Julian Seifter

Julian Seifter M.D.

After the Diagnosis

No Fault Illness

The mysteries of causation and the power of forgiveness

Posted Dec 27, 2010

Maureen, a patient of mine with lupus, sits slumped in the office chair, a picture of misery.  She's had a recent flare-up of symptoms and she feels it's her own fault: she's let the stresses of her life trigger an exacerbation.  In fact, according to Maureen, her disease is her fault.  She was depressed after college, when she lost her long-time boyfriend and her first job, and had to move back in with her parents.  Plus, she was fighting a cold that just wouldn't go away.  All these stresses made her immune system "go crazy" and begin attacking her own tissues.  Stress is our modern bugaboo, as repression of anger or sexual desire were to blame in earlier eras, for everything from cancer to ulcers to migraine.  But the truth is, the "cause" of most diseases is a mix of variables, not all of them well understood.  We just don't know how much, or in what ways, emotion affects physical health.

Many patients, with illnesses ranging from cancer to kidney disease to autoimmune diseases, subscribe to the private theory that somehow they contributed to their own misfortune, through poor control of their emotions or their habits, or because they are marked by bad heredity.  The society at large encourages this kind of self-blame.  In our health-obsessed, live-forever world, it's assumed that good health and long life are within everyone's control.  If you're sick, it's your own fault; your lifestyle, your genes, your fault.  This quickness to judge is fueled by a longing for power and safety.  Even more than we want to know "why" disease happens, we want to make sure it doesn't happen to us; and the more we can blame the victim for his own ills, the safer we are.

The anxious wish to name the culprit has contributed to a puritanical, sometimes even fanatical, approach to health in our culture.  I'm not promoting self-indulgence or do-nothing pessimism-there's no question that public awareness, preventive measures, and fitness recommendations are all important interventions.  But I do think there's a difference between Ten Rules for Healthy Living and the Ten Commandments.  Sometimes I think we've tipped too far in the direction of judgment and stigma; it's almost as though we're putting people in the stocks if they fail to meet the test of perfect self-control.

In our zealous pursuit of perfect health, we're forgetting that much medical knowledge is, unfortunately, inexact.   In many cases, why someone gets sick is unknown, and how to make him better uncertain.  And while we're busy censuring people for poor self-care or imagined sins of emotional excess, we're also ignoring some bedrock facts about human nature.  People have psyches as well as bodies, and inside each person is a world of drives, hungers, needs, and fears, all of which may be operating in direct opposition to the Ten Rules for Healthy Living. 

The truth is, no health policy or medical Ten Commandments will ever entirely tame the randomness of the universe or control all the variables affecting people's health.  Simply being alive means being vulnerable to time, chance, illness, death.  It's an illusion to think that if we do the right things, we'll be healthy, and if we're unhealthy, it's because we didn't do the right things. Not everything that happens to us is a measure of our character or will; sometimes an event is just a matter of luck.  Tolerance, forgiveness, and acceptance are attitudes that help us face whatever chance throws our way.  It's only by acknowledging what lies beyond our control that we can fully embrace the lives we have, for the time we have them.

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