Theorists writing about the social construction of illness have argued that legitimacy in medicine is primarily dictated by a reductionist epistemology—that is, in Western societies, diseases are legitimate when real, and “real” refers to symptoms that can be linked to an identifiable, biological pathology. 38 Ideally, the pathology should be “specific,” meaning that the pathology ought to uniformly produce a typical outcome in any man or woman no matter what his or her setting. In this reductionist view, which is based on germ theory, diseases are able to exist outside of individuals, independent of their manifestation in any particular person, and abstracted from social environments.
If you respond to the physical or social enviornment differently than other people, are you sick? Is it always bad to respond differently? What does it mean to be ill? Who gets to say you are ill?