Writing a blog is easy. You just say whatever’s on your mind du jour. You don’t have to be 100% sure of what you’re writing because if you don’t get it exact enough, you can correct it tomorrow. But books, especially paper ones, last longer so are more difficult to set straight. These days, then, as I massage this blog into a book, I need to think more carefully about what I’m writing.
I’ve described here how illness changed during the past half-century. When I was a kid, medical visits were principally for bacterial and viral infections. Now they’re mainly for conditions deriving from pathogenic (disease-causing) lifestyles, including horrendous diet, inadequate exercise, poor stress management, dysfunctional relationships, negative self-image, and exposure to literally a million toxins and carcinogens in our food, air, water, building materials, home products, cosmetics, and even medications. These behaviors predictably lead to obesity, type two diabetes, and much of cancer, hypertension and cardiovascular disease. This notion—that we cause most of our diseases—can be a hard fact to swallow. If you don’t believe it, ask your doctor.
Thinking about this shift critically, I’ve come to realize that pathogenic behavior isn’t intentionally self-destructive. On the contrary, it’s usually an attempt to cope with social demands, some of which can be frankly insane. My friends who began to smoke in their late teens and early twenties did so for peer acceptance; they lit up because their friends did, attracted by cigaret ads touting savoir faire. Alcoholics drink not to bring on cirrhosis, but to anesthetise the pain in their life. A teen doesn’t disappear into the couch-potato video game world aiming to flab his body, but to visit a place where he can win for a change. The compulsive eater doesn’t put away a quart of Ben & Jerry’s in response to a lipid deficit, but because she senses an internal emptiness, a feeling of literal unfulfillment. The employee or spouse who puts up with abuse does so because the prospect of responding to it honestly is even more threatening.
In other words, much current illness arises in unhappiness. Every culture's values inevitably dictate much of its constituents’ behavior. Our culture, leaning massively toward materialism, consumption, and individualism, ultimately breeds feelings of inadequacy, competition and separation. Little wonder, then, that we train our physicians to examine and treat individuals, virtually ignoring the context in which they live. Thus we docs wait in our offices and clinics for patients to show up with the diseases that have finally bloomed from their various unhappinesses, and we repair them enough to return them to their pathogenic lives.
This cycle is obviously ineffectual, not to mention ridiculously costly, but even worse, our treatments perpetuate misery by simply turning down its amplitude. Our patches, our tranquilizers and antidepressants, our BP meds and stents and stomach staplings do little more than numb the pain people have unconsciously chosen to live with. In the most honest light, much of our intervention can be seen as enabling neurotic behavior.
Certainly we should treat the longterm smoker's emphysema and the type two diabetes of the obese, since healthcare without compassion is only engineering. But while we perform those treatments, we need also to exercise commensurate skills in educating, encouraging, and supporting our patients in genuine prevention. Colonoscopies and mammograms have their place, but people need also to awake to the possibility of higher-quality lives, styles that honor their personal value and don’t just clear the lowest bar society offers.