The Stigma of Being Ill: thoughts on illness in America
At the beginning of each new year we often take the time to make resolutions which reflect our intention to change things we have done in the past. These can cover any number of behaviors and may range from, “I will get more exercise” to “I will be kinder to others”, for example. Often we start out well with our good intentions waning as the year progresses. But this year I would ask you to look at the ways in which you view illness and think about ways you may want to change those perceptions.
Since the end of May I have been looking at the new ways in which type 2 diabetes and obesity are treated. I am interested in these conditions and I teach this content to students in the nursing program at Sheridan College. Since I have the time to think about diseases/conditions and their prevalence I naturally have had some thoughts about disease in America. We don’t like it! Things that should scare us don’t and things that are unlikely to happen terrify us. Additionally, we have a propensity to assume that those who have diseases/conditions brought them on themselves while congratulating ourselves for being “well”.
I need to explain what I just said. I suggest that until meaningful discussion about disease/conditions becomes common, meaningful approaches to becoming a healthier nation are unlikely to happen. As a society there is often subtle blame ascribed to those with certain conditions and those who are ill often seem to have an uneasy feeling of shame for being afflicted or perhaps that it is a character flaw. There is an “ostrich” mentality to illness that dates back to the leper colonies of the medieval Europe. Society would rather not deal with the icky and simply avoid the difficult conversations. We don’t like to talk about disease in a way that is clear and honest nor do we like to admit to being ill. While in some cases causality is pretty clear, the smoker who has Chronic Obstructive Pulmonary Disease, ascribing fault to that individual interferes with the goal of positive collaboration to afford the best outcome for that condition. What is the point in ascribing fault when there is nothing that can be done about previous behaviors?
The conditions that I am studying during my sabbatical are ones that are frequently thought of as being caused by “bad” behavior. Obesity may be the worst as it is seen as a sign of weakness in the individual afflicted with this condition. Type 2 diabetes often accompanies obesity and as such gets lumped together with that impression of weakness or lack of will power. This perception prevents those suffering from feeling free to talk about their worries and possible paths forward.
I wonder if the American individualistic spirit has something to do with this approach to health. Do we see it as a sign of weakness that we become unhealthy? Are we so committed to doing things ourselves that we are reluctant to asking for help, comfort, solace and validation? Do we sense that others may be sympathetic but may also be congratulating themselves on being healthy?
Stigma associated with illness is common with most psychological disorders such as depression, psychosis, and PTSD. This in turn makes it hard for anyone with these conditions to talk about them and to seek help. This stigma is not new but remains pervasive. However, I was interested and saddened to note that many of the same stigmas are present with physical illnesses as well. We are incredibly adaptable but we are susceptible to a host of different conditions. Cause is important for treatment and prevention purposes but ascribing fault does nothing but create an unhealthy atmosphere and interferes with human connections that are so important to healing.