Op-Ed

The pressure to say you're OK

A colleague recently announced that he'd been diagnosed with a life-threatening cancer. Don't worry, he wrote. He promised to fight. He promised to recover.

As a survivor of multiple cancers and rare diseases, I've had to write my fair share of group emails alerting friends and family to medical news. So I understand the impulse to sound upbeat. Diagnosis emails and social-media posts are now a genre with set tropes and expected turns of phrase.

We swear we'll morph into rays of light during the darkest times in our lives. We vow to battle our infirmities — as if that were possible beyond seeking treatment — and to become “well again.”

We do this because we want to shelter ourselves from fear as much as we want to bolster the spirits of our loved ones. We may also feel the need to run damage control and manage ourselves like brands, lest we alienate fair-weather friends or fail to reduce the professional harm that reports of serious illness may bring.

When I graduated from college, my parents told me never to disclose my cancer history to colleagues or employers. They understood on an intuitive level what a recent article in the journal Cancer confirmed: Two years after a diagnosis, cancer survivors earn 40% less. By year five, they still haven't made it back to their original salaries.

Despite these statistics, and despite the debatable power of positive thinking — I'm an optimist with a taste for facts — I bridle at the social pressure to project exaggerated good cheer in the face of medical uncertainty. If we deserve anything after a grim doctor's visit, it's the uncommon chance to be authentic — even if that means remaining reticent, sobbing uncontrollably, attempting jokes that are mordant at best, ignoring those who tell us how to feel, or asking for help and company. This is our chance to share the disconcerting notion that we don't yet know how we'll go on — even if that means putting everyone around us in mind of their mortality.

Promising to “recover,” besides, masks the reality that recovering from a medical problem today doesn't mean what our outdated dictionaries say it does, what with mysterious late effects from treatments and additional medical problems caused by the first ones.

Guaranteeing to “get well” similarly reinforces the notion that health is a binary, with sickness on one side and wellness on the other. Is it? Doctors increasingly diagnose conditions pre-cancerous, pre-diabetic, pre-bad, and everyone's health is constantly fluctuating, like one's pulse or blood pressure. Cells change every second, and just because you've never had a body part scanned doesn't mean you're not undergoing negative biological transitions. Consider how many serious medical conditions are discovered by accident after a routine exam. Just as we speak about “neurodiversity” — the concept that a society of people with different neurological makeups is normal — so too should we accept and defend “health diversity.”

There's no need to insist that “everything will return to normal,” whether you're a patient or a member of a patient's support system. Chronic illness is normal. We have to get cozy with that notion and keep the medically stained from feeling cast out from society, left to wince and wonder in private until they're ready for some grand reemergence.

I've met people who view the ill as burdens on our healthcare system, on a company's productivity, on a family's savings. It's opinions like these that push patients to reassert their so-called normalcy and present inflated optimism. The pressure to report that you're OK when others check in with you is so strong — who has time for a real conversation today, especially one about something so unpleasant? — that many chronically and invisibly ill people fail to find the support they need.

Even for the most genetically lucky — although, show me someone whose life will never be touched by serious illness — there are practical benefits to supporting frank, authentic discussions about doleful diagnoses. Just as we work to remain mindful of what to do in an era rife with terrorism, so too should we toughen up to medical reality. There's power in understanding that good health is necessarily temporary, a subjective goal, while uncertain health is permanent.

Adam Baer is a Los Angeles writer who has covered chronic illness and cancer for various publications. Twitter @glassshallot

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A version of this article appeared in print on December 09, 2015, in the Opinion section of the Los Angeles Times with the headline "Sick, but nagged to say I'm OK" — Today's paperToday's paper | Subscribe
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