Dismantling the fallacies of the illness blame-game

The medical profession can find itself subconsciously supporting the idea that some people have only themselves to blame for their ill-health.

We know that many illnesses carry stigma. When I was a child, nobody ever had cancer. Instead, people whispered about the Big C, or the C-word (which makes me laugh, because the C-word I think of when I hear that phrase is definitely NOT something you would expect your Auntie Doris to say).

HIV and AIDS were unspeakable in most Irish houses in the ’80s and ’90s. Ironically, if anyone in the family was ever suspected to have died from an AIDS-related illness, the word would be spread around that they had instead died from malignancy, giving cancer a weird boost up the stigma ladder. At least no-one asked where you got it from and you weren’t maligned as a deviant simply because you had that diagnosis.

We like diseases to have a socially acceptable cause. People with lung cancer often talk about the shame they feel, or are subjected to, if they have been smokers. Media case studies will often focus on people who were very healthy before their shock diagnosis; never smoked or drank excessively, ran marathons, ate chia seeds every day, and yet were stricken by a cancer they ‘didn’t deserve’. The implication is, of course, that there are people who DO deserve to get cancer, because they were stupid/selfish/indulgent enough to have put themselves at risk through their unhealthy behaviours.

People who succumb to a screenable cancer are baffled how it could happen to them, if they had diligently attended for all their appointments. The phrase ‘she did everything right’ is commonly heard in these cases, and implies that there are some people who do everything wrong. There is an undercurrent of blame that can be too difficult and hurtful to ever put into words and yet most people with cancer inevitably have internal battles about what they could have done differently to stay healthy.

Any serious diagnosis can trigger an endless search for the ‘why’. Why did this happen to me? What did I do wrong? Whose fault is it? Shouldn’t someone have been able to prevent it? A string of ‘if onlys’ can go round and round in the person’s mind, resulting in agonising self-castigation, or angry resentment towards others.

Once diagnosed, a person can become consumed by the need to do everything in their power to ensure the best outcome. Sugar-free diets, green juicing, intravenous vitamins – the more restrictive and punitive the regime, the more redemptive it can be experienced by the patient. The quest for the elixir of life can often be a self-imposed punishment for whatever perceived behavioural deficit led to the diagnosis in the first place.

The medical profession can find itself colluding with this fallacy and subconsciously supporting the idea that some people have only themselves to blame for their ill-health. Doctors’ attitudes to intravenous drug users, people with multiple sexual partners, or those suffering from extremes of body weight, can be judgmental and offensive, often without the practitioner being aware of their unconscious bias. Understandably, anyone who feels a sense of approbation or disapproval every time they enter a healthcare setting is likely to avoid such interactions and the spiral of ill-health increases.

A person’s likelihood of succumbing to a particular illness has very little, statistically, to do with how much broccoli they ate in their teens or how many press-ups they do every morning. The concept of the social determinants of health has become more mainstream in recent years, but I think we are still slow to accept how limited conventional medical treatment is when it comes to really making a bottom-line difference to people’s wellbeing.

We can tweak anti-hypertensive doses and sweat about getting the HbA1c below a certain number, but this fine-tuning is potentially meaningless for someone whose ongoing social inequities mean that their life expectancy is 10 years lower than the next person who walks into the consulting room. 

This is why it irks me so much when I see well-meaning health advice being snazzily delivered to middle-class, privileged, well-educated people who have never even heard of an adverse childhood event. Health insurance companies offering ‘wellness checks’, internet stores hawking self-screening test kits, commercial entities flogging personalised nutritional products; when these are sold to a person with a secure home, a reliable salary, and a trauma-free environment, they are just fancy icing on a very healthy cake.

But they support the notion that somehow wellness is all down to the impeccable behaviour of the individual and that illness is an avoidable consequence of personal moral failings.