Monday, August 20, 2018

Vice-shaming and the Burden of Being Wealthy

I think I may have coined a new term. I looked it up on Google and didn't see anyone else having ever used it.

The other day I was talking with my wife about how people often say disparaging things about others' bad habits. Not major things, little things. A bit of dessert. A cigarette smoked at a party. Gluten.

So I said "We like vice-shaming people." Cutting people down because they do things we think no one should do. "You give your child soda?" one cries out, alarmed. "You eat meat?"

I looked it up to see if it hits in a search, and it doesn't, so I hereby claim invention of the term vice-shaming: the act of disparaging, publicly or privately, the minor vices of others.

There are other terms that do exist, like "fat-shaming" or "body-shaming"--those are popular right now. And the thing is with these: there's sanctimony on both sides of it. On the one hand you could say, "You know, being overweight is unhealthy." And the target of that comment could respond "You know, shaming people you don't know anything about for its own sake is kinda mean." So I guess, the shamer and the shamed can both claim the moral high ground here!

I've been thinking about this for a few days, and here's what I've been working with.

Medically, shame is a loser. If one of my students tells a patient something like "You know smoking is bad for you, right?" I'm liable to take her aside and shame her a little, "You know, there's no evidence that line works to get anyone to change their behavior, right?" Of course the patient knows that, everybody knows that. (Or almost everybody...but there are better ways to figure that out.)

Shame is how we in society let others know they are doing something shameful, like being mean to puppies, or throwing litter on the street, or saying awful things in public. It's a form of social control. It lets people know there are standards of behavior and that they need to get in line.

But what works for, say, getting the government to change its policy regarding family detention (that is, the use of shame), won't work and isn't applicable to the private behaviors of individuals. More to the point, not all standards apply to all people at all times. For example, if a patient tells me he uses e-cigarettes, because it helped him quit smoking real cigarettes...what? I'm supposed to criticize that?

I've had students say things like, "I work in the ER and I see these people come in and they're fat and they're all eating McDonald's while they're waiting for the doctor to come in."

I might ask the student: How do you know this isn't the first time that person has eaten all day? How do you know this person can afford--or even find--better food in their urban neighborhood? How do you know this isn't all that person could afford, both in time and money, as he sits here waiting for a doctor who makes $175,000 a year, while he misses time at his second (minimum wage) job because of this injury or illness?

So people have vices. Big deal. Yes, it's our job as health care professionals to guide them into thinking about ways they might be able to minimize the impact of those vices on their lives. Some vices are more harmful than others. Some things aren't really vices at all; the category of "vice" changes with the times. Medical research into things doesn't always clarify. So a "vice" can be a judgement call.

I've had doctors (mostly in alternative medicine) call into question meat, wheat, corn, corn syrup, sugar, salt, alcohol, grocery store vegetables (pesticides), saturated fats, unsaturated fats, any fat, anything but fat and protein, snacks and "junk food", candy, donuts, fast-food...anyway, you get the idea.

Now I'm not here to tell anyone that a Big Mac is a-ok. But neither is one Big Mac the end of health as you know it. But to anyone who reads my blog even semi-regularly, that's probably obvious by now. Stuff-that's-not-great-for-you is also not stuff that is going to kill you if you indulge once in a while.

But this whole line of thought got me wondering about vice, and what we think of as vices, from both the standpoint of the person engaging in what they term a vice and from the standpoint of the person labeling another's behavior as such.

I'm not going to go into real vices here: chronic cigarette smoking, uncontrolled gambling, alcoholism, heavy drug use, sexual addiction and so forth. These are vices in the classic sense: repeated, habitual, obviously-harmful behaviors that reliably lead to severe medical compromise, and harm others around the person who engages the vice.

What I started thinking about is how we have begun to label things that cause little evident harm or at least ought not to, as "harmful" or vice-like. As I noted earlier, gluten, one of the protein fractions of wheat and related grains, has taken on the cast of a "vice" in recent years. Now I will be the first to note that I have had patients state to me that their avoidance of gluten has led to improvements in their symptoms--although if it were just that, they certainly wouldn't be seeing me at all, right? These folks tell me about how much they miss, by avoiding gluten. And I have to ask: This is food, right? How is it that our food causes us this much complaint?

Google this or talk to your friends or natruropathic (and some regular) docs and they will tell you. It's...
  • The way wheat is bred and grown today
  • Additives
  • Allergies
  • (unspecified) "toxins" either in the food supply or in the general environment...
...and so on. But I find the evidence for these causes unconvincing. Of course, I certainly advocate for a cleaner, healthier, more sustainable food supply, but I also have to question how it is that in one of the wealthiest societies the world has ever seen, we have to start treating everything we love as a "vice"--a harmful habit that must be broken. 

On the website HealthLine the author warns about acrylamides in potatoes--so we're not supposed to eat cooked potatoes? He pans white bread--failing to distinguish soft, gooey Wonder Bread from stout, delicious baguettes from the bakery--in favor of "less bad" wheat breads and even ezekial bread. I've had ezekial bread. It's not a food that makes me enjoy eating bread. Maybe that's the point.

Maybe that is the point. In our great wealth and ease, have we somehow translated this into physical ailments that arise from the fruit of that wealth and ease?

That may sound silly, but I recently had a French patient of mine tell me there's no talk of peanut allergies in France. It's not a thing. My wife edited this entry and said "Is that true, or is that just her view point?" So I looked it up. Yeah, it's mostly true. Peanut allergy occurs most in developed countries like the US, but not uniformly. It is less to non-existent in many developed countries, and appears now in some developing countries. The distribution doesn't make sense.

So let us suspend for a moment the belief that every physical complaint or disease must have a material cause.

Is it possible that many ailments--even very physical ones--stem from psychic imbalances? This is well-known to practitioners in homeopathy, Chinese medicine, and Indian (Ayurvedic) medicine, as well as wise healers, shamans, and others who admit to the possibility of both individual and social causes of disease that are energetic or psychic in origin.

I'm not saying "it's all in people's minds." That would be mean, true, but worse, it would miss the real understanding: that perhaps society itself can alter the way our bodies and our minds respond to that society, both its riches and its "vices". Suddenly the things we love become our enemies, poisons similar to chronic tobacco use, heroin, and unprotected promiscuity.

I know this sounds bizarre. But I think it is important to explore the question, because I think it is reasonable to imagine that both individual and collective thought can create physical disease. That seems pretty "magical", I know. And I have no proof of this--actually, I'm not trying to prove it here, although there are instances of this occurring, detailed in such sources as the New England Journal of Medicine, American Family Physician, and scholar Rebecca Kukla, but there are many others.

Accepting this for a moment as a thought experiment, we can ask several questions:

Does wealth and ease lead to physical illness beyond the material influence of the things we ingest? That is, does collective guilt or boredom cause our bodies to react in new ways, giving rise to new "diseases"?

As these emotions grow among us and become more common, shared among many, is one possible reaction for members of that society to begin to "shame" others on their engagement in what should be otherwise neutral impacts to the body (vice-shaming)?

In health care, can this translate into a collective professional culture that shames people for things human beings ought to normally tolerate well, like eating peanuts, or gluten, or even modest amounts of sugar?

I don't have answers to these questions, but in Nursing, we recognize that human beings are unitary beings of body-mind-spirit, and as such we can admit the possibility that the rise of "new diseases" might be less a product of material things alone (like "toxins") and maybe a product of less material origins, like fear, boredom, stress, guilt, and so on. Extending that, it is also possible to imagine that among many individuals, similar physical problems could be collectively shared.

It sounds kinda crazy, but my research into the connections between the body's immune system and the mind suggest it might not be so crazy. This is an idea in development, and I would welcome the thoughts of readers or this blog, patients, and friends on this matter.