I was very impressed with this article which makes valuable points about how we judge and criticize others (consciously or unconsciously) for the nature of their illness or accident. Our first question often centers on how did it happen? did they deserve it? did they bring it on themselves? was their behavior or negligence a cause? Hospice workers, known for their non-judgmental mentality, are just as guilty of this as others. We strive to make meaning out of anyone else's misfortune in the hopes we can see how we don't fit THAT mold, we won't be a victim of their mistakes. What is really called for is compassion and kindness - living with what is - in the moment.
Inside Medicine: Care, not blame, is health goal
By Dr. Michael Wilkes -
Published Saturday, April 14, 2007
A family dies in a car crash, and reports on the news say they were not wearing their seat belts.
• A 46-year-old man dies of lung cancer, and his obituary says he was not a smoker.
• A 56-year-old woman in intensive care with liver disease needs a liver transplant, and the doctors go to great pains to emphasize to the other doctors that she is not an alcoholic.
• A 20-year-old college student is sexually assaulted in a parking lot after leaving her night shift as a waitress.
• A man is shot in his car at 4:30 a.m. while driving home after a night of partying.
Over the years, research has documented links between risk factors (smoking, obesity, sedentary lifestyle) and illnesses (lung cancer, diabetes and heart disease). Doctors remind people to live healthy lives and help minimize these health risks.
However, we fail to mention two key points. First, there are few risk factors that predictably result in a disease. Many factors only slightly increase a person's risk of illness over what would happen if the person didn't engage in the risky behavior. For example, seat belts and motorcycle helmets are certainly lifesavers. But if the crash is severe enough, as many are, the injuries will be fatal. Conversely, there are people who never engage in risky behaviors and still get diseases (lung cancer or cirrhosis of the liver).
For those people unlucky enough to get a stigmatized disease (cirrhosis of the liver, lung cancer) or injury (gunshot) without engaging in an associated risk factor, often lots of explaining and backpedaling needs to be done to convince people that the victim is "innocent."
But wait one minute. Why do we blame the smoker, drinker, rape victim or homicide victim? Do these people want to engage in these risky behaviors, or is it that they can't stop (smoking or drinking), have simply forgotten to protect themselves (to wear seat belts) or can't afford the less risky way of life (to heat their home with a central furnace rather than a kerosene floor heater, or to work a day shift)?
What is gained by blaming the victim? Clearly the disease or injury is bad enough without having to face social wrath.
I suspect the reason we blame victims isn't to punish the victim further but to protect or immunize ourselves from the same fate. If they didn't wear their seat belts or ate too much red meat or smoked cigarettes or were out until 4:30 a.m., and I don't do those things, then I will be protected. It gives us a sense of being in control of our own lives -- when in fact, we really aren't.
Social scientists call this the "just-world hypothesis." We assume that in a just world, bad things would never happen to innocent people unless they did something to bring on the harm. While this makes us feel safer in a world filled with random acts of violence, it is naive and unfair to the victims and their families.
This type of stigma, when inflicted by the medical profession, can also lead to poorer health. For example, for people who are not ready to lose weight, being repeatedly counseled by well-meaning doctors to diet often leads to a reluctance to visit the doctor for other medical problems.
Maybe some notions of blame are old-fashioned -- caused by an information lag between what we now know about the cause of a disease and what still exists as mythology in our culture. The next time you read or hear about a person with a sickness, ask yourself why we need to follow such bad news with an explanation of what they did to bring this on themselves. What is called for is genuine compassion, love and the acknowledgment that our world isn't perfect. And sometimes bad things just happen.