Nobody’s asking to be unwell

  • The just-world hypothesis helps the rich sleep easy

We all deserve good health, irrespective of the personal choices we make.

We’re inclined to believe that whatever misfortune we manage to evade, we do so by our hard work and wise decisions. And whatever calamity befalls another, is the result of their own irresponsible behavior.

This is neo-liberalism: the bizzare notion that who we are, is what we become. Hardworking people prosper, and idle people do not. Wise people make a lot of money, and irresponsible people do not. This falls in line with the just-world hypothesis, in which good actions always bring about good results. And if good fortune has evaded you, there must be something that you haven’t done right.

It’s a good notion to help the rich sleep easy at night. They live in luxury homes because they deserve them. A vast swatch of the population struggling with homelessness, food insecurity, and complete financial despair, brought this misery onto themselves. Or so the privileged choose to believe. This neoliberal mentality is fairly simply to demonstrate. Upper class sahib or memsaabs enjoy bonding over shared horror stories of their domestic help; of how lazy, unintelligent, or incompetent their house workers are. Isn’t that the reason we live up here, and they exist down there?

We view medical illness through the same lens. There’s a baseline assumption that anyone with unremitting medical problems is guilty of deliberate mismanagement or gross exaggeration. She’s depressed because she doesn’t pray enough and doesn’t socialize as much as she should. He’s diabetic because he’s been sneaking into the kitchen and eating sweets. The person with food allergies is probably just being fussy.

The neo-liberal notion that only the responsible among us ‘deserve’ good health, falls from the same ideological tree that brings us poverty, class discrimination, racism, and world hunger

Not us. We eat all the right foods. We exercise regularly, more or less. We believe firmly in Allah, and make the best decisions for our mind, body, and soul.

Wasim Akram, former cricketer, often speaks publicly of his shock on being first diagnosed with diabetes. Why him? A sportsman whose life is built around immense physical exertion and a healthy diet, probably believed that he didn’t deserve diabetes. But he got it anyway, and suddenly it wasn’t about what he had or hadn’t done. It was sheer misfortune.

Under neo-liberalism, the powerful often create circumstances that the rest of us are expected to tolerate like the unchangeable weather. They determine the price of tomatoes, the cost of your medicine, the condition of your roads if you’re lucky enough to have them, and the kind of facilities that are accessible to you. These are the circumstances you are not allowed to take into account for others. The only thing we must take into account for say a depressed person, is what he or she chooses to do under these unavoidable circumstances.

People struggling with weight problems are a particularly easy target. It’s simple, we say: they’re fat because they’re lazy and irresponsible. Their circumstances aren’t worth our consideration. The amount of high fructose corn syrup that they’re being fed, often because these foods are quite cheap and affordable, isn’t taken into account. Their genetic makeup, hormonal status and metabolic rates aren’t taken into account. Their inability to be satiated by a normal-sized meal isn’t considered. Their sitting jobs, that don’t allow enough time or energy for physical workouts, aren’t considered. Their psychological difficulties that encourage stress eating, are none of our business. Obese people owe us answers for the poor choices they make under these constraints. If we can be thin, so can they; never mind the unequal circumstances with which we must contend.

Among healthcare professionals, this bias is especially egregious. As a doctor, I’ve had access to staff-room conversations that occasionally left me baffled. It is not unusual for a doctor to feel personally attacked by a fat patient’s inability to lose weight despite counselling; or an alcoholic patient’s refusal to quit drinking. Such patients are grudgingly treated, with the assumption that treatment is pointless if the patient isn’t working hard enough to minimize health risks. These patients are also at risk of misdiagnosis. As an overweight person, I’ve never had an illness or injury that wasn’t attributed to my weight problem.

Nobody is trying to be unwell. We suffer through ailments either because of circumstances that are difficult to avoid; or due to misinformation that none of us choose to receive. The neo-liberal notion that only the responsible among us ‘deserve’ good health, falls from the same ideological tree that brings us poverty, class discrimination, racism, and world hunger.