Conceptualising illness and disease: reflections on Sharpe and Greco (2019).

In a recent paper, Sharpe and Greco suggest that chronic fatigue syndrome/myalgic encephalomyelitis (MECFS) can be viewed as an instance of "illness without disease", and consequently, treatment should be directed towards altering the patient's experience of, and response to, their symptoms. We discuss two broad issues that arise from Sharpe and Greco's article, one relating to the assumptions they make about MECFS and its treatment specifically, and the other relating to their conceptualisation of the illness/disease dichotomy. We argue that the term "illness without disease", in the sense that Sharpe and Greco use it, is problematic because it can lead to unwarranted causal assumptions. Following these critical comments, we present a new framework for conceptualising the relationship between explanatory disease models and the experience of illness. © Author(s) (or their employer(s)) 2019. No commercial re-use. See rights and permissions. Published by BMJ.