Visiting the doctor typically requires exposing the body to all its faults and flaws. In a society that increasingly values self-control and bodily perfectness, being sick or even merely old can lead to feelings of shame and inadequacy.
Any problems or difficulties can seem like personal failings, specifically if they are linked to lifestyles, like problems related to weight, sexual behavior, smoking, addiction, alcohol or other substance use. People with these issues face being shamed for “unnecessarily” using health or special needs services, or welfare benefits.
This is all component of the contemporary political dogma of “personal responsibility”, which in turn is reinforced by doctors who are now supposed to use every consultation– despite its original function– to talk with a patient about how to take responsibility for a more healthy lifestyle.
What’s wrong with a discrediting?
For centuries, religions and laws have thrived on the fact that shame can be used to change or control people’s behavior. And we know from reality TV series that being shamed can inspire some people to alter their life or behavior to something healthier. But, for the most part, shame makes people want to withdraw and hide.
Research study shows that experiencing shame in medical settings can be harmful. In a study conducted by the University of California, San Diego (UCSD), approximately 50% of patients experienced one or more encounters with a doctor that left them ashamed. And feeling shame is deeply unpleasant, to the point that people will get to avoid it even if doing this is bad for them. For example, some people will avoid seeing their doctor. Others will lie about the state of their mental or physical health, or lie about their lifestyle. Shame may even make them hide a medical diagnosis from relatives or friends.
In the UCSD study, not all of the patients felt that being shamed had been actually a bad thing, but even those who believed the experience was useful were most likely to lie to their doctor in a subsequent visit. None of this is likely to benefit a person who is unhealthy, and it can lead to useless or inaccurate therapies being prescribed.
While health-related shame concerns to most people, its impact is even more serious for those who are part of a stigmatized or marginalized group. These groups struggle with chronic shame about their identity, often related to matters like poverty, race, sexuality or social class.
Even though chronic shame usually exists in the subconscious, it can have a direct effect on a person’s health, even when they have a healthy and balanced lifestyle. Chronic shame is associated with a range of conditions, like weight gain, addiction, depression, decreased immune function and heart disease.
Health shaming is expected to work by inducing people to change for the much better. But there is little evidence that it functions, or perhaps that people who are targeted are open to the type of transformation expected by health professionals. This kind of shaming denounces people for having the wrong desires or the wrong body. It makes them feel individual to blame for not changing their habits or lifestyle.
Making use of shaming and judgment by public health campaigns is not only morally ambiguous, it runs the risk of making people’s health even worse instead of encouraging them to live a better lifestyle.