Sickness Is a Criminal Act in Minds of Health Puritans : Life Styles: Pressure mounts to avoid habits that increase the risk of disease. But equating illness with lawlessness is not a new notion.
It started out as benign common sense: early to bed, early to rise, seat belts, safe sex, sit-ups and green leafy vegetables. But now the good health movement has turned positively puritanical.
Bolstered by growing research that links behavior and life styles to increased risk of disease, the country has embarked on a mass medical guilt trip. Being stricken with disease used to be considered bad luck. Today, getting sick has an element of consumer choice, like buying a bicycle: It’s your own fault if you get a bad one--or if you fall off.
If you get sick today, it’s your fault because: You didn’t jog, you put too much butter on your toast, you smoked too many cigarettes, you drank too many martinis, you slept with the wrong person--and to top it off, you were born poor, you didn’t finish school, you don’t have a job, you didn’t go to the doctor when symptoms first appeared.
You have erred with eggs and strayed with gin and left undone the aerobics that ought to have been done. And so now, you sit in your green hospital gown with the Scarlet Letter sewn on the back--S for sick.
In this puritanical view of health, certain categories of patients--carriers of the AIDS virus or drug addicts, for example--are not to be pitied as victims of disease but punished as perpetrators of illness.
The notion of disease as crime is not new. In 1872, British writer Samuel Butler created a mythical kingdom in his novel “Erewhon” (Nowhere) where everything is in reverse: Patients are punished as criminals and thrown into prison; criminals are treated as patients and rehabilitated in hospitals.
In “Erewhon,” one of the leading (rich and healthy) citizens is diagnosed with embezzling a large sum of money from a widow. “He has quite got over it,” the hero is told, “and has made a really wonderful recovery,” thanks to weekly treatments (a blend of primal scream and interpersonal psychotherapy) with a “straightener” (the equivalent of a doctor).
But ill people in “Erewhon” don’t get such felicitous treatment. They are dealt with by the Department of Justice. In one especially serious case, a man is charged with the high crime of pulmonary consumption. He obviously is a bad sort, since he already had been convicted of aggravated bronchitis and 14 other episodes of illness. His defense is that he is just faking his disease to defraud the insurance company--which would make him a criminal and therefore eligible for treatment. But a series of witnesses testify to his coughing; he can hardly stand up before the jury and has been in and out of prison for lung disease all his life. The judge gives him the maximum sentence: life in prison at hard labor (capital punishment having just been abolished in Erewhon in a popular fit of tenderness).
When the patient pleads extenuating circumstances--he had been born into poverty and contracted the disease from his parents--the judge rejoins that “whether your being in consumption is your fault or no, it is a fault in you.” Adds the judge: “Infliction of pain upon the weak and sickly was the only means of preventing weakness and sickliness from spreading.”
“Erewhon” could be written off as great 19th-Century satire except that the trend to make criminal certain diseases has already taken hold in the United States today. One such criminal type, for example, is the pregnant woman who is addicted to drugs and alcohol. Just as in “Erewhon,” last year in the District of Columbia a Superior Court judge sentenced a pregnant woman to jail in an attempt to keep her from drugs. The woman was convicted of second-degree theft, but the judge said at her hearing: “I’m going to keep her locked up until the baby is born because she’s tested positive for cocaine. . . . She’s apparently an addictive personality, and I’ll be darned if I’m going to have a baby born that way.”
Although this and other current examples may be extreme, making criminals of patients is right out of “Erewhon.” What fuels this form of medical puritanism is the notion that a sick person is at fault. “You are a bad and dangerous person,” the Erewhonian judge told the condemned lung-disease patient. His modern counterpart in Washington said to the pregnant addict: “I can’t trust you . . . and that’s a hell of a thing to say.”
The dilemma of mixing morals and medicine is that many causes of death and disability fall into that twilight zone where behavior and biology overlap. A recent report on the health status of poor children in New York City found that “diseases of life styles” have replaced traditional infectious diseases as the main causes of death. These included pediatric AIDS, child abuse and substance abuse.
What’s more, most of the major “physical” diseases have a life-style component. Indeed, an estimated 83% of lung cancers are attributed to smoking; perhaps 95% of back problems could have been prevented with exercise. Does that mean getting lung cancer or having back surgery is your own fault? And if you wear the Scarlet S Letter, do you deserve society’s punishment?
The answer is that America is already leaning toward punishment. Outgoing Surgeon General C. Everett Koop noted that while Americans are “still . . . forgiving,” they are “already traveling the road of retribution” in public health. Their target is “the individual who willfully behaves in a high-risk manner: drunks, drug addicts, smokers, sexually promiscuous people of all ages, dangerous drivers, child beaters, the person with AIDS.”
Who will land next on the medical hit list? Cholesterol abusers, pole vaulters and motorcyclists, sugar fiends, soda guzzlers? The trend toward blame has already progressed far enough that some ethicists are sounding a tocsin. “We do have to take responsibility for our health,” says Robert N. Butler, professor of geriatrics at Mt. Sinai Medical Center in New York and former director of the National Institute on Aging. “But we have to be careful not to end up blaming the victim.”
That’s the point, of course. No matter how you live your life, there are major elements involved that you just can’t change. For instance, you can’t turn in your parents because they gave you bad genes. But the fact is that genes affect how your body reacts to your life style. One person can cover food white with salt and have no reaction, while another would collapse of high blood pressure from years of over-salting meals.
The ticking of the clock is also out of your control. Most diseases are a function of getting older. About 85% of all cancers occur in people over 50. Sure, you can take better care of yourself to delay the clock. But it is set for different times for different people and, inexorably, it’s going to catch up with you someday no matter how you live.
What all this seems to mean is: Be prudent--but not penitent. A bit of medical puritanism is common sense. But too much can be hazardous to the country’s health, fueling the social diseases of intolerance, discrimination and revenge. They are worse than a lot of physical diseases.