Cause and aetiology words and concepts

The Oxford English Dictionary (second edition) defines 'cause' as 'that which produces an effect; that which gives rise to any action, phenomenon, or condition', and 'aetiology' as 'that branch of medical science which investigates the causes and origin of diseases; the scientific exposition of the origin of any disease'. Through time, however, both terms (and their accompanying concepts) have undergone repeated metamorphosis.

The Latin stem causa meant 'reason, motive, inducement, occasion, and opportunity'. It translated the Greek aitia and aition (stems of 'aetiology'), which themselves started by meaning 'origin', 'ground', and 'the occasion of something bad' (although for the third meaning the Romans used the word crimen). To the Greeks, 'cause' was a relational concept, i.e. one 'without which another thing (called effect) cannot be'. In the event, causa came into most European languages, and up to the late medieval period all vernacular renditions shared with Aristotle(4) the recognition of four types of cause:

!. material

2. formal

3. efficient

By the late Renaissance, however, a debate had broken out as to whether the four meanings (a) were 'really' different, (b) might work better when 'combined', or (c) were of equal importance or in fact one was more important than the others. Also, since the scientific revolution of the seventeenth century and the development of 'mechanicist' models of the world,(5) the third efficient type became the core meaning of causation.

The fourfold classification suggests the question as to which of the four senses of Aristotelian 'causation' was more influential in medicine. The view that mental illness was 'caused' by demons means something different depending on whether cause is understood as formal, material, or efficient. The received view is that it followed sense (3), i.e. that physicians believed that there were real objects called demons who could cause madness. (6) Thus understood, this aetiological view can easily be derided, but it is possible that physicians at that time (and all knew their Aristotle well) had in mind sense (2), i.e. that 'evil' was the 'formal meaning' of madness.

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