More often than not patients feel as though they have little autonomy on the trajectory of their lives. We make statements like “it runs in my family” or I can’t help but do this. We have, probably rightly so, made conditions like addiction a disease, in which we have little or no control over our actions – ie they are compulsions.
I tend to struggle with this line of thinking. By limiting ourselves to labels I think the net outcome is negative. Labels are like a diagnosis where we feel we were smited by God to forever live with a condition. The reason I find this troublesome is I’ve encountered a multitude of people who have changed this situation for the better. There are those that come from abusive households who go on to be loving parents and end the cycle. There are children of obese diabetics who live healthy lifestyles and do not have these conditions. There are those who do not come from backgrounds with educational achievement and they go on and get advanced degrees.
In considering Robert Sapolsky’s new book determined he projects that many of our behaviors are involuntary/pre-determined. There are a multitude of factors that go into this, but I think his conclusion is more that we should not blame people for perceived negative actions due to the multitude of factors that lead up to these decisions. It’s lowering the bar from a social accountability standpoint. I’m uncertain this mindset is really helpful to anyone. If you continue to reiterate to people that they are in a marginalized class or they cannot take ownership of their situation, I feel they are less likely to put forth any effort to modify their current position.
I often see this in medicine. People are provided a diagnosis and the easy answer is to accept it and give up all ability to change this situation. This is becoming more common in mental health disorders. I’ve always viewed it to be an issue with the diagnosis of PCOS. Patient’s are provided the diagnosis and they are told it will be a challenge for them to lose weight or get pregnant. As a result they don’t even try to modify lifestyle or they give up on their efforts.
The solution I still think remains to focus on small controllable habits to modify your personal position over time. If you’re in a significant amount of credit card debt. Cut up your credit cards or remove them from your online profiles. If you’re morbidly obese. Get the purchased processed foods out of your house. If you’re out of shape, cancel your Netflix subscription. These first steps, and more importantly the subsequent ones, are more likely to lead to an outcome that people ultimately desire.
Most American’s have the ability to implement change in their lives. There are most certainly social determinants of health and discrimination. I’m just uncertain the solution to those problems is just telling people they exist. A more reasonable model is providing people with a sense of hope, purpose and autonomy. Thinking of the ways that things can be different is probably a better way to change the situation than giving up and accepting the cards we’ve been dealt.
Seeking Progress 