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On Sanctioning Bad Behavior and Feeling Good About It

We're not doing ourselves any favors by lying about what's killing us

I was at dinner with a few people not long ago and we were all ordering generally unhealthy options. Only one plate lacked for a slab of red meat, and even it (a fish dish) was floating in enough butter to make a cardiologist cringe. Jokingly, someone said, "I'll have to eat nothing but lettuce for the next three days to equal this off." Someone else responded, also jokingly, "Just take your Lipitor and forget about it. No worries."

Even though this was just happy dinner banter, I can't help but pluck from it a splinter of psychological revelation. I think there's a presumption among many that medical science has come along far enough to wall off our behavioral choices from their outcomes. This seems especially true when it comes to cardiovascular disease. With the growing variety of cholesterol-lowering and blood pressure-reducing drugs on the market, the belief that we can have our proverbial artery clogging cake and eat it too is strengthening.

It would be unfair, and not a little disingenuous, for me to write about this subject without putting myself on the dissection table. I have taken a statin drug for cholesterol and a blood pressure-lowering drug for a few years. I've asked my doctor about the possibility of eventually getting off these drugs, because I'd rather not be on them, and he tells me that while it's not impossible, in his experience it's highly unlikely. His reasoning is that in people with both a strong genetic and behavioral component to cholesterol and blood pressure elevations, like me, even radical changes in behavior are usually not enough to control the problem completely.

Perhaps he's right. Even when I was in much better physical shape, I still had marginally high blood pressure and an LDL cholesterol level higher than it should have been. But for a moment I want to put aside the genetic part of this and focus on behavior. Let's say that his response to me was, "Well, since your problem is largely behavioral, yes, you could get off those drugs if you changed your lifestyle." And then let's say that I thought to myself, "Hmmm, but all I need to do to continue ordering juicy steaks and cheesecake is pop a couple of pills every day? Why would I not do that?"

If this were the case, I'd have to wonder why anyone would support my decision to stay on the drugs indefinitely. But it wouldn't matter who supported me, because as long as I could pay for the prescriptions, I could continue taking the drugs. It's this tacit approval of costly recklessness that interests me. The approval happens on two fronts: societal and internal. We could debate for days whether or not our society can afford to sanction bad health habits, and the discussion would of course have to include smoking. There's plenty to chew on in that debate, but for the sake of this post I'm more interested in how we internally sanction our behavior.

For the sake of argument, I want to submit that every person who indulges the self-sanction described above is lying. Not necessarily in an overt sense, but in the sense that they are denying an essential truth about their health: that the reason they are on medication is an outcome of dangerous behavior, not a safeguard to enable more of the same behavior. I think the ubiquity of drug advertising, combined with the saturation of overindulgence advertising (food, et al) has over many years shaped our perception to accept the lie as a given. And because humans are creatures prone to the path of least resistance, it's really not a hard sell at all. One set of products is enjoyable and convenient but potentially bad for you; another set of products allows you to indulge in the first set without harming yourself. What could be easier to accept?

You have to be willing to peel back the commercially grown husk to see the lie -- and that's no easy feat. Harder still is fending off rationalization. If your lifestyle is fast-paced and pressure-filled--as many of ours are--it's understandable that medication would seem a sort of prophylactic against the side-effects of a manic existence. Again, the point of the commercial spear is aimed right at this tendency to rationalize, and it lands on target only because we're willing to accept it.

There's no easy answer here and I don't claim to have one. Against the component of my cardiovascular problem that is behavioral, I'm clearly failing; I'm sure in no small part due to denial born of rationalization. I'm not a doctor, but it makes practical sense to me that if I reduced the behavioral influence, the genetic influence wouldn't be as amplified (which is simply to say, I'm not letting myself off this hook).

Self-flagellating health messages aside, the issue here is really the willingness to tell oneself the truth. As I argued in a previous post, our commercial culture is not constructed to help us do that. Quite the opposite, it's configured to help us keep lying and feel good about it. It strikes me that one of the biggest challenges psychology, along with education, must face in the coming years is to help turn that tide -- a monumental challenge by any standard.