EXPLAINING ILLNESS ACROSS HISTORY

Throughout history, people have feared illness. To relieve their anxiety and make the world seem less frightening, many have sought explanations for why illness occurs and why it strikes some rather than others. Most often, these explana- tions defined illness as a deserved punishment for sinful or foolish behaviors and blamed individuals for their own illnesses. Such explanations provide reassurance by reinforcing people’s belief in a “just world” in which punishment falls only on the guilty. For example, both the Jewish and Christian Bibles describe leprosy as punishment for sin. As a result, throughout the Middle Ages, Christian society required anyone diagnosed with leprosy to participate in a special mass for the dead, in which a priest would shovel dirt on the individual’s feet to symbolize his or her civil and religious death. From then on, the indi- vidual was legally prohibited from entering public gathering places, washing in springs or streams, drinking from another’s cup, wearing anything other than the special “leper’s dress,” touching anything before buying it, and so on.

By the early 19th century, prescientific ideas about illness had begun to erode as the idea grew—especially among cultural elites—that scientific principles con- trolled the natural order. According to the new scientific thinking, illness occurred when biological forces combined with personal susceptibility. Lacking a concept of germs, doctors argued that illness occurred when persons whose constitutions were naturally weak or had been weakened by unhealthy behaviors came into contact with dangerous miasma, or air “corrupted” by foul odors and fumes. As a result, these new theories blamed illness on unhealthy behavior rather than on immoral behavior.

As the history of cholera shows, however, these new ideas still allowed the healthy to blame the ill for their illnesses. Cholera first appeared in the Western world around 1830, killing its victims suddenly and horrifyingly through overwhelming dehydration brought on by uncontrollable diarrhea and vomiting. Cholera is caused by waterborne bacteria generally transmitted when human wastes contaminate food or drinking water. It most often strikes poor persons because they are the most likely to lack clean water and to be weakened by insufficient food, clothing, or shelter.

To explain why cholera had struck and why it struck the poor especially hard, early 19th-century doctors asserted that cholera could attack only individuals who had weakened their bodies through improper living. According to this theory, the poor caused their own illnesses, first by lacking the initiative required to escape poverty and then by choosing to eat an unhealthy diet, live in dirty conditions, or drink too much alcohol. Thus, for example, the New York City medical council concluded in 1832 that “the disease in the city is confined to the imprudent, the intemperate, and to those who injure themselves by taking improper medicines”. Conversely, doctors (and their wealthy patrons) assumed that wealthy persons would become ill only through gluttony, greed, or by “innocently” inhaling particularly noxious air. This theory of illness allowed the upper classes to adopt the new scientific explanations for illness while retaining older moralistic assumptions about ill people and avoid- ing any responsibility to aid the poor or the ill. In sum, instead of believing that immorality directly caused illness, people now believed that immorality left one susceptible to illness.

Despite the tremendous growth in medical knowledge about illness during the past 200 years, popular explanations for illness have remained remarkably sta- ble. Many religious authorities continue to blame illness on sin, and many secular and medical authorities continue to blame illness on poorly chosen (it not nec- essarily sinful) behaviors and attitudes. Parents still act as if colds are caused by playing in the rain rather than exposure to viruses, and public health authorities more often focus on urging people to exercise than on addressing the conditions (such as dangerous neighborhoods, lack of gyms, or the need to hold down two jobs) that keep people from exercising. Similarly, in her hugely popular book The Secret, author Rhonda Byrne argues that individuals “attract” health, wealth, sickness, or poverty to themselves simply by thinking about these conditions. In sum, theories of illness that focus on individual responsibility continue to reinforce existing social arrangements and help us justify our tendency to reject, mistreat, or simply ignore those who are ill.