Wednesday, March 6, 2013

Our health isn't all up to us

I inherited motion sickness from my father's side of the family.  I can't sit in the back seat of a car for more than 10 minutes without becoming sick.  I take meclizine before every plane flight.

I inherited asthma from my mother's side of the family.  Exposure to perfume, 90+ degree temps with 90+% humidity, or even a good laugh will all prompt me to cough.

These two maladies of mine have one thing in common - multiple people over the years have informed me that they're "all in my head."  Among the advice I've received:  
       "You just need to distract yourself."
       "It's all stress.  You need to relax."
       "Yoga. Yoga will realign your energies."
       "You're taking too much medication.  Your body is reliant on it."

Upon hearing these statements, I rapidly cycle through the following emotions: Hurt. Indignation.  Disappointment.  Anger.  None of those emotions provide a good starting point for hearing this advice, which I have to admit is probably well-intended.

But, if I am honest with myself, I can't pretend that I am not guilty of thinking some of the same things about my patients.  I get frustrated that my overweight patients continue to choose unhealthy foods and avoid exercise.  I bite my tongue when my patient with liver damage continues to drink alcohol.  Maybe blaming others makes us feel better about ourselves, and it might even make us feel that we're invulnerable to the disease under discussion; we're making the "right" choices, after all, and that somehow makes us superior to the afflicted person.*  I am certainly guilty of those same thought processes.

When I catch myself thinking this way, I try to override these thoughts with the knowledge I gained through my studies in Health Behavior Theory (HBT).  The basic tenet of HBT is that each individual believes that the health choices he/she makes are rational and reasonable.  These choices are usually based on 1) the priorities their environment imposes on them and 2) their beliefs about health.  For example, if a person grows up in a poor neighborhood where most people are overweight and with limited access to healthy food, this person will likely deduce that being overweight and eating fast food everyday are normative conditions.**

HBT teaches that blaming others for their health problems helps no one.  Whether it's motion sickness, asthma, mental illness, fibromyalgia, obesity, diabetes...most 21st century health conditions are due to some combination of genetics, environment, and personal choice.  Health is a combination of personal responsibility along with the luck of the genetics and environment we're born into.

Maybe if we could spend less time on blame and more time on supporting each other - and creating healthier environments - our good intentions might result in more than just hurt feelings.

* I can't take credit for these ideas - that belongs to Susan Sontag and her ground-breaking book Illness as Metaphor. If you are interested in learning how and why humans assign emotional value to various diseases, this short book is a worthy read.
** This is a terribly oversimplified description of HBT.  I'll discuss this topic further in a future post, but if you'd like to read more in the meantime, check out: and,%20brewer%20&%20rimer.pdf.

1 comment:

  1. SPDJ-Great post.
    Thanks for the self disclosure.
    One of my favorite relationship aids with patients is curiosity. Who is this person? What are their assumptions about life/health/themselves? What is their context/role on which we will base our interaction? (Then- they all eventually die-even the thin non-smokers with great lipids and impressive A1c's).
    Family Doctors have lots of ways to engage patients which suit the individuals involved at the time of the involvement. Some might say, "We have an App for that". But Family Medicine can say, "We have a Doc for that."
    Blog On! We need your insights.