I’m not afraid of my dentist, I like her, I respect her, she has exceptional professional skills and a kind, compassionate demeanour.
So why to I avoid her?
Why did I feel terrible about myself the last time I went to her and she filled some cavities in my mouth? The discomfort was tolerable and brief. She performed flawlessly and within a day it was nothing but a memory.
It’s not just dentists lots of us avoid, it’s doctors in general, perhaps even health care providers as a whole.
Lot’s of times people come into my office and say, “I know I should have come here a long time ago but…”
Why do we have such difficulty taking care of ourselves and seeking help when we need it?
I’m aware that expense and inconvenience, and the prospect of getting really bad news are at work in some of our avoidance, but I think there’s another emotional experience that keeps people from going and getting the help they need when they need it.
Not – “shame on you for not going”, but rather, we avoid going because we feel shame about our health not being ideal.
Let me unpack this a little bit.
Is it you’re fault you’re sick? (I certainly felt like that cavity was a moral failure on my part – how could I have been so reckless as to allow my teeth to rot – what a lousy person I am)
Did you bring that flu on yourself?
Did you have a heart attack because you ate far too many fries in your lifetime?
Did you cause a terminal illness like cancer by living constantly stressed out and not eating enough blueberries?
Most of us would say “no”, when comes to other people’s illness. Yet many of us, including people I see in my own practice feel personally responsible for their illness, whether it be physical or psychological.
Models of holistic health, with their emphasis on prevention have been a welcome counterbalance to the mainstream disease model of western medicine. Previously, the prevailing notion was that diseases just happened – bad luck, karma, fate, the devil, genes; whatever explanation you chose, the common theme was that ill health largely entered your life by factors outside of your control. And, in the places and times when most humans died from infectious diseases this was partially true (especially before Louis Pasteur identified how germs were transferred) The consequence of more holistic and preventative thinking however, has been a shift of responsibility to the choices of the individual. An unintended side effect of the rise of preventative medicine, is that we now view ourselves as being in control of our health. Which is at best a half-truth. It is a reliable scientific fact that lifestyle factors play a significant role in the development of heart disease. If you don’t smoke, maintain a certain level of physical activity, manage blood sugar levels, eat a certain kind of diet, maintain social connections, and manage stress well, you stand a pretty good chance of REDUCING your risk of heart disease. But notice that it’s not eliminating risk, only reducing it. All of us hear stories (often from the darkness that is social media) about some otherwise healthy 40 year-old that drops dead from a tragic and unpreventable disease and it makes our stomachs churn a little.
In fact your ability to eliminate your risk of dying is zero.
A rather obvious but hard to swallow fact isn’t it?
We like to deny the eventuality of our deaths, and the idea that wheat-grass and kale in my morning smoothy could give me control over this is an appetizing prospect, even if the ingredients aren’t.
The truth is that you can influence what you might be killed by – but ultimate control is not in your hands.
We, internet educated citizens of western civilization in the 21st century live in a very confusing time. Our information and learning create the illusion that any problem is solvable with the right knowledge. The attraction of this way of thinking is that it is partially true – there are a great many solutions that can be discovered by our human ingenuity and capacity for transmitting knowledge. But all these notions of personal responsibility for our health feed a little monster that lives in most of us – a monster that loves the idea of control and being able to avoid suffering or death through our actions.
The challenge is in navigating a tension that cannot be fully resolved: Are you responsible for your health? Yes and No.
There are factors that you have a large degree of influence over. There are others you do not. It does matter what you eat and how much exercise you get (and I’m saying this to myself as much as any of you). It matters how much stress you have in your life. But it’s not quite so simple as telling yourself not to get stressed-out is it? You could skip out on that very stressful job, but eventually you’ll just have traded that one particular stress for the stress of the bank repossessing your home and you having to move back into your parents’ basement. Of course, lots of people in the world have very little choice about the stressful circumstances they are under: poverty, war, persecution, drought, famine, displacement, slavery, oppression, or unreliable internet connections (I had to add in a funny because that list was just too upsetting on its own) . But many of us in the wealthy nations of the planet have more choice than we often realize about stress because we can choose how we perceive and react to the world around us.
The bottom line is that health and choice are extremely complicated realities. Too complicated for a simple assignment of blame or responsibility. If you believe that you’ve caused your own particular states of un-health or illness, going to talk someone requires you to face a sense of personal failure. Is it any wonder then that people are often too embarrassed to mention symptoms to their doctors? When shame enters the room, most of us shut down – it’s a natural human response. And of the course the idea of taking time out of our normal routine to go talk to someone and face our shame is a recipe for an endless plan to make the phone call or book the appointment “soon”, but not until something forces us to.
I don’t know if it’s your fault that you’re sick. It’s not even really the right question to ask because it’s not really answerable. But I do know that if you’re assuming the answer is that you’re to blame for your own suffering, it’s very likely a road to shame, avoidance, and worse health outcomes in the long run.
Don’t let shame be the thing that keeps you from going to the doctor or dentist or psychologist, or whomever you need to see that can help you. Begin by naming your shame and confronting it. Recognize how shame shapes your behaviour (avoidance) and consider whether or not you want to choose the possibility of help over the discomfort of the feelings that come with a potentially false sense of responsibility for your symptoms. Even if you have made some kind of contribution to your health problems, treat yourself with gentleness and kindness, like you would a good friend who deserves help irrespective of whether they created their own suffering or not.