Malady
Last updated: November 6, 2025
In January 1781, The London Medical Journal published a 19-page review of a book written by Dr Tiffot, a member of the Société Royale de Londres, entitled Traité des Nerfs et de leurs Maladies. (Treatise on the nerves and their maladies). Since then, malady has been used in the context of a person’s health, but not extensively. What is a malady?
The Oxford English Dictionary [OED] defines malady as meaning “a disease or ailment” and “a serious problem”; the entries suggest an association with severity. In this post, I will examine the use of the term ‘malady’ in healthcare literature.
My main argument is that malady is a helpful term for all individuals who see themselves as ill, regardless of whether they are recognised as sick by the healthcare system, other societal organisations such as the Department of Work and Pensions, or some members of society. I have used the General Theory of Rehabilitation to reframe malady as a sign of imbalance in a person’s biopsychosocial state might encourage a non-judgmental discussion about contributing factors and how to restore equilibrium.
Table of Contents
Introduction
The COVID-19 pandemic, especially Long Covid, has highlighted societal divisions over who is genuinely considered ill and the status of illnesses not clearly linked to specific organ damage. It has reignited debates and disagreements about many other so-called functional disorders, such as chronic fatigue syndrome, ongoing pain conditions, and post-viral syndromes. Historically, this has been a recurring debate, for example, concerning neurasthenia, railway spine, and shell-shock.
Many words are used to describe different states of being unwell, but we rarely agree on their exact boundaries. Elizabeth Barnes, in her recent book on Health Problems, is among many authors examining this complex area. She notes, “Health is an intractable mess, and any artificial precision we layer on top of it will obscure as much as it illuminates”. This post considers non-health, which may be more manageable!
The challenge posed by these boundaries is minor compared to two other difficulties. The chosen word influences the person’s access to resources. Secondly, the terms often imply a cause different from the patient’s belief. This upsets some people because they interpret this to mean the professional does not believe their symptoms.
In my post discussing Disease, illness, sickness, and disability, I start by suggesting malady could be a helpful umbrella term for (ill)-health because it might sidestep some of the difficulties. I will now examine this idea.
Brief History
Malady was first used in the late 1200s, with the meaning “a physical disorder or disease”; it was derived from a similar Old French word, maladie, which began as malade in the 1100s. Mal came from Latin, which carries connotations of being bad, wrong, and evil.
Later, in his book, The Prince, published in 1532, Machiavelli wrote, “as the physicians say it happens in hectic fever, that in the beginning of the malady it is easy to cure but difficult to detect, but in the course of time, not having been either detected or treated in the beginning, it becomes easy to detect but difficult to cure”.
Next, PubMed Central records the earliest reference to ‘malady’ in a healthcare context in 1781. By 1850, there were 250 mentions, and by 1900, this figure reached 400 annually. Over the following 90 years, the usage remained relatively stable. From around 2000, the rate surged to 5,447 by 2022, before beginning to decline. Sickness, illness, and disease exhibit similar trends, peaking at 11,000, 123,000, and 680,000, respectively.
Malady has long been associated with poor health, but it has not been widely adopted thus far. This gives it less baggage than common words like sickness, illness, condition, disorder, and disease, which is a notable advantage. However, it still carries some association with immorality, which could be a potential drawback.
Revival of malady.
Danner Clouser, Charles Culver and Bernard Gert revived the word for modern use. In June 1981, they published an article entitled “What Do Death, Pain, and Disability Have in Common?” Malady: a new treatment of disease. I will extract their central arguments. I have used the subheading from their paper.
Setting the scene.
In their introduction, they ask whether labelling a state as an illness is subjective and therefore idiosyncratic across cultures. Their third introductory sentence encapsulates a crucial challenge: “In this view [i.e. being subjective] there can be no objective guidelines to help decide, say, whether such conditions as addiction to tobacco or having had a breast amputated represent diseases or maladies, and thus whether smoking clinics or breast reconstruction surgery ought to be covered by health insurance.”
Their core argument is clearly outlined on the first page. Many words are used to describe ill health, such as disease, illness, injury, disorder, affliction, and condition. Using good examples, they demonstrate that the use of each word is inconsistent, excludes some obvious disorders, includes non-disorders, and has arbitrary boundaries. They convincingly show that, for existing words, coherent definitions are impossible.
They end by proposing malady “as the general term that includes them all. … meaning … any condition in which there is something wrong with a person”.
Learning from previous efforts.
They briefly review many previous attempts to define ill health in a single word. Most are dismissed with illustrations of incoherence or failures.
They consider attempts to define ill health by reference to how a person reacts to environmental changes as having some value. For example, they quote a definition from George Engel, “When adaptation or adjustment fail and the pre-existing dynamic steady state is disrupted, then a state of disease may be said to exist until a new balance is restored which may again permit the effective interaction with the environment.” George Engel later developed the biopsychosocial model of illness.
This approach interests me because it describes biopsychosocial homeostasis, which I have discussed in the context of my General Theory of Rehabilitation.
They also consider a definition by J.G. Scadding, who suggested a definition that referred to being abnormal and at a biological disadvantage. They link this to definitions that look at the features associated with ill health, such as distress, disability, and disadvantage.
I will develop these ideas on how well someone reacts to changes later.
Further development of malady.
They then outline the characteristics of malady that they use later to reach a definition. The foundation is derived from their overview of previous definitions. They base the rest of their paper on the answer to the question, “What do death, pain, and disability have in common?” They answer that “No one wants them, unless they have some reason not to avoid them.”
Their article considers a series of features. I will review them, using the headings they provided. Their starting point is that the person “has a condition such that one is suffering or has an increased probability of suffering some evil.”
Having something wrong;
maladies and evils.
This builds upon their foundation. Evil refers to harm: pain, death, and disability. Pain includes emotional suffering. They define ‘evil’ more broadly as “that which all rational persons will avoid unless they have a reason not to.” The second part, about choosing not to avoid evil, is included because many people will prioritise their autonomy or their duty to others, or will have some other rational reason for not avoiding harm.
The crucial consideration is that malady is an unpleasant state for the person, and they will want to avoid or escape from it. It is bad, not morally but actually.
Having something wrong with oneself:
maladies and the absence of distinct sustaining causes.
This builds upon their foundation. Evil refers to harm: pain, death, and disability. Pain includes emotional suffering. They define ‘evil’ more broadly as “that which all rational persons will avoid unless they have a reason not to.” The second part, about choosing not to avoid evil, is included because many people will prioritise their autonomy or their duty to others, or will have some other rational reason for not avoiding harm.
The crucial consideration is that malady is an unpleasant state for the person, and they will want to avoid or escape from it. It is bad, not morally but actually.
Abnormality and distinct sustaining causes.
This feature is necessary to distinguish causes that lead to evil in everyone from those that occur solely because of a specific ‘abnormal’ characteristic of the individual. For instance, being inside a freezer would harm anyone, but exposure to certain pollen would only be harmful to someone with an allergy to that pollen.
Abnormality and disability
This is discussed to avoid some misunderstandings and challenges. The authors first distinguish activities that no person can achieve, such as flying, from those that a substantial proportion of people can, such as walking. They then distinguish between inability arising from a child’s immaturity and disability, which is the loss of a previous ability.
Third, they propose that disability can be considered normative, an issue mainly related to congenital limitations such as deafness or phocomelia. They further argue that abilities dependent on maturity only become a disability if performance is ‘extraordinarily’ low compared with others of the same maturity.
However, they specifically do not accept that the expected (normal) level should decline with ageing.
They conclude that a “person is suffering a disability when he or she lacks an ability that is characteristic of the species, or when he or she has an extraordinarily low degree of that ability”
Comment
Their discussion on disability was written in 1980.
Their assumption is that disability is an evil people wish to avoid. While this may be true for many people who suddenly become disabled, this attitude is socially challenging. It appears to devalue people whose abilities differ from those of the typical population, especially individuals born with a condition.
In 2019, Heidi Janz powerfully and succinctly expressed the hidden bias in healthcare in a piece titled “ Ableism: the undiagnosed malady afflicting medicine. She quotes Fiona Campbell’s definition of ableism, “a network of beliefs, processes and practices that produces a particular kind of self and body (the corporeal standard) that is projected as the perfect, species-typical and therefore essential and fully human. Disability then, is cast as a diminished state”
I suspect that the authors would not write this section now, or at least would alter the premise and the argument.
Abnormality and increased risk.
The authors were concerned that many disorders, such as high blood pressure or carrying the Huntington’s disease gene, would undoubtedly be considered maladies even when the person showed no symptoms. They therefore introduced the phrase, ‘or being at an increased risk of evil’. The increase is relative to that of similarly situated individuals in the population, not in comparison to a previous state.
They point out that both the absolute increase in risk and the severity of the resulting condition must be considered before classifying a risk as a malady. If the potential outcome is severe, even a low increase in risk might qualify as a malady, whereas for a less severe outcome, the risk would need to be higher before it is deemed a malady.
Abnormality and the other evils:
Loss of pleasure, freedom, or opportunity
The authors have identified the main harms related to a condition as death, pain, or disability, but also mention other harms: loss of pleasure, loss of freedom to act freely, and loss of opportunities to engage in activities. The paper explores how an allergy might prevent someone from visiting certain places or eliminate the chance to pursue a particular profession. For example, a person with a latex allergy might be unable to become a surgeon, or someone who has experienced an epileptic seizure could lose the opportunity to operate a passenger aircraft.
Malady – definition.
At the end of their investigation of different aspects of malady, Clouser et al proposed a definition: “A person has a malady if and only if he or she has a condition, other than a rational belief or desire, such that he or she is suffering, or at increased risk of suffering, an evil (death, pain, disability, loss of freedom or opportunity, or loss of pleasure.” I will review their proposal below.
Other papers.
Bjørn Hofmann, in chapter three of the Routledge Companion to Philosophy of Medicine wrote, “Malady will be used as a generic term covering a wide range of terms, such as disease, illness, sickness, but also injury, lesion, defect, disorder, disability, impairment, infirmity, etc” I have been unable to find other papers discussing the context.
Searching PubMed reveals that authors use “malady” as a generic, catch-all term. For example:
- “gene expression patterns which are governed by epigenetics can result in autoimmune diseases, cancers, and various other maladies.”
- “to play a role in the development of both severe early-onset maladies and chronic age-related diseases”
- “Les virus sont depuis longtemps associes aux maladies auto-immunes”
Synthesis: a current challenge.
When classifying potential ill health states, there is an obvious terminological lacuna: how do we describe someone who has unpleasant symptoms but is not considered ill by healthcare, other societal organisations, or their family and friends?
Many benefits are contingent on the person being accepted as sick:
- Access to healthcare – diagnosis and treatment
- Access to socially provided resource, such as free personal care, help with housing, and an income
- Support from family and community, such as not needing to help in household tasks, or some undertaking shopping
- Insurance benefits, such as reimbursing holiday costs in the event of illness.
The lacuna means that the person thinks they are sick, but because no one else does, they are not helped by others. More troubling, the lack of clear boundaries and natural variation between people or professionals means that the person may have support from some but not others, leading to many often acrimonious arguments.
Because many conditions are near the border and the benefits can be significant, the scope for disagreement is evident. For example, general practitioners in the South Wales valleys in the 1970s and thereafter would sometimes certify people as sick and unable to work because, living in the communities, they knew there were no jobs nor would there be. They knew that the unemployment benefit was too little to live on. Sick pay, though not generous, enabled their patients to survive.
The challenge remains significant, both intellectually and morally, as well as in terms of numbers; the number of people not working due to certified ill health is rapidly increasing. It arises from a combination of factors:
- A belief that all sicknesses have a single root cause that must be identified and treated. Most people do not accept multifactorial explanations.
- A cultural attitude that prioritises sickness with a demonstrable, externally verifiable bodily pathology over sickness attributed to psychological causes.
- A pervasive tendency to stigmatise, devalue, or disbelieve psychological difficulties.
- A conflation of demonstrable pathology with the inability to work or do other activities. The medical diagnosis, rather than capabilities, determines access to support. Where capabilities are considered, the person is disbelieved.
- Lastly, and most seriously, the state or society (NHS, employers, Department of Work and Pensions, etc.) makes little effort to facilitate a person’s adaptation, either directly or indirectly.
Malady, a potential solution.
The General Theory of Rehabilitation offers a way forward, drawing primarily on the holistic biopsychosocial framework and the concept of biopsychosocial homeostasis. My argument is as follows.
Sustained failure of homeostasis leads to adverse feelings. A persistently high blood glucose or low blood pressure is associated with an unpleasant feeling. If this is true for physiological homeostasis, it is likely also true for biopsychosocial homeostasis. Someone who repeatedly fails to obtain work will, sooner or later, develop unpleasant feelings of worthlessness. They might, alternatively, develop pain.
Biopsychosocial homeostasis is influenced by numerous factors: environmental, social, bodily resilience, psychological strengths, financial status, and more. Usually, it is the combined effect of several or many factors that causes a persistent imbalance.
For example, a person who is given extra responsibilities at work, while at home his youngest son uses cannabis, and his parents have recently moved nearby to offer support, might find it difficult to maintain stability. They might be signed off work sick with a diagnosis of depression or anxiety, but the reality is that they are responding to multiple stressors in a natural way. Their reaction is normal in that most people would react similarly. Being signed off sick may exacerbate the situation, adding financial worries to the others.
The solution is to acknowledge that he has a health condition. This affirms his experience and keeps him involved. Additionally, a health condition is always influenced by many factors, even if a specific issue is identified, and so, one could investigate the various contributing elements. This could lead to practical steps: the employer might be asked to lessen his duties, social services could evaluate his parents’ circumstances and offer some support, and he might delay major changes to his garden for six months.
In other words, using a label, malady, that has no implications except that malady never has a single cause and typically has many contributing factors, allows a non-judgmental approach so that the healthcare professional can review the whole situation. Under those circumstances, one might elicit that he has started drinking more alcohol and, rather than immediately suggesting it is the cause, one can approach it collaboratively as another symptom, not a cause.
A woman was referred to me with chronic back pain. She was a University of Oxford researcher who had to apply for research grants to fund her salary. One year earlier, she was within two weeks of a deadline. She worked ten or more hours each day on her application. Every evening, she returned to her flat. Her partner lived four hours away. She had been standing on a chair when she fell off, injuring her back. She worked hard to complete her grant application. Then, for several months, she attended rehabilitation, mainly being prescribed opiate analgesics. She continued to commute four hours every Friday and Sunday evening to be with her partner, working (she secured her grant) 8-12 hours daily, and sleeping or keeping her flat tidy. After she explained her daily and weekly schedule, I asked her what she thought. She immediately said, “Well, having listened to what I said, I am obviously stressed and not leading a proper life. I need to rebalance my life.” She thanked me and left to sort out her own balance.
Conclusion
The concept of malady could become central to biopsychosocial healthcare. It could be a term for biopsychosocial disequilibrium, which is a non-threatening, non-judgmental diagnosis. The explanation would always stress that loss of biopsychosocial balance is always multifactorial, never has a single or even primary cause, and is rarely resolved by a single action. Rather than giving a diagnosis, the person could be helped to analyse and understand their situation; they will often reach their own conclusion and plan a way forward.