The more confidently prevention science speaks about interventions and treatments, effective dosage and measurable benefit, the more relevant become medical anxieties about changeable social attitudes to illness and disease.

Similarly, arguments surrounding the often uncomfortable relationship between clinical diagnosis and cultural or political context are more likely to spill over into the territory of social care.

So, if medicine continues to be charged with inventing and maintaining “lifestyle disorders,” prevention science might be tarred, too – for seeking to mitigate their constructed effects, for example by turning schools into field hospitals.

In recent months, there was been a spat in the pages of the online newspaper The Huffington Post about the nature of obsession as a shaping dynamic in twentieth century culture, or as a malaise manifest in Obsessive-compulsive Disorder (OCD) – or both at once.

The argument has been chiefly between Lennard Davis, Professor of Medical Education at the University of Illinois and author of plain Obsession, and Dan Agin, Emeritus Associate Professor of Molecular Genetics and Cell Biology at the University of Chicago, and a regular Post columnist.

Davis argues in his book that the terminology of obsession speaks for a wide range of mental experience originating innocently enough in the sensation of being besieged and beset from without by ideas.

He identifies the notion of obsession with the possibility of “partial insanity” and with the growth of psychiatry as a source of partial remedies, also with another nineteenth century preoccupation – endeavor, typified by “science, specialization – and overwork”.

As his British Medical Journal reviewer Ian McClure observed, such a reading permits the argument that a mental disorder – experienced for example by obsessive insomniacs such as Darwin, Coleridge, Freud or Zola “influences a shifting culture, which in turn solidifies the disorder’s prominence […] Some might say that attention deficit hyperactivity disorder is a prodigy of an attention deficit society”.

Davis claims a parallel with OCD, tracking its “meteoric rise” during the late twentieth century from obscurity to fourth in the Wikipedia rankings of most common mental health problems.

Dan Agin protested. Davis – a literature specialist – was repeating the kind of error humanists made whenever they stuck their noses naively and arrogantly into science. When medics talked about OCD, he insisted, they were not talking about “productive behaviors” but serious dysfunction.

One of his supporters amplified the point in the ensuing blog fight: “Those who suffer from OCD turn to psychiatry for some relief from their torment, not for aesthetic perspective!”

A crucial distinction here separates illness from disease.

As the philosopher A C Grayling put it in The Lancet in the context of a similar discussion three years ago:

“Illness denotes the subjective experience of one or more of a constellation of experiences that have perennially afflicted mankind […] Disease denotes the objective entity that people describe and theorize about in trying to explain the reasons for and nature of the illness.”

By which reckoning Lennard Davis was writing about obsession as a disease, only to be reminded by his critics that it is also an illness.

Grayling’s twin definitions figured in his Lancet review of a collection of lectures by the Canadian hematologist (and humanist) Jacalyn Duffin, half of whose subject was another changeable but enduring formulation of obsession: lovesickness.

Her theme in Lovers and Livers is the cultural construction of disease – how one sickness ceases to be recognized as such, just as another – Hepatitis C in this case – can almost as mysteriously emerge.

Her fieldwork included participation exercises in which she tabulated the symptoms of love her lecture audiences volunteered. The long list included: anorexia, insomnia, irrational behavior, mania, mood swings, nausea, obsessive thinking, semi-obsessive pursuit, depression, pessimism and palpitations.

Her book also traces the historical progress and mutation of lovesickness from Sappho (“my skin became as yellow as though in boxwood dyed / My hairs fell out and all my frame wasted to skin and bone”) through eighteenth century confusions between lovesickness and venereal disease, into the realms of PET (positron emission tomography) brain scanning in the 1970s, to the work of Donatella Marazziti, who in the 1990s began to theorize, on the basis of MRI brain scan patterns, about the resemblance between the condition of romantic love and – yes – Obsessive-compulsive disorder.

At which point Duffin's speculations take an unexpected turn with the argument not that OCD might be regarded as a mutable ill-defined disease, rather that (“erotic, limb-loosening, brain-befuddling”) love might even yet be mistaken by society for social behavior in need of effective intervention.

“Suppose love, or some kind of love is already deemed bad, or socially unacceptable, or pathological – like that of women with DSM erotomania. […] How long would it be before drug companies conducted trials for medications to solve the problem, using drugs like Fluvoxamine and Clomipamine that are now employed for OCD?”

At which Orwellian juncture it may be as well to allow Professor Agin the last word. He interrupted his Huffington Post blog combat with Lennard Davis with this plea:

“It would be helpful to everyone if there were some understanding that people who work as scientists are not idiots; they are fully aware of the limitations of what they do, and that's particularly true of brain research. Your caveats are all already in the scientific and clinical literature on OCD, schizophrenia, autism, and so on, and it's unfortunate if the general public is given a wrong impression about that.”

See
Davis, L J (2009) Obsession: A history, Chicago University Press
McClure I, (2009) “The Roots of our Obsession” British Medical Journal, 338: b882
Duffin J (2006) Lovers and Livers: Disease Concepts in History
University of Toronto Press, 2006
Grayling A C (2006) “Lovesickness and hepatitis C: what is a disease?” The Lancet Vol. 367, 9509, pp 465 - 466