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Chronic Illness

Self-Blame and Chronic Illness

Understanding and letting go of a painful narrative.

Key points

  • Our culture often attempts to alleviate anxiety about illness by blaming those who become ill.
  • Ill people may internalize cultural blame and experience self-blame, which is associated with increased emotional distress.
  • Working through and discarding self-blame is important for mental and physical health.
Katie Willard Virant
Source: Katie Willard Virant

If you’ve been around a young child for any amount of time, you know that “why?” is a favorite question. “Why is the sky blue?” “Why do leaves fall off trees?” “Why do I have to go to sleep at night?” They so want to understand the world around them that it’s as if they can’t move forward until they have explanations that allow them to make sense of a world that can feel scarily random.

We’re not so different from the children we were. We don’t like not knowing. We strongly prefer order to chaos, explanations to questions. We formulate belief systems to attempt to understand frightening concepts like death and evil. We also formulate belief systems to attempt to understand chronic illness (Williams, 1984).

Medicine has come a long way. For many diseases, we have a scientific understanding of what happens in the body to cause certain illness. But we are still drawn—both societally and individually—to fill in the void of “why.” Why did this person get diabetes? Why did this person get cancer? Why did this person get lupus? This “why”—why do some people become ill?—is so powerful that it affects obituaries: “John Smith died of lung cancer, although he did not smoke.” It affects social policy and creates/deepens prejudice against certain groups: “AIDS is a gay disease and people wouldn’t get it if they weren’t having gay sex.” It affects how ill people are seen by friends and family: “He’s a workaholic; I’m not surprised he developed heart disease.” And, of course, with all of this blame coming at us, it affects the way we who live with chronic illness see ourselves.

The notion that people who are ill are responsible for their illnesses is comforting to people who are not ill. They can put us in a penalty box “over there” and keep themselves safe. “She should have lost weight.” “He drank too much.” “She was fragile emotionally.” The subtext is not hard to ascertain: “I am thinner/sober/emotionally sturdy. I won’t get sick.” This doesn’t really hold, of course. Some people who are thinner/sober/emotionally sturdy do get sick. Some people who carry more weight, drink more, and are emotionally fragile do not get sick. But the wish to feel safe by developing an explanation of blame is strong. And chronically ill people know this, hear this, and are affected by it.

Self-blame for illness is associated with increased emotional distress. (Callebaut, Molyneux, & Alexander, 2016.) Illness is stressful enough without self-blame. To add into the mix, “I am sick because I caused it,” adds an unnecessary layer of shame to an already painful experience.

How do we manage self-blame when we know that various factors are, in fact, risk factors for illness? We know, for example, that childhood trauma puts people at heightened risk for chronic disease. We know that lifestyle factors like diet and exercise are important factors in health. We know that stress does matter, as our bodies are not meant to stay consistently in fight-flight-freeze mode.

Repeat after me: “I did the best I could with the resources I had at the time.” Think about this. Feel it. Really take it in. And say it again. It may be hard to believe this. Perhaps you have the notion that you should have been able to walk away from trauma unscathed, that you should have lived on broccoli and skipped cookies, that you should have stuck with meditation even though it made you want to jump out of your skin. You did the best you could with the resources you had at the time. You were vulnerable to trauma; you liked cookies; you really hated meditation. You were—and are—human.

If you can hold on to that radical orientation—“I am an imperfect human who has done and is doing the best I can”—you can truly care for yourself. You are neither doomed to illness nor exempt from it. It simply is. When you get up in the morning, try to let go of—or at least loosen—the critical self-blame you may feel. “You’re sick because you’re not a good enough person” is neither accurate nor helpful. It closes down growth, connection, and health. Instead, ask yourself: “How can I best care for myself today?” Maybe today you eat more broccoli. Or maybe you really need an extra cookie. Maybe today you need more rest. Or maybe you have the energy to go to the gym. Maybe today you need a stress-reliever—and you know meditation is not for you—so you decide to take the time to listen to some of your favorite music. Perfectly imperfect, listening to your needs, doing the best you can with the resources you have: You are enough.

Self-blame can be a vise that clamps onto our minds and won’t let go. But it can be worked with and changed. If you’re struggling with self-blame, please know that psychotherapy can help. Separating your illness from a belief that you deserve to be sick is vitally important for your emotional, mental, and physical well-being.


Callebaut, L., Molyneux, P., & Alexander, T. (2016). The relationship between self-blame for the onset of a chronic physical health condition and emotional distress: A systematic literature review. Clinical Psychology and Psychotherapy, 2016. DOI: 10:1002/cpp.2061.

Williams, G. (1984). The genesis of chronic illness: narrative re-construction. Sociology of Health and Illness, 6(2), 1984.

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