appropriate when referring to mental health?
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Patients’ interpretations of the terms 'chronic' and 'disease'

Chronic

I think there’s a lot of confusion about what the term chronic means. I am confused. My interpretation of chronic is something like a debilitating condition but I believe it is recoverable and I would actually like as part of this exercise for chronic to be spelt out to what it actually means. Further to the fact that I said I believe that chronic can be long term but it is recoverable and I guess the case that I pin that on is my wife, she had a chronic depressive illness for a long, long time, ten to eleven years but she has recovered to the point that she is working full-time and she doesn’t have that condition and that’s why I said before there is confusion about what chronic means. It doesn’t mean that you can’t recover from it in time.

I’m comfortable with the term chronic being applied to mental health in terms of it being a persistent or lasting medical condition but I think that the real issue is not what the term ‘chronic’ means, it is the ability of the psychiatrist to convey that meaning to the consumer or carer in a way that they can understand – that’s the key issue.

I think the term chronic may be technically correct in its description but I don’t find it very helpful, I don’t find it very engaging; a very meaningful term for me. I prefer to think about long term or even life long as a description of the sorts of issues that I deal with. I don’t object to it but I don’t find it particularly helpful.

It is more comfortably used with people with a physical as opposed to a mental medical condition. It certainly is debilitating and long term as far as mental illness is concerned. It is the interpretation as it is received by the person who is actually suffering which is worse because it sounds so much more hopeless.

I find myself as a consumer constantly in debate with my psychiatrist as to wether I have a chronic condition or not. I have been out of the hospital system since 2001and in a state of on-going recovery and I feel that the term does not apply to me.

Disease

My psychiatrist has never mentioned the word ‘disease’ before; however I think that someone earlier said in regards to chronic that it is the way in which things are conveyed to you. My psychiatrist has never mentioned the word ‘disease’ to me but if he were to talk to me about disease then I could understand it, it is just a word. To me it is how you are dealt with by the people dealing with you that makes it sort of palatable. I would rather not have disease but there you go; condition is better.

I guess I feel very strongly that mental illness is not a disease; it’s an illness or a condition. I see disease as malaria, those sorts of things. I don’t like the term disease in mental illness.

In reference to mental health I prefer the term mental disorder as it is a way of acknowledging the complex interaction of biological, social and psychological factors that occur in psychiatric conditions.

I don’t see it as a disease, much more comfortable with illness, condition or even disorder - it’s not one I have thought of before but it seems more applicable. For me disease connotates something that you catch or something that you have. It’s a kind of black or white thing; you have it or you don’t. It’s not how I see mental health. I see it as a continuum for everyone and completely well at one end and seriously unwell at the other. I think everyone moves up and down that spectrum in their lifetime and for those people who have a mental health condition, they might tend to spend more of their time up the unwell end of the spectrum but it is not black or white you have it or you don’t.

I think the term in relation to mental illness is totally unacceptable and that the idea of disorder is actually somewhat more acceptable. The notion of disease for me conjures up a whole load of germs, running around doing damaging things, which can be more successfully possibly treated chemically or hopefully treated chemically and available to be subject to scientific experiment and resolution and I don’t think that is true when applied to mental illness.

I find it quite unpalatable, if I find it quite unpalatable being a consumer, what will the broader community think that’s already struggling with mental illness. It’s a no-no.

I totally dislike the word disease. It sort of brings to mind things entering your body from the outside and contamination of the body and to a degree and also the possibility that it can be passed on to others as well, certainly you have to keep clear of other people.

Definition of 'chronic condition' and 'chronic disease'

The World Health Organization (2002) recommended that the term ‘condition’ is more appropriate and should be used rather than the term 'disease'.⁽²⁾ In this resource, the term 'chronic condition' will be used rather than 'chronic disease'.

The Flinders Human Behaviour and Health Research Unit definition of chronic condition is based on literature reviews and National Reference Groups.⁽³⁾

“The term chronic condition encompasses disability and disease conditions that people may ‘live with’ over extended periods of time (i.e. more than 6 months). … Chronic disease is a subset of chronic conditions and refers to a specific medical diagnosis. It may be more likely to have a progressively deteriorating path than other chronic conditions (WHO, 2002).”

References

Glasgow NJ, Jeon YH, Kraus SG, Pearce-Brown CL. Chronic disease self-management support: the way forward for Australia. Med J Aust 2008;189(10 Suppl):S14–16.
World Health Organization. Innovative care for chronic diseases. Building blocks for action, Global Report, 2002.
Battersby M, Lawn S. Capabilities for Supporting Prevention and Chronic Condition Self-Management. Flinders Human Behaviour & Health Research Unit, Flinders University, Adelaide, 2009.

Continue to Module 1.3: Defining Self-management and Self-management Support.