On the tetrad of human malady: disease, illness, sickness, and existential suffering.

The triad of disease, illness, and sickness is well established in the philosophy, sociology, and anthropology of medicine as well as in clinical practice. Nonetheless, the triad is criticized for being too simplistic and for excluding important aspects of human suffering. One such critique is that it does not account for existential suffering, which is especially relevant in severe and life-threatening diseases. Accordingly, this study investigates whether existential suffering adds to the concepts of disease, illness, and sickness making up a tetrad of human malady. To do so, I investigate the concept of existential suffering, which is frequently described in medical terms, is diagnosed, acknowledged by health professionals, managed in treatments and care, and recognized in disease classification systems. Then I present ontological, epistemological, conceptual, normative, and pragmatic justifications for extending the triad of disease, illness, and sickness with existential suffering. Lastly, I will discuss counterarguments and objections to the various justifications. I conclude that on specific premises existential suffering can be a relevant extension of the triad to a tetrad of human malady, especially in cases of severe and life-threatening disease, but that we need to avoid medicalizing existential suffering and making health professionals masters over human meaning-making.