It surely must please any author to know that someone has read their article, but to have a commentary, albeit critical, is a special accolade. So my thanks to Gilleard and Higgs for their time and effort. I think we are agreed that chronic illness is largely a 20th century phenomenon, that it appeared early in the century and grew to become the major morbidity problem it is today. Where we differ is in how this phenomenon is to be explained; and underpinning this disagreement lie our different approaches to what might be construed as an adequate explanation and to method. My article was descriptive in the sense that it tried to take contemporary observations (as recorded in the articles, reports, correspondence and editorials of JAMA) to reconstruct the changing perceptions of the nature of disease and its distribution during the 20th century. My 'revisionist' claim was that these changes in perception could account for the apparent growth in the prevalence of chronic illness without invoking a real or biological change in the form or distribution of morbidity. The latter explanations, in fact, emerged only towards the end of the century, well after the cognitive transformation had been accomplished.
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