This post is the second in a 3-part series on Health Stigma and Healthy Privilege. You can read the first post here.
In the previous post, I talked about the possible definitions of health stigma and healthy privilege. As far as I am concerned, those definitions are simply a starting point. I want them to create discussion, get debated, get amended. My goal with offering those definitions was to offer a possible common language to help patients, providers, and caregivers better have important discussions. In this post, I want to talk a bit more about the damage that health stigma may cause. It is well documented that stigma has negative effects on those who are stigmatized (for more on that, you can read here or here, just to get started).
Health stigma is not a new thing–just look at the biblical references to leprosy. All areas of stigma, prejudice, and privilege have some important similarities. However, I believe that health stigma has several unique challenges. Let’s explore those now.
- Many challenging, painful, and downright debilitating health conditions are completely invisible. That can mean that healthy people in your life have a difficult time understanding the extent to which your illness affects your daily life. Patients talk about being described as “lazy,” “unreliable,” “resistant,” or my least favorite, “non-compliant.” People coping with the invisible illnesses are often judged on the same scale and standards as those who are healthy.
- Health status can change, sometimes rapidly. This important point was brought up in the comments on last week’s post by commenter The Afternoon Napper, who said: “Please consider the element of unpredictability—some days are better than others for no clearly explicable reason; some activities will be perfectly acceptable one day and exhausting the next. We live in a constant state of adjustment, major and minor. The “healthy” fail to appreciate how exhausting this is in and of itself. We invisibly ill push ourselves to meet expectations, and yet it seems that by doing so we set ourselves up for failure—when our pushing inevitably leads to crashing, we are deemed wanting.” I believe that the reality that we can transition from healthy to coping with illness without notice (or control) is something that many people are uncomfortable thinking about, which leads to our next point.
- Health is often seen as a result of choices, willpower and behavior–something that people can “choose to achieve.” There are many case studies that disprove this myth, many people who live active lives and make healthy lifestyle decisions but still face cancer, heart disease, stroke, depression, anxiety, multiple sclerosis (you get the picture). However, it is a strongly held belief by many people that those facing illness, “brought it on themselves.” Commenters Kate and Carolyn both had something to say about that last week. Kate said, “Regardless of the fact that type 2 diabetes is not caused by obesity or eating too much sugar, that is what the public believes. Therefore, it is thought that “all we have to do” is stop eating sugar and lose some weight! Even many doctors look down upon those with type 2 diabetes when their glucose control isn’t the best and the patient insists that they aren’t “cheating”. They are labeled as non-compliant. That label, along with the stigma we face in the media, causes untold stress and anxiety. That stress and anxiety can often lead to depression and binge eating. A vicious circle.” Carolyn added, “Heart disease is another chronic condition that appears invisible. Not only invisible, but it enjoys the double whammy of being widely considered to be self-inflicted from all those years of bad living. And when you have this self-inflicted, invisible condition accompanied in up to 65% of cases by significant symptoms of depression – and you now have the double-whammy stigma of self-infliction plus mental health issues. Two stigmas for the price of one!” As a psychologist, I can tell you that many of my patients have been told that they can rid themselves of depression or anxiety just by “thinking positively.” That position manages to simultaneously discount someone’s suffering and blame them for their mental health strategies.
I could keep writing all night long–but this is already getting to be a long post. In the last part of the series, I’ll begin discussing how to push back against health stigma and call out healthy privilege. Until then, I would love to hear your thoughts on the damage that health stigma may cause.
Image Credit: “Stampede!” photo by MSVG via Flickr under Creative Commons License