It is really hard to abandon the idea that conditions are moral failings when society at large bleats that they are.
Tie your hat down. This is going to be a longish article. I’m going to highlight some ways in which doctors and the general population hold onto an obsolete model of our somatic and mental processes. The model in question is this one:
Somatic and mental processes operate in different people in essentially the same way.
Holding onto this obsolete notion has multiple consequences. Doctors will tend to pull their Big Book of Medicine, plug in your symptoms, and come up with a diagnosis. The general population — and doctors too, because they are part of this population — will additionally infer knowledge about your mind from what they can observe about you. Once such common inference is that your conditions are moral failings.
Note that I do not question in this article whether something is a moral failing or not. There are certainly cases where someone could legitimately claim that something that someone considers to be a moral failing is not in fact a moral failing. Perhaps there are no moral failings at all. In the rest of the article, I’m going to take the public’s view on moral failings at face value.
I’m a medical unicorn, in the sense that I’m a rare beast in the medical world. I realize now that my conditions are not moral failing. However, it took some work to get there. When society keeps telling you that you are a moral failure, you may start to think that you are, in fact, a moral failure. Furthermore, I use the term “condition” here to talk about things that are illnesses, like my familial hypercholesterolemia, but also things that are not illnesses in and of themselves, like my autism.
Let’s start with my heart attack. I had it at the age of 24. I know the cause of my heart attack. It is familial hypercholesterolemia. My genes are messed up. In fact, my genes are more messed up than the average person with my condition. How do I know this? Multiple people on my father’s side of the family are affected by this condition. However, I’m the only one in my family that had a heart attack due to familial hypercholesterolemia. I know from talking to my father that he does not need to take as many drugs as I do to treat his hypercholesterolemia, because his case is milder than mine.
Told ya! I’m a unicorn!
Shortly after my heart attack, I did have some healthcare workers — I don’t remember if they were doctors, or nurses — ask me point-blank:
Heart attack at 24? You were doing drugs, right?
Drugs? Nothing that would cause a heart attack. I was not sober yet, or maybe I had just become sober, so yes, I did get dead drunk sometimes, but this does not cause a heart attack. I did smoke when I was in my early teens, for maybe two years. This is definitely not the cause of a heart attack years later. I did pot a bit, but, again, this does not cause heart attacks. I did not do those drugs that are associated with heart attacks. This is not mere inference on my part. The doctors that have thoroughly examined my case completely agree with my assessment here.
Mind you, I don’t think it is a good idea to make addiction itself a moral failing, but society does categorize it as a moral failing. If you get addicted, it is your own damn fault. People like to be able to point to reasons as to why something bad happens to someone else. Maybe they can look at their own lives, note that they do not do the thing that supposedly caused misfortune, and breathe a sigh of relief. As I said above, however, I’m taking society’s stance at face value here.
So I was off to a great start with people already attributing to addiction the cause of my heart attack. I could correct them quickly, however. Still, in the years that followed, doctors continued to go down the route that moral failings were the source of my problems with cholesterol. I did have familial hypercholesterolemia, yes, but see, if I just did a bit more exercise, or watched my diet more, then my cholesterol would get back to normal. They could even point to all those people who did just that and their cholesterol came back to normal. If I did not get the same results, it was because I was lazy, or cheating, or some other thing that I was doing but did not disclose.
Guess what? I’m vegetarian. I also watch my cholesterol intake. Yet, the diet advice kept coming. The situation became so ridiculous that I once joked that with all the advice I got about diet, I might as well just get on bread and water. Additionally, once upon a time, I was exercising a solid two hours per day. I was doing cardio and weightlifting. This did exactly nothing. My cholesterol stayed high. My weight did not go down appreciably. In my mind, I was not failing at taking care of myself. However, in the eyes of my doctors and in the eyes of society at large, I was failing. So there was always a doubt. What if the doctors and the society were right, and I was just deluding myself when I thought I did everything I could?
What if my failure at controlling my cholesterol was, in fact, a moral failing?
Eventually, a miracle happened. The drugs manufacturers came up with a new class of drugs, the PCSK9 inhibitors. These drugs are made for people who have my genetic defect, and they annul it. Wonderful? I added a PCSK9 inhibitor to my atorvastatin and my zetia, and it brought my cholesterol back to normal range. What does this say about the doctors who kept harping on diet and exercise? I’m going to tell you what it says.
Those doctors were full of shit.
I have a genetic condition, but they kept harping on changing my behavior, when my behavior was pretty much already perfect. It also means that my doubts that maybe there was something more I should have done were misplaced. There was no moral failing on my part.
I spent a good deal of time on my heart attack in this article, but I think the demonstration was worth it. Somatically, some of us do not find within the textbook cases. Our bodies do not operate in the same way as the majority of the population. When doctors are faced with our conditions, they do not know what to do. When the general population is faced with our conditions, they attribute it to moral failings.
I’m a unicorn in another way. In the summer of 2022, I suddenly entered a deep depression. I was so depressed that even getting off the couch to go to the bathroom was a hurdle. I had never felt this way before, and I’ve not felt this way since. The situation was highly disturbing. I sought help from my doctors, but, as usual, they pulled out their Big Book of Medicine and did not find anything that could explain my situation.
I started looking at the side effects that the drugs I was taking at that time might have had on me. Eventually, I found a drug that had for extremely rare side effect, depression. I had been taking this drug for over a year without issues. Why would it start causing problems now? I figured that this was my only lead, and decided to stop taking this drug. It was an anti-reflux drug. Unfortunately, I had a rebound of my reflux, but I pushed through it. After a few days, my mood was back to normal.
I am absolutely certain that if someone had observed me from the outside, they would have called me lazy. How come I was previously able to do everything, but suddenly I couldn’t? Since even the doctors could not pinpoint my problem, the general public would have had to assume that my problem was laziness, pure and simple. My real problem was that there was a chemical imbalance in my head, but nobody knew this, not even me. I learned that this was the real problem only after I stopped taking my medicine.
We can also put my insomnia issues in the same bucket of mental conditions. I’ll remind you that I’ve tried just about all sleep medicines on the market. They did not work, or worked only for a little while. I had two sleep specialists on my case, one neurologist, and one psychologist. They had me do all the things that doctors recommend neurotypical people do. It did not work for me. I eventually sacked the both of them.
Again, the general public here too would be likely to attribute to moral failings what is most likely a peculiarity of my brain. If nothing worked, that’s because I did not do the work, or I was lazy, or there was some other cause that I hid from my sleep specialists. It definitely wasn’t because I’m a medical unicorn.
There’s moreover something similar to this going on when it comes to autism. Our traits are not seen as just different, they are moral failings. If you don’t look someone in the eye, then you are hiding something. If you do not want to go outside, due to noise sensitivity, you are just being a baby. If you do not perceive your wife’s glares, that’s because you deliberately ignore them. The cause cannot be that you are just neurodivergent.
Mentally, too, I am not made in the same way other people are. Doctors ignore this, and so does the general population.
The Obsolete Model
Let me repeat my formulation of this model:
Somatic and mental processes operate in different people in essentially the same way.
No, they do not. There is a subset of the population for which this saying is utterly bunk. I don’t know the size of this subset. However, it definitely exists. The health care system in the US has failed me in many ways, but one of the ways it has failed me is to insist that I’m a textbook case. I absolutely am not a textbook case. I’ve shown that I’m not a textbook case both somatically, and mentally.
Moreover, another issue here is that the general population, holding onto this model, projects its own mental processes on me, or onto other people with conditions like mine. If their high cholesterol is easily fixable with diet or exercise — and for a lot of people it is — then when someone else has high cholesterol, the problem must be that they did not diet or exercise adequately. It is a moral failure. If only they just found the fortitude to stick to their regimen, then the problem would be fixed.
Similarly, they project their own mental processes onto people who have mental conditions. If someone suffers depression due to a chemical imbalance, they attribute the depression to a deliberate decision on the part of the person. If someone does not see glares, they attribute this to a deliberate decision to ignore these glares. Maybe it is true that if those neurotypical people ignore someone’s glares, it is a deliberate decision on their part. It does not follow, however, that it is a deliberate decision on my part. Much like the person who is color-blind, I am constitutionally unable to respond to people’s glares, due to my autism.
Conclusion: No Moral Failings!
All of these manifestations of conditions that people attribute to moral failings, are not in fact caused by moral failings. They are caused by the fact that we do not actually operate essentially in the same way, somatically or mentally. Mentally, I am wired differently than the neurotypical majority. Somatically, I am also different from the majority.
Both doctors, and the general population, ought to recognize this diversity, and stop attributing to moral failings those conditions with afflicts us. To insist otherwise is to subject us to a mental strain that won’t do anything good for our mental state.