Disease is a fluid concept influenced by societal and cultural attitudes that change diachronically in response to new scientific and medical discoveries. Historically, doctors defined a disease according to a cluster of symptoms, and as their clinical descriptions became more sophisticated they started to classify diseases into separate groups, so that from this medical taxonomy came new insights into disease etiology. Before the 20th century, schizophrenia and syphilitic insanity were treated as the same disease, but by early 1900 it became evident that psychoses without associated dementia represented a separate disease for which the term schizophrenia was then coined. The definition of schizophrenia continues to evolve from the psychiatric disease of the 1960s to an illness with a suspected genetic etiology, though the existence of such an etiology remains uncertain. While an optimistic hunt is still on for the genes involved, we must continue to define schizophrenia in terms of the presence or absence of “positive” and “negative” symptoms.
Labeling someone as diseased, however, has enormous individual, social, financial, and physic implications, for irrespective of disease symptoms, the label itself may lead to significant distress. Individuals with asymptomatic conditions, including genetic variations, may be perceived by themselves or others as having a disease. It is not that labeling someone as diseased is always positive—it does have severe ramifications, affecting decisions to have children or resulting in unjust treatment by life, medical, and disability insurers—but it can be beneficial, legitimizing symptoms, clarifying issues of personal responsibility, and improving accessibility to health care. Nevertheless, deviations from normal that are not associated with risk should not be considered synonymous with disease. Two schools—nominalist and essentialist or reductionist-have debated the clinical criteria used to label a patient as diseased. Nominalists label symptoms with a disease name, such as schizophrenia, and do not offer an explanation of the underlying etiology, while essentialists contend that for every disease there is an underlying pathological etiology, and now argue that the essential lesion defining the disease state is a genetic abnormality.
It has been suggested that diseases defined according to the essentialist tradition may be precisely wrong, whereas those defined in the nominalist traditional may be roughly accurate. But in labeling a disease state, we must consider both the phenotype (symptoms) or the genotype (genetic abnormality), for adverse consequences, while the latter helps suggest specific genetic or pharmacologic therapies. Thus, both clinical criteria and genetic abnormalities should be used to define a disease state, and the choice of a disease definition will vary according to what one wishes to achieve, the genetic counseling of family members or the effective treatment of the patient.
1.The author of the passage is primarily concerned with（ ）.
2.It can be inferred that the author considers the way schizophrenia has been classified by doctors after 1960s to be an example of which of the following?
3.According to the passage, an adherent of the “nominalist school' would classify a rare new fever in which of the following ways?
4.Which of the following best describes the function of the last paragraph in relation to the passage as a whole?
5.It can be inferred that which of the following situations is likely to be most problematic to an adherent of the “essentialist” method of pathological taxonomy?
