(no subject)

[eirias]

I've been thinking a bit lately about social attitudes toward responsibility and disease. (I'm focusing here on mainstream and conservative attitudes; the majority of you are liberal types with backgrounds a bit different from mine, and so I know that your attitudes may not fit my description.) Under most conditions, upon learning that someone is sick, the socially appropriate response is to offer sympathy. But in the case of certain types of illnesses, there's a split: everyone offers sympathy, of course, but many of those people also privately blame the sick person for his or her affliction. Presumably, the particular circumstances that lead to blame might say something interesting about our society. Are we consistent in assigning personal responsibility for illness? What are the mitigating factors?

I've been thinking about this partially in the context of herpes, which is an STD in the sense that it is easily transmitted by multiple kinds of intimate contact, but gets classified differently by people depending on which quarters of the body it has infected. Admission that one suffers from cold sores is nothing much and barely registers on the TMI scale, but I have only in one instance heard someone say publicly that she suffered from genital sores. Cold sore medications are advertised on TV at all hours, IIRC, while I don't believe I've ever seen a TV ad for genital herpes meds. (If you think it's just about talking about genitals during prime time, compare to ads for Monistat and Viagra.) It strikes me that people's attitudes toward this disease really don't lend themselves to explanations of the "self-preservation" variety, at least not healthwise - compared to other STDs it's awfully minor. Hell, compared to a *lot* of communicable diseases, it's awfully minor. Influenza is highly contagious and sometimes lethal, and yet people don't shy away from telling their friends they've got the flu.

More generally, I think our response to VD is telling in how it differs from our response to other disease, life-threatening or not. A lot of people tend to look at VD as some kind of justice - as if to say, "well, if you didn't want to get gonorrhea, you shouldn't have been such a damn whore." They don't say this to sick people, of course - most Americans are civilized enough and have enough sense to know that that's inappropriate and cruel - but it's there all the same, in the fervor with which sexual abstinence is pushed as the best solution to public health crises, in the silence that surrounds a typical person's diagnosis. Absent wide agreement on the will of God, moralism nowadays is couched in terms of a dearth of personal responsibility. And it's of course true that one can take measures to avoid acquiring STDs, and that, where reasonable, one should do so. But really, one could take measures to prevent acquiring just about any transmissible disease. We (as a society) could take the position that kissing people is risky, and so people who do it are deserving of whatever they get - but we don't; by the same token, we could take the position that handshakes or hugs or air travel or really anything else that puts one in close proximity to a potential disease carrier constitutes a lapse in judgment worthy of punishment - but again, we don't. We could even extend this beyond sex and look at attitudes toward non-transmissible disease - when someone dies of lung cancer, the first question people tend to ask is whether s/he smoked, but when was the last time you heard anybody ask about the dietary habits of a victim of colorectal or pharyngeal cancer?

I was raised very much according to an ethic that frames itself as prudence: people who engage in certain behaviors under certain conditions are putting themselves at risk, and so when illness or tragedy befalls them, they are not entirely deserving of sympathy. I realized quite a while ago that this is not a particularly nice way to think about things (see above re: civility and sense ;) ), but it's only been within the last year or two, in part thanks to some enlightening conversation with ukelele*, that I've realized that it's also inconsistent with the way we respond to others' personal misfortune more generally. I don't think there's a way to write a formal model of moral responsibility based solely on risk that fully accounts for (mainstream and conservative) attitudes toward VD, abortion, and so on. I think that one could account for a good chunk of it, weighting by something like "perceived utility of behavior" - i.e., taking risk is more permissible if the behavior is something we accept as integral to living a normal life. But I suspect that there would still be a good deal of variance leftover. For instance, automobile accidents are a leading cause of death in my age range; and while it's true that Americans see cars as integral to living a normal life, many of us also use our cars in ways that are not at all necessary and sometimes downright stupid and wasteful. Nevertheless, I don't see anybody pushing for teaching "vehicular abstinence" in driver's ed courses, or urging youngsters to "save themselves for their commute."

I think we must ultimately ascribe this leftover variance in attribution of responsibility for disease to implicit influence from the Judeo-Christian sexual ethic of purity. Those acts which are pure according to this code are blameless, and so we feel sympathy for people who acquire disease while holding to that standard of purity; all others who suffer deserve their fate. But why should we as a society view sex with a lover as less pure than a handshake with a stranger?

*which had nothing to do with herpes.

Comments

[feuervogel]

Never seen a Valtrex ad on TV? I've seen a couple, and I watch TV maybe an hour or two a week. They usually involve people walking on the beach or something, with a voice over about herpes.

I wouldn't say herpes is entirely benign: I've seen 2 patients already this month who had to be tested for HSV meningitis, along with multiple patients with shingles (herpes zoster).

And, in conclusion, as a medical professional, handshakes are filthy. I try to avoid them when possible.

[cognative.livejournal.com]

Certainly if some ill befalls a person we may think about it differently depending on what lead to it. Was it totally by chance, like getting struck by lightning? Did the persons action lead to it, like playing in traffic? Or perhaps a combination of the two. A person who breaks their arm in a car accident that was caused by the other driver is going to be viewed a lot differently than one who does so while driving drunk.

How you determine the reasons for the persons misfortune is another story and is subject to some biases. In the case of diseases there clearly are some societal biases. But if we have a clear cut case of persons' actions directly leading to unfortunate event (with their knowledge) I don't see why less sympathy is out of the question.

(btw there are tons of Herpes adds on TV. You must not be watching the right stations.)

[kirin]

"Nevertheless, I don't see anybody pushing for teaching 'vehicular abstinence' in driver's ed courses, or urging youngsters to 'save themselves for their commute.' "

Not often, no, but I think it'd be great. :)
(Disclaimer: yeah, I do drive to work. Yes, I wish this country had better public transportation.)

But seriously, a common thought I have that (barely, tangentially, perhaps) relates to your post is that I'm constantly *amazed* by the disconnects and inconsistencies in our society when it comes to risk assessment, and cars are the most glaring example. Almost any other industrial product that caused, say, a dozens of deaths a year would be cause for severe alarm, massive warnings, and possibly outright bans. And yet we hardly bat an eye at our insane number of automobile deaths per year - it's just seen as a fact of life.
People are weird.

[thekat03.livejournal.com]

society stigmatizes a lot of people for various diseases, STD or not
it's easy to think "[person] is taking another sick day because of [chronic condition] again? [he/she] can't really be that sick" or to look at someone who has suffered from a chronic disfiguring skin condition and think it's icky looking, and thus the person is icky, too
it's easy to look at a child with ADHD and blame it on bad parenting, even if the parents have healthy, well-behaved children as well
likewise, it's easy to assume that only promiscuous people get STDs, when anyone who has any sort of sexual encounter with another person can get an STD, even if it was only one sexual encounter
it is easy to get preconceived notions about illness, and let those notions color our views of people
even doctors who theoretically understand the illnesses involved are succeptible to unfairly judging patients, assuming that the reason they aren't compliant is because they don't want to be
oftentimes, there is some reason why a patient isn't taking his or her medications, whether it's because they can't afford it or the med makes them feel ill or they are afraid of some potential side effect
what i think a lot of it comes down to is it's easy to make assumptions and judgements without really understanding what is going on

[ukelele.livejournal.com]

Wow. I can't at all remember what that conversation was. I was hoping the footnote would remind me...nope. Funny, though!

[ukelele.livejournal.com]

(Come to think of it, I might be able to sort of guess the conversation, but every time I think I can pin it down it slips away.)

Anyway. I had to read this a couple of times to get all the strands of thought clear but I think I've got them now...I think you've almost got it with "perceived utility of behavior", but what you're really looking for is "perceived normality of behavior".

(Damn. There was this essay I read a while back that was talking about the conservative mindset as organized around the principle "working hard at normal things caused success for me and/or my ancestors; if others fail to have success because they fail to work hard at normal things, it's pretty damn annoying that we have to take care of them; therefore, departure from the norm should be heavily discouraged and seen as ipso facto bad (even though it is really only second-degree bad, and that only maybe). But I can't remember where.)

Anyway. I think people don't tend to think closely about the risk or utility of things that are normal. Indeed, they don't tend to think about them at all. Being omnipresent, they hide in plain sight. And, after all, people do normal things all the time, and the vast majority of them do not result in any particular harm. (This is true even of relatively dangerous normal activities, such as driving a car.) Thus they don't fault people for doing things that are normal.

Conflate "normal" with "moral" just a little bit -- and, really, they're not all that different, particularly in some worldviews -- and I think you've got your model.

(I think there may also be an aspect of group definition/self-preservation, although I've been reading so much adolescent psych lately that I tend to see everything in terms of group definition, so take this with a grain of salt. I'm thinking this particularly in terms of Scary Diseases -- AIDS and mental illness spring readily to mind. I think it is important (psychologically) for a lot of people to define these illnesses as somehow germane to a behaviorally-defined group to which they do not belong. After all, if AIDS is the vengeance of God for being gay, and you're not gay, you don't run any risk of ending up with that particular terrifying disease, right? (Right.) Similarly mental illness, which in a very marked way puts people in a separate world from the norm; people want to stay part of this world and they want to feel that it is within their own choices to do so.)

(And there may be a bogus-attributional aspect, too. Emotionally, I can't help believing that a major component of constitution, sickness, and recovery is attitude -- those that take the attitude that it's not worth their time to be sick won't be, whereas those who find some advantage in wallowing in it or are weak in its presence will be. Intellectually, I know this is unsupportable. However, I have always held the attitude that I don't care to be sick, and I have almost never been sick (and never severely) -- look at that! "Clearly" I have made a superior type of choice that has led me to a superior lifestyle. Mind over matter. Why can't others do the same? And, for any such bogus-attribution, people are likely to have met *just* enough people who illustrate both sides of the choice (or can be read as thus illustrating) that it becomes terribly convincing indeed. (My husband and his sister, say; one for each side.))

[ksledge.livejournal.com]

Almost any other industrial product that caused, say, a dozens of deaths a year would be cause for severe alarm, massive warnings, and possibly outright bans. And yet we hardly bat an eye at our insane number of automobile deaths per year - it's just seen as a fact of life.

Yeah, and the terror warning stuff...remember how people FLIPPED OUT about the anthrax scare even though it only killed a few people? People are so irrational about this stuff. So many people will drive places because they are too afraid to fly. Umm...driving for 10 hrs is not only less convenient than flying a few hrs, but it's a shitload less safe.

[lyonesse.livejournal.com]

i don't watch teevee and can't speak to the ad content, but valtrex is not site-specific; my dentist prescribes it for my oral hsv.

[leora.livejournal.com]

The sad thing is, I think you're overestimating most people's decency.

From what I've seen personally and from others in disability communities - have any illness for over a year and people will start blaming you for symptoms of it.

They may not blame youf or the illness itself, but they will blame you for not being able to do things because you are sick.

People are often blamed for illnesses that they are more likely to get by being overweight. This even happens from doctors. This even happens to people with diseases that affect weight, like thyroid disease. Even if they gained weight as a symptom of a disease, or a side effect from being unable to exercise, they will be blamed.

Certain diseases are legitimate - cancer (if you didn't smoke), heart attack (if you weren't too heavy), leukemia (pretty much regardless of why). But other diseases aren't, regardless of how "good" you were - chronic fatigue, fibromyalgia, multiple chemical sensitivity, depression, bipolar, etc.

[leora.livejournal.com]

*nods* I used to blame people more for their choices. And even if you do get sick, why can't you work to get better?

Now I understand that many forms of sickness directly affect your brain's ability to concentrate, remember, deal with stress, etc. And people don't like to think about the fact that their very identity can be taken away from them by illness.

You don't always have the choice of how you will deal with illness. But with the exception of Alzheimer, we seem to blame people for it anyway.

It actually really surprises me how many people will look at someone who makes drastic changes in their behavior, becomes less competent, etc. with illness, and blame them and not the illness. Oh no, if they just tried harder... those sick people are always slacking.

I really think it's a matter that many people are lucky, and some things cannot be understood without getting very close to them.

[ukelele.livejournal.com]

And, again, I note that the "OK" diseases (cancer, heart attack, leukemia, Alzheimer's) are extremely common and/or have prominent charities associated with them (and/or are most common in children, who aren't generally perceived as having a high level of control over their destiny anyway), and the "not OK" ones are less common, frequently mental or sexual, and frequently only recently named & described, poorly understood, and in some cases still on uncertain scientific ground. They're not "normal", as per my comment above.

[feuervogel]

Uh, yes, I know that. It's also used for HSV meningitis, but you have to give really high doses so it penetrates into the CSF.

However, the Valtrex advert content, both on tv and in print ads, is genital herpes-specific.

(Random note)

[roamin-umpire.livejournal.com]

That's the highest ratio of parenthetical text to non- that I've ever seen. :P

[lyonesse.livejournal.com]

like i said, i don't watch teevee, and i have never seen a valtrex ad in print (the only magazines i usually read are "journal of cognitive neuroscience", "aikido today", and "bitch", none of which seem like appropriate venues). but don't drug ads in print have to contain essentially the package insert? or do the ads show somebody's genitals or something?

personally i would imagine that people walking along the beach might have plans to kiss. (or fuck, but either way, you might well have herpes on yer mind.)

[leora.livejournal.com]

Yes, and I think that's a good distinction. I think there is also a visible versus invisible distinction that is important (with treatment affecting this. I think cancer patients would not be as widely accepted if they didn't lose their hair) and a duration of illness component or perhaps a duration that is interlaced with ability to function.

Mononucleosis is perfectly respectable - unless it drags on for too long.

Injuries, even through admitted stupidity, are generally perfectly acceptable. In fact, someone who is 30 and in a wheelchair who says, "Yes, I was stupid at 17 and got into an avoidable car accident" will generally be seen in a highly positive light (oh, how strong you must be to go on). However, if that same accident did a Phineas Gage (sp?) on the person and created clear brain damage that made the person obnoxious, they would likely not be viewed well.

[feuervogel]

Yes, drug adverts in print are required to have the package insert printed on the back of the page. However, I don't know many people who actually read the stupid things (who aren't also in pharmacy.) But when the front of the ad has something like "genital herpes" in 32-point red Arial, genital herpes is the disease you think of first.

The American Journal of Health-System Pharmacists has a tonne of drug adverts. I tend to ignore them.

[cognative.livejournal.com]

They way I explain the whole car vs plane thing is that the relative safety of planes over cars is an overall average. That has to do with the both the chances of an accident and the severity of an accident. I think people start from the point of assuming there is an acident and don't really take the chances of getting into one into account. I think there's plenty of psych stuff on people being really bad with probabilities. Anyway, if you start from the point of "given that there will be an accident" then cars may seem safer.

Either way people are not very good at assessing risk.

[eirias.livejournal.com]

I think you're probably right that "normality" is a better predictor here than "utility" (see my bit on cars), although they do overlap a fair bit. What I was originally trying to do (something I've tried to do with a number of now-rejected moral stances from my upbringing) was to couch mainstream American attitudes toward VD in a way that keeps me from wanting to hit people. Unfortunately, the "normality principle" fails this test, being that "normality" is a standard I have managed to fail in about a billion ways in my lifetime, and I don't think I am particularly deserving of anguish ;).

I think you are spot on with the group definition bit, but I know almost nothing about social psych, so I say that as a layperson and not a professional ;).

[eirias.livejournal.com]

And, in conclusion, as a medical professional, handshakes are filthy. I try to avoid them when possible.

*G* Thanks for that datapoint! :)

[eirias.livejournal.com]

I think that people's assessments of risk just aren't linear - there is a huge weighting factor of salience, so really unusual or really bad things are likely to be weighted much more heavily in decisions and emotions than they should be according to a purely rational system. This is actually something I struggle with all the time - every time I get on a plane or read about some new, wacky disease.

[eirias.livejournal.com]

No, that's totally relevant to stuff I've been thinking about too along the same lines. I don't actually drive at all - to me it has so far been an unacceptable level of risk, so I have managed to structure my life in ways that let me avoid it. (Madison has very good public transportation for a city its size; I am almost never inconvenienced, and for the times when a car really is necessary, there's Graham's membership in Community Car (http://www.communitycar.com/).)

[ksledge.livejournal.com]

some other factors in play in people's minds:

1) every plane accident gets reported, but car accidents don't get much press (because they're so common! But people don't realize that.)
2) general fear of heights -- a lot of people have this anyway, and I can't think of something equivalent that a lot of people have that has to do with driving.
3) people trust what they can control. When they are the ones driving (as opposed to some pilot off in the cockpit), they feel safer.

[ukelele.livejournal.com]

Wow. It's not , but it's the same idea and essentially the same graphic design. Wacky. Good stuff. (http://www.zipcar.com)

[ukelele.livejournal.com]

Or, ya know, I could use proper syntax on my links:

Wow. It's not Zipcar (http://www.zipcar.com), but it's the same idea and essentially the same graphic design. Wacky. Good stuff.

[eirias.livejournal.com]

Isn't it, though? We're actually friends with one of the people who runs the company - we went to her house for dinner a while back. She's really nice, and she lives in our neighborhood. :)

(Did I mention that I love Madison? :) )

[cognative.livejournal.com]

well then why don't you just marry it :P

[eirias.livejournal.com]

Yeah.... when it comes to the definition of marriage in modern America, somehow I don't think "One Ph.D. Student, Two Hundred Thousand Men and Women" is going to fly...