The line between health and illness, then, can be somewhat arbitrary, and it is here that the real problems begin because it is not obvious whose responsibility health is. In our society we do not blame people for being ill – even if they themselves nave played a part in the onset of illness. We have more ambivalent feelings when it comes to VD and suicide attempts but even then most people do not come down too harshly on the ‘ill’ person.
Although we as a culture do not blame individuals for their illness we do expect them to do simple things to help themselves, and most of us think that ill people should co-operate with doctors to make themselves better. When looked at from a purist’s point of view, much illness is preventable-indeed this book is about what we as individuals can take responsibility for-yet as a culture we have not yet arrived at the stage where we condemn people who do not co-operate, though there are signs that this is starting to happen with smoking-related diseases. Indeed, the anti-smoking campaign in certain western countries has taken something of a dramatic turn recently. But treating smokers as if they were lepers may not be the answer. It could, arguably, push those who would have smoked into other equally dangerous pursuits which fulfill their needs in the circumstances. In the final analysis everyone has the right to kill themselves in the way they choose. The truth is that most will almost certainly do so irrespective of government regulations and social prohibitions. Perhaps the most influential work about health and the lexicalization of modern society is Ivan Illich’s book Medical Nemesis: The Expropriation of Health. In Illich’s view:
In a morbid society the environment is so rearranged that for most of the time most people lose their power and will for self-sufficiency and finally cease to believe that autonomous action is feasible. The result is a morbid society that demands universal medicalisation and a medical establishment that certifies universal morbidity. In a morbid society the belief prevails that defined and diagnosed ill health is infinitely preferable to any other form of negative label. It is better than criminal or political deviance, better than laziness, better than self-chosen absence from work. More and more people subconsciously know that they are sick and tired of their jobs and of their leisure activities, but they want to be lied to and told that physical illness relieves them of social responsibilities. They want their doctor to act as lawyer and priest. As a lawyer, the doctor exempts the patient from his normal duties and enables him to cash in on the insurance fund he was forced to build. As a priest the doctor becomes an accomplice for the patient, creating the myth that he is an innocent victim of biological mechanisms rather than a lazy, greedy or envious deserter of a social struggle for control over the tools of production. Social life becomes a give and take of therapy, medical, psychiatric, pedagogic or genetic.
In a sense we all control our own health-at least to some extent. We decide on certain health activities (even if they are as simple as cleaning our teeth) and avoid dangerous or illness-promoting situations (by driving carefully, for example), but the level at which we do this depends on all kinds of things, such as our perception of the amount of control we have over our surroundings (and thus our health), our personalities and our social class. Because class is a factor we as a society can influence, perhaps we should look at it in more detail because it has important implications for preventing disease.
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