Julián Bohórquez and Ivory Day reflect on the importance of translating fundamental terms in philosophy of medicine into Spanish, as well as the value of importing Spanish terminology into the Anglophone discussion.
The conceptual problem
Medical education in Spanish-speaking Latin America is strongly shaped by the United States’ model. Nearly all the scientific literature is written in English. This extends to the philosophy of medicine, where most seminal texts remain untranslated into Spanish. This is particularly evident in the terminology used to address a central question in the field: “What is disease?” Andrew Twaddle (1968) proposed a model to address this question which has been widely adopted in philosophy of medicine. His model distinguishes three constitutive categories:
1. Disease: the objective, biological aspects as identified and interpreted by medical science and healthcare professionals.
2. Illness: the subjective experience of the patient.
3. Sickness: the intersubjective, social and institutional recognition, constituting a condition’s meaning within a community.
In what follows, we present a two-part analysis of problems in philosophy of medicine stemming from the dominant use of the English vocabulary of Twaddle’s model. Focusing on Latin American Spanish, we propose two solutions that incorporate Spanish-language terminology to mitigate these issues.
The first problem concerns the fact that Spanish-language texts often use the English words “disease,” “illness,” and “sickness” without translating them. The second problem is that two terms in English texts overlap. In academic writing, the word “disease” is often used as a broad term that includes disease, illness, and sickness all together. But it’s also used to refer just to the biological category. This overlap causes confusion, since “disease” can mean both the general concept and one specific part of it.
To resolve the first problem, we propose a translation of Twaddle’s tripartite model into Spanish, drawing upon ordinary language with the following equivalents: patología for “disease,” padecimiento for “illness,” and afección for “sickness.” We contend that:
a) This translation constitutes a necessary conceptual intervention to facilitate clearer and more robust discourse on the question “what is disease?” within Hispanic philosophy of medicine.
b) This everyday Spanish lexicon can refine Anglophone discussions, as the proposed terms denote the phenomena of the three subcategories with greater precision than their English counterparts.
To resolve the second problem, we propose the Spanish term enfermedad as the comprehensive term for the unified biological, subjective, and social phenomena (i.e., patología, padecimiento, and afección). The use of enfermedad is justified on two grounds:
a) It removes the confusion found in the English model by introducing a broader, overarching term that clearly separates the general category from its specific subcategories.
b) In everyday Spanish, enfermedad naturally includes all three parts of Twaddle’s model. It can refer to any of them without causing confusion, making it a good choice for explaining how the model’s parts fit together as a whole.
Ultimately, this contribution aims not only to demonstrate the advantages of Spanish-language terms for articulating “what is disease” for a Spanish-language audience, but also to establish that Spanish provides a valuable conceptual vocabulary, capable of refining and advancing these philosophical debates. As such, this analysis serves as a case study for a broader methodological claim: that cross-linguistic engagement is a fruitful source of conceptual innovation for certain discussions within the philosophy of medicine. To support this proposal, we will define each Spanish term proposed, illustrate its use with everyday examples, and provide approximate English translations for clarity.
Definitions: patología, padecimiento, afección
Patología
Patología was selected as the translation for “disease” for three primary reasons. First, it is already the established technical term in numerous Spanish-language medical texts for the study of the nature, causes, and development of diseases. Second, its scientific connotation is reinforced by its etymology, deriving from the Greek pathos (πάθος, “suffering” or “disease”) and -logia (-λογία, “study of”). Third, the term is readily accessible to a Spanish-speaking audience, being used not only in professional but also in lay contexts.
Example
“Mi madre irá al laboratorio por los resultados de patología.”
[My mother is going to the lab to get the test results of her patología.]
This example shows that the term patología, is imbued with scientific and professional medical connotations, even in layperson’s usage. That is, the common term already possesses the connotations that philosophy of medicine assigns to the term “disease.”
There is a final advantage of this terminological choice: it is easily integrated into Anglophone discussions. The semantic connotations of patología align closely with those of the English term “pathology.” This approach has precedent: Christopher Boorse (2014) advocated for “pathology” over “disease” to achieve the desired connotations.
Padecimiento
We propose the term padecimiento as the translation of “illness.” This term was selected for two reasons. First, its etymology is directly rooted in suffering: the verb padecer originates from the Latin pati [to suffer / to endure], from which the noun passio [suffering] is also derived. Second, the term is established in ordinary Spanish usage, effectively capturing the first-person, lived dimension of discomfort, pain, or affliction due to a disease (patología), condition, or adverse circumstance. Two examples are given here to demonstrate the term’s use as a noun and a verb in Spanish.
Examples
“Su padecimiento le produce mucho dolor.”
[His padecimiento causes him much pain.]
“Me dijeron que tenía diabetes, pero yo me sentía bien. Solo hace unos meses empecé a padecer la enfermedad.”
[They told me I had diabetes, but I felt fine. It was only a few months ago that I began to padecer the disease.]
In the second example, the verb padecer refers specifically to what we have tentatively translated as “suffering,” as stemming from the physical effects of the subcategory “disease.” However, padecimiento, in the first example, remains ambiguous in regards to the emotion or physical effects of the “disease.” These two examples demonstrate that the common use of padecimiento (or padecer) possesses the core connotations of subjective suffering—which can be physical or emotional—that philosophy of medicine assigns to the term “illness.”
Afección
We propose the term afección as the translation of “sickness.” This term was selected for two reasons. First, the term derives from the Latin affectio, affectionis, which comes from the verb afficō, afficere [to affect]. This etymology is important for the use of afección because it allows an easy terminological link to how disease affects not only the individual but also the society in which it is embedded. Second, the social and evaluative connotations of “sickness” are already present in afección’s ordinary usage in Spanish. We provide two examples to demonstrate the social breadth of this term.
Examples
“Las afecciones mentales involucran siempre al paciente, su familia y su entorno social.”
[Mental afecciones always involve the patient, their family, and their social environment.]
“No solo hay afecciones cardiacas o renales. Hay afecciones sociales, como la pobreza, que son más graves.”
[There are not only cardiac or renal afecciones. There are also social afecciones, such as poverty, which are far more serious.]
The first example is particularly relevant as it demonstrates that while the term afección can have personal connotations (akin to padecimiento), its primary weight often lies in the social domain. The second example is especially pertinent as it demonstrates how, from the medical connotation of afección, the term can be extended to purely social negative connotations. That is, the Spanish term afección possesses all the connotations that philosophy of medicine assigns to the term “sickness.”
In summary, the proposed Spanish lexicon offers a distinct conceptual clarity for its native speakers. While “disease” is commonly used in English to refer to biological phenomena in both academic and everyday contexts, “illness” and “sickness” lack distinct meanings in ordinary language. Contrarily, the terms patología, padecimiento, and afección are etymologically and semantically grounded in the very distinctions Twaddle’s model proposes. This makes the Spanish triad more accessible within the Hispanic world and demonstrates a clearer framework, provided by the Spanish language, to answer the question “what is disease” in philosophy of medicine—a framework that can be offered back to Anglophone scholarship as a resource for refining its own conceptual vocabulary.
Definition: Enfermedad
We propose using enfermedad as the broad, overarching term that includes the more specific terms patología, padecimiento, and afección. In this way, enfermedad brings together medical, subjective, and social aspects as connected parts of what is often a single, unified experience. As a result, the term enfermedad naturally creates a clear hierarchy of related concepts—something that the original English model lacks. The following three examples illustrate how enfermedad can function as a synonym for patología, padecimiento, and afección:
Patología
“Mi padre tiene una enfermedad cardiaca muy grave.”
[My father has a very serious cardiac enfermedad.]
This example demonstrates how enfermedad can refer to the biological facets of patología as identified and interpreted by medical science and healthcare professionals.
Padecimiento
“Mi enfermedad me produce temor y ansiedad.”
[My enfermedad gives me fear and anxiety.]
This example demonstrates how enfermedad can refer to the subjective experience of suffering in a broad sense.
Afección
“En algunos países, la resaca es considerada una enfermedad. Allí, si tienes resaca, puedes faltar a tu trabajo.”
[In some countries, a hangover is considered an enfermedad. There, if you have a hangover, you can miss work.]
This example illustrates that the semantic range of enfermedad extends to the social domain.
In this way, enfermedad acts as a flexible, unifying term that naturally includes all three subcategories. It offers a conceptually consistent framework based in a contemporary and widely used language for exploring the question, “what is disease?”
Conclusion
The Spanish lexicon—structured by the unifying term enfermedad and its specific terms patología, padecimiento, and afección—provides a naturally precise and coherent framework for addressing the question, “what is disease?” This terminology offers a dual contribution: it is an essential intervention for Hispanic scholarship and, simultaneously, a valuable resource for refining Anglophone philosophical discourse. The clarity of this classification demonstrates that the question itself is a conceptual puzzle whose resolution can be advanced by the tools afforded by different languages (Cassin 2004). Indeed, the structural resources of Spanish directly address the core problem of integrating and distinguishing the biological, subjective, and social dimensions of enfermedad [disease], offering a more nuanced model for the philosophy of medicine—one that can be fruitfully incorporated into predominantly English-language discussions on the subject.
It is clear that having Spanish equivalents for the terms discussed here is essential if Spanish-speaking clinicians, patients, and society at large are to engage meaningfully with the scientific, subjective, and intersubjective aspects of disease. Furthermore, in contemporary medical and philosophical discussions about the concept of disease, the biological component is often assumed to be more important than the subjective and social ones (Agich 1983; Hall 2016; Cooper 2017). As a result, disease is typically understood as a primarily biological phenomenon, whose effects on a person’s inner world or social environment are seen as secondary or less significant.
We believe this tendency arises, in part, from the linguistic issue we have already noted: the English word “disease” refers both to the complex overall phenomenon and to its specifically biological component, which gives undue priority to the latter. Yet this raises an important question: is the biological aspect of disease truly more important than the others? It is worth recalling that science would not study diseases at all if they did not affect patients’ lived experience and society as a whole. Moreover, the physician is not the only expert on disease. Patients and those around them also possess a unique form of expertise—they know firsthand the pain, limitations, and suffering it entails (Tattersall 2002). We contend that the Spanish terms we have proposed—above all enfermedad, which captures the complex reality of “disease” without privileging any single dimension—help to emphasize the equal value of the scientific, subjective, and social perspectives.
About the authors
Julián Bohórquez-Carvajal is a Colombian Medical Doctor with a Master’s and a PhD in Philosophy from the Pontificia Universidad Javeriana. His research focuses on philosophy of medicine, philosophy of biology, and bioethics. Additionally, he investigates the relationships between medicine, literature, and the arts. He is currently a postdoctoral researcher at the Institute for Philosophical Research of the National Autonomous University of Mexico (UNAM). You can write to him on: julian.bohorquez@filosoficas.unam.mx.
Ivory Day earned a Bachelor of Fine Arts from Emily Carr University and a Master’s in Philosophy of Language from King’s College London, while maintaining her artistic practice. She then earned her Doctorate in Philosophy from Université Paris 1 Panthéon-Sorbonne, working in philosophy of language under the supervision of Jocelyn Benoist in the continental tradition. She is currently a postdoctoral fellow with the Secretary of Sciences, Humanities, Technology and Innovation and the Universidad Michoacana in Mexico, researching possible contributions of twentieth-century Mexican philosophy to contemporary philosophy of language and new realism.
References
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Hall, John E. 2016. Guyton and Hall Textbook of Medical Physiology. 13th ed. Elsevier.
Tattersall RL. 2002. “The expert patient: a new approach to chronic disease management for the twenty-first century.” Clinical Medicine 2 (3): 227–29. https://doi.org/10.7861/clinmedicine.2-3-227.
Twaddle, Andrew. 1968. “Influence and illness: Definitions and definers of illness behavior among older males in Providence, Rhode Island.” PhD diss., Brown University.
