Sociologist Frank Furedi recently published an article at Spiked about “Our unhealthy obsession with sickness”. The arguments he makes all, it seems to me, are mistaken. It’s rare I disagree with someone so completely on a topic outside of politics, so I thought I’d go ahead and explain why I disagree… not with a few simple facts, but with his assessment of those facts.
We live in a world where illnesses are on the increase. The distinguishing feature of the twenty-first century is that health has become a dominant issue, both in our personal lives and in public life. It has become a highly politicised issue, too, and an increasingly important site of government intervention and policymaking. With every year that passes, we seem to spend more and more time and resources thinking about health and sickness. I think there are four possible reasons for this.
The reasons he lists are as follows:
- the medicalisation of everyday problems
- a presupposition that illness is as normal as health
- [the use of] health to make sense of the human experience
- the politicisation of health
While a certain understanding of these trends could be quite worthwhile, it seems to me Furedi’s take on each is basically in error.
Furedi explains that medicalization refers to the way “that problems we encounter in everyday life are reinterpreted as medical ones.” His examples include problems like shyness, distress, or disappointment. He asks , “when even love can be seen as the harbinger of illness, what aspect of our lives can be said to be illness-free?” Of course, it’s a well-established fact (wonderfully treated in Mary Frances Wack’s Lovesickness in the Middle
Ages: The Viaticum and Its Commentaries, among other books) that the notion of love-sickness has its roots in antiquity, and figured prominently in Arabic medical texts like the Kitab Zad al-musafir wa-qut al-hadir, a book which, when it reached Europe, spawned a whole academic debate on the treatment of the disease known as “amor hereos”, or in English, love-sickness. The idea, whether or not it is creditable, is at the very least far from new: it’s hundreds of years old.
Now, Furedi does have a point about the medicalization of all human experience being problematic. However, the real issue here is not the medicalization itself, but the implications of the medicalization. If medicalization meant simply the understanding of daily problems as being related to, or in part caused by, physical phenomena, then this would be a fundamentally unobjectionable trend. People think and feel a certain way because of physical processes in the body: anyone who refuses this fact is welcome to explain human experience in other waysin terms of “the soul” or some other romantic notionbut it’s certainly within the scope of sensible science to assert that this is true, even if we don’t fully understand the processes themselves. Further, to consider certain kinds of deviations from the mean medical problems is not an issuemost people will agree that suicidal depression and irresistible addictions are definitely problems, and many will even admit they’re (at least partly) medical problems. The question is at what point troubling physical phenomena become medical problems, really.
And this brings us to the real issue at stake, which is that effective overmedicalization has everything to do with the pharmaceutical industry. The incentive to medicalize everything lies in our love-affair with medical treatments, especially easy-way-out treatments. This is not to say that all pharmaceutical treatments are simply an easy way out, but rather that physicians and patients alike have great trouble resisting quick fixes to problems that may not necessarily require medical treatment at all, when the treatments make money for doctors, manufacture peace of mind for patients, and are kept available because, simply put, they make piles of money for the companies peddling them.
Furedi proceeds on his second point, which is that
there is now a presupposition that illness is as normal as health. Earlier theories of medicalisation still considered illness to be the exception; now, being ill is seen as a normal state, possibly even more normal than being healthy. We are all now seen as being potentially ill; that is the default state we live in today.
Actually, Furedi isn’t being clear about his terms. What he means is that there is a growing sense of illness as ubiquitousit’s “normal” in that it is everywhere. This, he finds objectionable because, I suppose, he would like us to see illness rather as the exception and not the rule.
The fact that he’s got it wrong is obvious to anyone who’s traveled to somewhere like Paris, Seoul, Iran, or Tokyo lately. He’s got it backwards: the social truth is that certain kinds of illness in Anglo/American culture have been “normalized” so that to many people they are not at all seen as illness. Certain kinds of lifestyles and diets, resulting in common obesity, and certain kinds of addictions or routinely overused drugs, say to nicotine or alcohol, come to mind as prevalent examples. As unacceptable as being a smoker seems to be becoming, it’s not so unacceptable that smoking is seen as evil; stupid, yes, but not evil. It still even retains the aura of “cool” in many places or strata of Western society.
Seen rightly as illness, certain sicknesses pretty much are ubiquitous, at least in North America (about which I write because my experience is focused there): diet related illnesses are particularly prevalent, for example, and with obesity and hypertension come a whole host of other diseases. Depression, too, seems rampant, even if one takes into account the effects of overprescription of antidepressants. Illness isn’t quite ubiquitous, but it is rather common enough to be considered “normal” for a lot of people; or, rather, it is worth reexamining what many people consider normal, because by sane medical standards, it is radically unhealthy. Furedi argues that we risk linking our identities too deeply with our illnesses, but people do this already, even in the absence of medicalization and “normalization” of illness. Fat people form their identities around their fatnesssomething I’ve seen more times than I care to get into, something I’ve even experienced myself.
Kibbitzing about the terminology of “wellness” (or, here in Korea, the even more annoying polyglot term “welbing”for well-being) aside, the rise in effective preventative medical care makes a lot of sense. Massive numbers of illnesses are, after all, preventable, and regardless of the costs, are likely to save both individuals and society a lot of pain and expense down the road.
Another interesting point to note is that illness in fact is a natural state of affairs. Illness is part of being human, and part of being human-in-nature. Our ties with the world make illness quite a natural human experience, and I for one would welcome any sign that we are getting over the neurotic illusion that we are separate from, or above, nature, and that illness is an aberration to be stomped out with all our force, regardless of the consequences to the world. If illness is truly being normalized, then people will accept illness, and see it in a way that fosters more patience, more natural treatments, rather than turning to companies and authoritarian father-doctor figures to provide quick chemical fixes for every little thing that ails them. If illness is actually understood natural, we’ll accept it even as we resist it. We’ll be realistic about taking measures to avoid illness, which needn’t mean standing in grocery stores reading the fine printnobody I know does that here in Korea, and yet obesity is far from being a problem here, even though people have the resources to eat as much as Americans do, should they so wish. The key is that once certain forms of illness are understood as the result of a kind of unhealthy lifestyle, people will seek to replace the unhealthy elements in their lifestyle with elements that are obviously healthier. One needn’t read the fine print to know that habitual consumption of fried foods, oversized portions, and junk food are bad for peoples’ health over the long run, and that human beings need regular exercise. The fear isn’t that people will magically revert to being ill; it’s that many already are, and that without careful attention to basic elements of their lifestyles, they will either remain so, or become more ill.
The use of health to make sense of the human experience, Furedi’s third point, is hardly remarkable. The making of meaning in human life is an activity we throw ourselves into with great gusto, and I think that in making sense of one’s life through illness and health, in an age where more attention is rightly paid to the subject, is hardly objectionable. Furedi’s complaints about the kinds of learning people attest to illnesses or conditions makes him sound somewhat naive: in my humble opinion, anyone who has survived cancer or paraplegia has a right to at least claim he or she has learned something from the illness, and it may do us less-unlucky folks some good to shut up and listen to whatever lessons they believe can offer. In any case, the notion that suffering or hardship is far from new, and while romanticizing it would be foolishtuberculosis is not, after all, the reason Keats was a brilliant poetit’s equally ridiculous to think that people can undergo major illnesses without some kind of pedagogical experience. The value of the experience is neither here nor thereit’s plainly human to consider all kinds of experiences as pedagogical, and has been for ages. If you don’t believe me, go read The Confession and see how much Augustine learned from his youthful folly. Humans always struggle to make sense of pain, to find some good in it, and really, it makes a lot of sense to do so when dealing with illness, which is, after all, quite a natural (if often unpleasant) component of human experience.
I think what’s peeking through here is a complaint that we’ve abandoned “better” ways of making meaning in our lives. Witness one of Furedi’s examples, when unpacking his third point:
At a time of moral and existential uncertainty, health has become an important idiom through which to provide guidance to individuals.
This is now so prevalent that we no longer even notice when we are doing it. For example, we no longer tell teenagers that pre-marital sex is good or bad or sinful. Instead we say that pre-marital sex is a health risk. Sex education programmes teach that you will be emotionally traumatised if pressured into having sex and will be generally healthier if you stay at home and watch TV instead.
There are few clear moral guidelines that can direct our behaviour today; but we have become very good at using health to regulate people’s lives in an intrusive and systematic fashion.
Well, now, that’s fascinating.
Furedi wants us to believe that we are becoming “morally illiterate”. I can’t tell, therefore, whether or not he believes that this use of health as an implement of intrusive social control is objectionable. He claims that we perceive and talk about medical issues in terms of moral connotations, where “some drugs are said to be bad for the environment”, while natural compounds are seen a “morally superior”. Organic food is “good”, he tells us, and we see junk food as “evil”. I’m not sure where he’s getting this, but it seems a bit misguided if you ask me. I’ve never met anyone that considered junk food evil, per se. I certainly don’t perceive any notion of fat people as having “a serious moral problem”, the way that Furedi claims. A serious problem? Yes, of course. But where does morality enter into it, beyond the arguable selfishness of those who choose a self-destructive lifestyle in full knowledge of the fact the rest of their society will have to pay for their medical bills when their lifestyle catches up with them? (And since most people arguably don’t think in these terms, I don’t see how morality enters into the discussion.)
No, Furedi seems to be dissociating from reality even more than those he’s criticizing. If he’s not heard the news, certain drugs are bad for the environment; certain foods are pretty much categorically not good for people when habitually eaten. Overweight people do tend to have a whole host of standard fat-people medical problems, which are to some degree avoidable. Certain lifestyles do pretty much create illness where there need not be any. Not all artificial compounds are bad for you, but certainly overuse of artificial medicines can be bad for people, and many natural compounds are often less likely than artificial compounds to be used in permanently damaging overkill, to result in dependency, and so forth. Reality is a baby I would prefer not to throw away with the bathwater of the real problems in the health industry.
And to be honest, I don’t perceive anything like the overblown moralizing that Furedi thinks is inherent in such distinctions of better and worse. In fact, I think he’s conflating two complaints of his own into one point: that we’re not really discussing things in terms of moral codes because we no longer believe in them in the way we used to, and that we tend to base a lot of decisions on whether they’re likely to be healthful or not, rather than whether they’re likely to be good or evil. We do, to some degree, conflate the healthful with the good… but is this objectionable? Humans have done this for ages, in fact there’s plenty of evidence to suggest we’re mentally programmed to consider health a good thingwhich is why all the signs of healthclear skin, shiny hair, and physical bilateral symmetry, for exampleare also the things we find attractive in a potential mate. Over the long term, this has worked pretty well for us as a species. And as anyone who has experienced illness (which means almost everyone alive) would agree, being healthy really is preferable to being ill, regardless of how natural illness is!
Furedi’s fourth complaint is what he calls “the politicisation of health”. Essentially, he thinks that governmental and political activity with regards to health is objectionable in several ways. His two main complaints, in his own words, are as follows:
First they encourage introspection, telling us that unless men examine their testicles, unless we keep a check on our cholesterol level, then we are not being responsible citizens. You are letting down yourself, your wife, your kids, everybody. We are encouraged continually to worry about our health. As a consequence, public health initiatives have become, as far as I can tell, a threat to public health. Secondly, governments promote the value of health seeking. We are meant always to be seeking health for this or that condition.
Now, this seems outright ridiculous to me. What ought governments to promote? The absence of introspection, and the avoidance of health? Because, really, it seems to me that in a lot of individual cases, this is precisely what many people have already embraced… and honestly, I have embraced it from time to time in my own life. Now, given the choice between having people perform self-examinations and be vigilant about their own health, and having people wander about willy-nilly not noticing lumps developing on body parts until, whoops, it’s too late, I know what I’d choose. In fact, if you want to see the opposite, I invite you to visit the hospital where my girlfriend is interning as a medical student. She can show you just how sad it is to see older women, who spent their lives free from government interference, suffering and dying from cases of breast cancer (a leading killer among women worldwide) which are so often diagnosed too late because older women from the countryside know nothing of breast self-exams. Ignorance is often not so much bliss but a cot in a cancer ward, waiting to die. One hardly needs to be an obsessive to be wary, but Furedi doesn’t seem willing to admit the difference.
The wider impetus of pursuing health also makes sense, and one need only think for a few moments in order to understand why: it’s not only good for individuals, but for a society as a whole. A society that pursues health of its own accord will be more productive, less prone to lose work-hours or creativity to time spent recovering from illness, and more likely to be healthy.
Finally, Furedi seems to be whining, more than anything, in asserting that being urged to pursue health makes us all feel even more sick. Certainly, the pursuit of health can be daunting for those who are already cemented into unhealthy lifestyleslifestyles that generally lead to obesity and ill-healthbut the solution is not stop encouraging people to get out of those ruts.
No doubt there are serious problems with the kinds of health-consciousness that have emerged in North American society in the last decade or two. The profiteering of pharmaceutical corporations and overprescription of medications, the use of wellness as a marketing ploy, the missing-component of the year (when I left North America it was Fat-free, but I’ve heard it’s since become more fashionable to bill something as having “No Carbs”) as an alternative to whole-lifestyle adoption of healthful living… there are endless problems, of course!
But the points Furedi seems to eager to complain about are in the end negligible; they seem to be the recalcitrant converse of the health-focused introspection that he believes governments foist upon citizens, complaints about the worries we feel when we’re informed we can, and probably ought to, pursue health instead of not considering it. He’s right that we need cultural changes, but those changes will not come from a change in rhetoric; instead of worrying mainly about the effects of narratives or discourses related to health care, concretely addressing the way health is marketed, sold, prescribed, provided to the public, and sought out would actually serve to address the mounting problems that do, of course, really exist and have existed since long before we ever took notice of them.