Teresa Ingleby explores the intersections of pathology and personhood in the 21st century, discussing neoliberal constructions of health, agency, and identity in self-accounts of sickness.
Historically, sickness and morality have been causally entwined. Predating the scientific advances of Louis Pasteur’s ‘germ theory’ (1861) and Ignaz Semmelweis’s ‘hand hygiene’ (1827), the physicians of medieval Christendom prescribed flagellation, prayer, fasting, and ritual as remedies for ill health (Mark: 2020). Under the assumption that the illness was caused by divine fury, suffering was believed to be a consequence of sin, and disease was conceptualised as a moral index of character (Krzysztofik: 2022). Plague struck the wicked, disfigurement marked the villain, and the sinner and the leprous were one and the same: ‘surely he will save you from the fowler’s snare and from the deadly pestilence…’, reads Psalm 91. ‘You will only observe with your eyes and see the punishment of the wicked’.
Culturally we have moved beyond theological explanations of illness in terms of divine punishment and demonic possession. However, the notion of sickness as a personal and moral failure remains deeply engrained. Diabetes, obesity, coronary heart disease and alcoholism, the so called ‘diseases of affluence’ that dominate Western society (Ezzati: 2005), are repeatedly stigmatised and ridiculed. Indeed, the social conflation of sickness with individual failure is an indisputably contemporary issue, as recently shown by the media coverage and press briefings of the Coronavirus pandemic. ‘Lose weight: Save the NHS’ (Brookes: 2022) reads a tabloid published in the summer of 2020, displacing government responsibility onto the shoulders of the individual.
In this short piece of writing, I explore the influence that our current culture of hyper-responsibility has on personal conceptions of health, agency, and moral identity. To do so, I look at two studies. A project initiated by Dr Michael Ward, senior lecturer in Social Science at Swansea University, and an interactive exhibition that was held at the Wellcome Institute, titled ‘Do You Consider Yourself Healthy’. Both studies demonstrate that within the purview of the 21st century, to be ill is to be guilty: under neoliberal decree the ‘sick role’ masquerades as personal condemnation.
“Just don’t get sick”: Covid 19 and the cult of the individual
The ‘Neoliberal Age’ in Britain ostensibly blankets the late 20th century onwards. In the Guardian in 2017, Dani Rodrick refers to the political philosophy of neoliberalism and its ‘usual prescriptions: always more markets, always less government’ (Rodrick: 2017). Privatization, diminished public spending, deregulation and financialization, he clarifies, are all characteristic of the neoliberal agenda. Epitomised by the former Conservative Prime Minister Margaret Thatcher’s assertion that ‘there is no such thing as society’ (Thatcher: 1987), neoliberal governments push the ideology of individualism and self-responsibility.
The influence of neoliberalism stretches beyond the economic landscape into the sociological setting. In an article tracing the psychological consequences of neoliberal policy on food bank users, Swales et al (2020) unpack the ‘superegoic imperatives’ of the agenda. The emphasis on self-sufficiency, and thus the stigma attached to seeking assistance, results in individuals experiencing guilt and shame for ‘failing to meet the standard promoted’. This latter sentiment is not only applicable to poverty but also to sickness. Neoliberal ideology not only limits access to healthcare but enforces a shift in which illness is reconstructed as a personal rather than cultural problem. It produces a privatisation in multiple senses.
In her meditation on neoliberal health care during the pandemic, Jane Shulma recounts an observation she first shared on Facebook:
‘COVID-19 will be a fantastically tragic model to explain to students the neoliberal agenda of putting onus on the individual to obfuscate the reality that most of the horrors of our time are neoliberal-made disasters… we swallow the absurd dominant discourse because we have to, i.e., ‘it’s your responsibility to not catch a highly contagious virus’ (Shulma: 2020).
Shulma argues that the government framing of the virus was an attempt to deliberately shift the object of medical attention away from the failures of policy and onto the shortcomings of the individual. Vision statements underscoring press meetings such as ‘Stay home > Protect the NHS > Save lives’ served to further fortify a culture of hyper-responsibility in a time of national crisis.
The ‘CoronaDiaries’
Keeping the above in mind, in an ironically neoliberal move, I turn away from national policy and hone in on the individual.
In March 2020, Dr Michael Ward piloted the ‘CoronaDiaries’, a project compiling first-hand experiences of 185 participants during the Covid-19 pandemic in Britain. In these entries, the psychological consequences of cultivating individual blame and stigmatising infection are prevalent.
Days before the legal imposition of lockdown, one contributor (Sam) provides an account of interacting with an electrician:
‘My god, what a resplendent idiot he was. Diabetic, with cancer, and a heart problem, but fully on the “coronavirus is being whipped up to scare people” bandwagon of malignant scrotes…after I pointed out that he can die however he damn well pleases…but he’s also going to kill other people, he seemed to change his tone.’ (Ward: 2020)
Another participant relayed her distress at having to avoid her daughters who had rushed home from university: ‘It’s horrible not being able to hug them. They think I’m being distant but I’m just trying to protect us all’. Both extracts demonstrate how the individual was being ascribed an unprecedented amount of agency at a time when they have never felt more out of control: ‘maybe the fact nobody has any control over anything right now has been wearing me down without realising it’ (Sam).
What is clear from Ward’s study, is that the social dimensions of illness were keenly felt during lockdown. The affiliation of transmission and murder (‘he’s going to kill other people’) dominates the subtext of the collected diaries. Participants agonise over their new, precarious positions as they teeter ambiguously between protector and offender (‘I felt guilty any time anyone walked past me’). Sickness is treated as evidence of perpetration: ‘we’ve just had the results of my positive covid test’, laments Jamie-Leigh towards the end of her entry, ‘all I can do is feel overwhelmed by anger and guilt’.
Conceptualising wellness in the 21st century
The association made between sickness, guilt, and individual blame is by no means unique to coronavirus infections. Documenting lived experiences of care and chronic illness in a 2021 installation at the Wellcome Collection, artist Oreet Ashery invited members of the public to answer a single question: ‘Do you consider yourself healthy?’
The resulting 150 responses provide valuable insight into contemporary conceptions of health and wellbeing.
Four perspectives stand out:
1) Health as a collective condition beyond individual control: ‘I can’t be healthy; the body is a component of a sick society’.
2) Health being predominantly biologically determined: ‘I’m worried about my genetic susceptibility to X’.
3) Health positively defined in terms of personal actions: ‘I’m healthy because I do X’, ‘I’m as healthy as I can be in spite of Y’.
4) Health negatively defined in terms of personal shortcomings: ‘I could be healthier’, ‘I should do X’, ‘I should stop Y’.
Different demographics dominated different categories. The more positive, autonomous position of point 3 was largely expressed by children and sufferers of chronic illness. For these people, sickness and health were not mutually exclusive. One speaker with Multiple Sclerosis (MS), for example, responded to Ashery’s question with an unequivocal ‘yes’. Another separated their diagnosis from their self-perception, and in doing so transformed what it means to be ‘healthy’: ‘I was diagnosed with lupus eight years ago, so that’s a complicated question. Healthy has come to mean something different.’ Rather than being bound to medical diagnosis, the noun ‘health’ was modified into a verb, defined through action: ‘I exercise, I eat well’.
In contrast, participants who had few medical conditions tended to report nagging suspicions of ill-health and looming disease: ‘technically, technically I am but I don’t feel healthy’. These individuals also expressed great levels of personal dissatisfaction: ‘I’m not as healthy as I could be’; ‘I could do more and would like to stop drinking Pepsi Max’. In these examples, the more positive perspective outlined above- I’m healthy because I do X’ or ‘in spite of Y’- was inverted. Health was similarly conceived of as being conditional and controllable, but rather than being praised for the body’s condition, the self was blamed.
The neoliberal identification of sickness with individual responsibility underscores Ashery’s collection of interviews. For a number of objectively ‘healthy’ participants, fear of getting sick is bound up with the politically promoted fear of personal failure.
Conclusion
In both Ward and Ashery’s collections, sickness, guilt, and self-blame are seldom far apart. For a significant number of contributors, being ‘healthy’ is inextricable from self-worth. The healthy body is not only considered successful (through self-responsibility) but, more crucially, innocent. Harking back to the historical matrimony of disease and sin, neoliberalism, it seems, unrobes the hyper-individualism of medieval aetiology and redresses it in contemporary colours.
About the author
Teresa has a BA in English Literature and Language from the University of Oxford. She graduated last summer and is interested in further exploring interdisciplinary approaches to health and wellbeing. She can be found on Twitter @teresaingleby.
References
Ashery, Oreet. 2021. ‘Do you consider yourself healthy?’ The Wellcome Collection, Do you consider yourself healthy? | Wellcome Collection
Brookes, Gavin. 2022. “‘Lose Weight, save the NHS’: Discourses of Obesity in Press Coverage of Covid-19.” Critical Discourse Studies 19:6: 629-647. https://doi.org/10.1080/17405904.2021.1933116.
Ezzati M, Vander Hoorn S, Lawes CM, Leach R, James WP, Lopez AD, Rodgers A, Murray CJ. 2005. “Rethinking the “diseases of affluence” paradigm: global patterns of nutritional risks in relation to economic development”. PLOS Medicine. 2 (5): e133. doi:10.1371/journal.pmed.0020133.
Holy Bible, “Psalm 91.” New International Version 2011. Biblegateway.Com. Biblica, Inc, https://www.biblegateway.com/passage/?search=Psalm%2091&version=NIV.
Krzysztofik M. 2022. ‘The Image of Disease in Religious, Medical-Astrological and Social Discourses: Old Polish Literature as an Example of Early Modern European Mentality’. Journal of religion and health, 61(4), 3340–3349. https://doi.org/10.1007/s10943-020-01056-x
Mark, J. 2020. ‘Medieval Cures for the Black Death’ World History Encyclopaedia. Medieval Cures for the Black Death – World History Encyclopedia
Rodrick, D. 2017. ‘The Fatal Flaws of Neoliberalism: it’s bad economics’ The Guardian. The fatal flaw of neoliberalism: it’s bad economics | Economics | The Guardian
Shulma, J. 2020. “Just Don’t Get sick”: Neoliberal Health Care in the Pandemic’, Centre for Research in Cultural Studies, The University of Winnipeg. “Just Don’t Get Sick:” Neoliberal Health Care in the Pandemic | Centre for Research in Cultural Studies | The University of Winnipeg (uwinnipeg.ca)
Swales, S, M Nuxoll, and C Tucker. 2020. “Nuxoll M, Tucker C. Neoliberalism, Guilt, Shame and Stigma: A Lacanian Discourse Analysis of Food Insecurity.” Journal of Community and Applied Social Psychology 30: 673-687. https://doi.org/ 10.1002/casp.2475
Thatcher, Margaret. 1987. “Interview for Women’s Own.” derived from Margaretthatcher.org. Margaret Thatcher Foundation, n.d. Interview for Woman’s Own (“no such thing as society”) | Margaret Thatcher Foundation
Ward, Michael. 2020. ‘CoronaDiaries’ Swansea University Digital Collections. CoronaDiaries · Corona Diaries · Swansea University Digital Collections
