Our depressions, anxieties, and addictions are no joke.
I know this from personal experience and from working as a psychotherapist in New York City for more than twenty years. What continues to surprise me is how much can turn on what appears to be a minor conceptual confusion, but in reality functions more like the proverbial flap of butterfly wings in New Jersey that somehow contributes to a hurricane in California.
Translation. Small misunderstandings about what kind of problem we are actually dealing with can quietly send us searching in the wrong direction for years.
A Little Bit of History
The word disease is far older than modern medicine.
For most of human history, disease simply meant dis-ease. Not at ease. Troubled. In pain. Unable to function well. Life feels wrong. Something is deeply off. The word referred broadly to human suffering, emotional, behavioral, moral, relational, spiritual. Disease named distress, not physiological mechanisms.
Only much later, with the rise of anatomy, physiology, and eventually germ theory, did the meaning of disease begin to narrow. As humans learned how the body actually functions, how the heart pumps, how circulation works, how cells function, how organs coordinate, how bacteria cause infection, it became possible to identify malfunction.
That step matters.
You cannot identify malfunction until you understand function.
Astounding Scientific Advance
Once this knowledge emerged, the word disease increasingly came to refer to identifiable physiological breakdowns.
- The word diabetes has been around since the 2nd century CE, and its original meaning referred to excessive urination. It comes from the Greek diabainein, meaning “to pass through” or “to siphon,” describing the way fluids seemed to pass straight through the body.
- The word syphilis entered medical language in 1530, originating not as a biological diagnosis but as the name of a fictional character in a poem by the Italian physician Girolamo Fracastoro. The term initially referred to a devastating constellation of symptoms and social panic, not to a known physiological cause.
- The word cancer dates back to ancient Greek medicine, at least 400 BCE, when Hippocrates used the term karkinos, meaning “crab,” to describe tumors whose spreading shape reminded him of crab legs. It named what could be seen and felt, not what was understood.
But with new knowledge about how the human body actually works, diabetes became a problem of insulin regulation. Syphilis became a bacterial infection. Cancer became uncontrolled cellular growth.
The words stayed the same. The meanings shifted.
These shifts saved millions of lives. They represent some of the greatest achievements in the history of medicine. And so it was no surprise that humanity, faced with serious and frightening conditions, learned to ask a powerful and fruitful question.
“What is the underlying physiological malfunction?”
Using the Word Disease Carefully
It is okay to use the word disease in different ways. We simply need to be honest and clear about what we mean when we use it.
This is where the work of Marty Mann and others becomes so important. They were leading a humane public health movement at a time when alcoholics were treated as moral failures, social liabilities, and objects of punishment.
Marty Mann and others were invoking the original meaning of disease. They were pointing to dis-ease. A state of profound suffering, loss of control, and impaired functioning that deserved compassion rather than condemnation.
At the same time, given the medical and cultural climate of the era, they understood that the movement would be taken more seriously if alcoholism could be framed as involving a physiological vulnerability. Emphasizing a hypothesized bodily malfunction, often described as an “allergy” to alcohol rooted in genetic predisposition, made alcoholism intelligible within medical, insurance, and policy frameworks.
And it worked.
Alcoholism began to be met less with punishment and contempt and more with care and treatment. Many lives were saved. That was a genuine civilizational advance.
It would have been ideal if leadership in healthcare and public policy had clarified something essential at the time. Alcoholics needed and deserved care and compassion whether or not a specific physiological malfunction was ever identified. Compulsive, self-destructive patterns of behavior are deadly serious conditions in their own right.
And in fact, many people have experienced profound and lasting recovery from addiction even though the physiological mechanisms of human decision-making remain largely mysterious. Writers and researchers such as Johann Hari, Philip Flores, and others document these realities clearly.
At the same time, yes, of course we should remain deeply interested in discovering physiological processes associated with human suffering. To the degree those mechanisms can be understood, we can then discern whether malfunction is actually involved.
The key word there is discern.
Physiologically healthy hands can commit violence. A physiologically healthy voice box can say devastating things. And a physiologically healthy brain can participate in profoundly unhealthy patterns of thought, feeling, and behavior. Biology participates in everything we do, but participation is not the same thing as malfunction.
An over-reliance on presumed physiological malfunction creates serious problems. Many people today assume that psychological and emotional suffering must be rooted in biological defect. These claims are often made without clarification, without evidence, and without grappling with what is actually being asserted.
In the process, the most effective and humane forms of help are often ignored. Ways of living, relating, speaking, and understanding that have helped millions of people recover.
That is not science.
That is ideology.
And it is a destructive force in modern mental health culture.
That Pesky Law of Unintended Consequences
Over the past forty years, pharmaceutical corporations, working alongside advertising and public relations firms, discovered that enormous profits could be made by repeatedly asserting that scientists had identified, or were on the brink of identifying, the physiological malfunction underlying anxiety and depression.
This was very far from the truth.
Yet after decades of relentless messaging, much of the Western world now hears the words anxiety or depression and reflexively thinks malfunctioning brain.
Are we therefore doomed to an ever-worsening epidemic of anxiety and depression?
Not at all.
Just as with addiction, there are countless cases of deep and lasting recovery that had nothing to do with identifying a biological defect or applying a mechanical fix.
Instead, people changed how they lived.
They altered daily habits.
They built meaningful social connection and reliable support.
They changed patterns of self-talk and inner narration.
They reorganized relationships.
They adopted new understandings of suffering, responsibility, and meaning.
They addressed unhealed wounds.
So are anxiety and depression diseases or not?
People in recovery often say, “I have a disease that wants me dead.” They are not referring to a physiological malfunction like cancer. They are naming something else entirely.
They are pointing to habits and patterns of mind, heart, and behavior that, if left unattended, can grow stronger and more destructive over time. They are describing the very human capacity to feel terrible and then respond in ways that compound suffering.
In that older sense of dis-ease, the word disease is accurate and serious.
Trouble arises only when we forget that the word has multiple meanings and quietly slide from one meaning to another without noticing.
Confusing Habits and Patterns With Physiological Malfunction
Addiction, anxiety, and depression are not like syphilis, diabetes, or cancer.
No amount of improved self-talk, strengthened relationships, or meaningful community will cure untreated syphilis. No shift in perspective will reverse Type 1 diabetes. These conditions required identifying specific physiological malfunctions and developing technical medical interventions.
But anxiety, depression, and addiction are different kinds of problems.
Mild to moderate forms of these struggles are part of the human condition. Life includes pain, fear, loss, disappointment, craving, and longing. These experiences will never be eliminated, nor should they be.
When we confuse habits of living with mechanical failure, we go looking for the wrong kind of solution. And in doing so, we overlook the forms of change that have helped millions of people recover, heal, and live better lives.
