Frank Furedi

Our unhealthy obsession with sickness

Why is being ill now embraced as a positive part of the human experience?

We live in a world where illnesses are on the increase. The distinguishing feature of the twenty-first century is that health has become a dominant issue, both in our personal lives and in public life. It has become a highly politicised issue, too, and an increasingly important site of government intervention and policymaking. With every year that passes, we seem to spend more and more time and resources thinking about health and sickness. I think there are four possible reasons for this.

First, there is the imperative of medicalisation. When the concept of medicalisation was first formulated, in the late 1960s and early 1970s, it referred to a far narrower range of phenomena than is the case today - and it was linked to the actions of a small number of professionals rather than having the all-pervasive character that it does now.

Essentially, the term medicalisation means that problems we encounter in everyday life are reinterpreted as medical ones. So problems that might traditionally have been defined as existential - that is, the problems of existence - have a medical label attached to them. Today, it is difficult to think of any kind of human experience that doesn't come with a health warning or some kind of medical explanation.

It is not only the experience of pain or distress or disappointment or engagement with adversity that is medicalised and seen as potentially traumatic and stress-inducing; even human characteristics are medicalised now. Consider shyness. It is quite normal to be shy; there are many circumstances where many of us feel shy and awkward. Yet shyness is now referred to as 'social phobia'. And, of course, when a medical label is attached to shyness, it is only a matter of time before a pharmaceutical company comes up with a 'shyness pill'. Pop these pills, and you too can become the life and soul of the party!

One of my hobbies is to read press releases informing us of the existence of a new illness, the 'illness of the week', if you like. Recently I received one that said: 'Psychologists say that love sickness is a genuine disease and needs more awareness and diagnoses. Those little actions that are normally seen as the symptoms of the first flush of love - buying presents, waiting by the phone, or making an effort before a date - may actually be signs of a deep-rooted problem to come. Many people who suffer from love sickness cannot cope with the intensity of love and have been destabilised by falling in love or suffer on account of their love being unrequited….'

Of course, an intense passion can and does have an impact upon our bodies. But when even love can be seen as the harbinger of illness, what aspect of our lives can be said to be illness-free? What can we possibly do that will not apparently induce some sickness or syndrome? Medicalisation no longer knows any limits. It is so intrusive that it can impact on virtually any of our experiences, creating a situation where illness is increasingly perceived as normal.

This leads to my second point - there is now a presupposition that illness is as normal as health. Earlier theories of medicalisation still considered illness to be the exception; now, being ill is seen as a normal state, possibly even more normal than being healthy. We are all now seen as being potentially ill; that is the default state we live in today.

This can be glimpsed in the increasing use of the term 'wellness', with well men's clinics and well women's clinics. 'Wellness', another relatively recent concept, is a peculiar term. It presupposes that being well is not a natural or normal state. After all, there are no such things as 'sunshine clinics' or 'evening clincs'; such normal things do not normally need an institution attached to them. And why would you have to visit a wellness clinic if you were well, anyway? It makes little sense.

Wellness has become something you have to work on, something to aspire to and achieve. This reinforces the presupposition that not being well - or being ill - is the normal state. That is what our culture says to us now: you are not okay, you are not fine; you are potentially ill. The message seems to be that if you do not subscribe to this project of keeping well, you will revert to being ill.

In supermarkets, especially in middle-class neighbourhoods, buying food has become like conducting a scientific experiment. Individuals spend hours looking at how many carbohydrates there are, whether it's organic, natural, holistic. Spending time reading labels is one way of doing your bit to keep well.

Being potentially ill is now so prevalent that we have reached a situation where illness becomes a part of our identity, part of the human condition.

Some of us might not flaunt it, walking around saying, 'I've got a gum disease' or 'I've got a bad case of athlete's foot'. That doesn't sound very sexy, and is unlikely to go down well at the dinner table. But it has become acceptable to talk openly about other illnesses - to declare that you are a cancer survivor, or to flaunt a disability. As we normalise illness, our identity becomes inextricably linked to illness. So it is normal to be ill, and to be ill is normal.

The nature of illness changes when it becomes part of our identity. When we invest so much emotion in an illness, when it becomes such a large aspect of our lives through the illness metaphor, we start to embrace it - and it can be very difficult to let go of that part of our identity. This is why illness tends to become more durable and last longer. Sickness is no longer a temporary episode: it is something that, increasingly, afflicts one for life. You are scarred for life, with an indelible stamp on your personality. This can be seen in the idea of being a cancer survivor or some other kind of survivor; we are always, it seems, in remission. The illness remains part of us, and shapes our personality.

As this happens, illnesses start to acquire features that are no longer negative. In the past, illness was seen as a bad thing. Today you can read illness diaries in the Guardian and other newspapers and magazines. We often hear the phrase: 'I've learned so much about myself through my illness.' It becomes a pedagogic experience: 'I may have lost a leg and half my brain cells, but I'm learning so much from this extremely unique experience.' It's almost like going to university, something positive, to be embraced, with hundreds of books telling us how to make the most of the experience of sickness.

We are not simply making a virtue out of a necessity; rather we are consciously valuing illness. From a theoretical standpoint, we might view illness as the first order concept, and wellness as the second order concept. Wellness is subordinate, methodologically, to the state of being ill.

The third influence is today's cultural script, the cultural narrative that impacts on our lives, which increasingly uses health to make sense of the human experience. The more uncertainty we face, the more difficult we find it to make statements of moral purpose, the more ambiguous we feel about what is right and wrong, then the more comfortable we feel using the language of health to make sense of our lives. At a time of moral and existential uncertainty, health has become an important idiom through which to provide guidance to individuals.

This is now so prevalent that we no longer even notice when we are doing it. For example, we no longer tell teenagers that pre-marital sex is good or bad or sinful. Instead we say that pre-marital sex is a health risk. Sex education programmes teach that you will be emotionally traumatised if pressured into having sex and will be generally healthier if you stay at home and watch TV instead.

There are few clear moral guidelines that can direct our behaviour today; but we have become very good at using health to regulate people's lives in an intrusive and systematic fashion.

Even medicine and food have acquired moral connotations. So some drugs are said to be bad for the environment, while others, especially those made with a natural herb, are seen as being morally superior. Organic food is seen as 'good', not only in nutritional terms, but in moral terms. Junk food, on the other hand, is seen as evil.

If you look at the language that is used to discuss health and medicine, or obese people and their body shapes, it isn't just about health: we are making moral statements. A fat person is considered to have a serious moral problem, rather than simply a health one. As we become morally illiterate, we turn to health to save us from circumstances where we face a degree of moral or spiritual disorientation.

The fourth influence is the politicisation of health. Health has become a focus of incessant political activity. Politicians who have little by way of beliefs or passions, and don't know what to say to the public, are guaranteed a response if they say something health-related. Some also make a lot of money from the health issue, from pharmaceutical companies to alternative health shops to individual quacks selling their wares - all are in the business, essentially, of living of today's health-obsessed cultural sentiment.

Governments today do two things that I object to in particular. First they encourage introspection, telling us that unless men examine their testicles, unless we keep a check on our cholesterol level, then we are not being responsible citizens. You are letting down yourself, your wife, your kids, everybody. We are encouraged continually to worry about our health. As a consequence, public health initiatives have become, as far as I can tell, a threat to public health. Secondly, governments promote the value of health seeking. We are meant always to be seeking health for this or that condition. The primary effect of this, I believe, is to make us all feel more ill.

Here's a prediction - Western societies are not going to overcome the crisis of healthcare; it is beyond the realms of possibility. No matter what policies government pursue, or how much money they throw at the problem, even if they increase health expenditure fourfold, the problem will not go away. As long as the normalisation of illness remains culturally affirmed, more and more of us are likely to identify ourselves as sick, and will identify ourselves as sick for a growing period of time. The solution to this problem lies not in the area of policymaking, or even medicine, but in the cultural sphere.

First published on spiked, 23 March 2005