Diagnosis as category and process: The case of alcoholism

Abstract Concepts of health and sickness change continually. A notable change during the last century or so has been the inclusion within the idea of “sickness” of behavioural, environmental and social problems, and an attempt to return—within a vastly more complex scientific context—to older concepts of “the patient, not the disease”, or “man in equilibrium with his environment” as things that medicine should properly be concerned with. One example of such a “new” diagnosis is the disease of alcoholism. An examination of the way in which doctors use this particular category led to a consideration of the nature of that activity known as medical diagnosis. How are such social diagnoses fitted into doctors' normal classificatory practice or systems? And can this tell us anything about the adaptive processes of medicine in general'? The conclusion reached is that the diagnostic activity is essentially a prescriptive one, and that even though a condition may have been clearly accepted into the medical gallery, doctors may be reluctant to use it as a classification if it is one for which no clear medical prescription exists.