Saturday, April 28, 2007
Shaming the Patient
Last week in my "Women and Literature" class, one of my students gave a presentation on Lucy Grealy's powerful memoir of disfigurement, Autobiography of a Face. From there, we moved naturally into a discussion of body image and physical beauty.
Many of the students, all too predictably, had struggled with appearance, especially around issues of weight. We were talking about shame, and I mentioned how often, at the hospital, I hear medical staff lecturing patients about how they have to stop smoking, stop drinking, or lose weight. My sense has always been that the patients already know this, and that by shaming the patients about these subjects, doctors and nurses just make it more difficult for them to seek medical help when they need it. It's a lot harder to go to the doctor when you're ashamed of yourself, especially when you expect the doctor to try to make you feel more ashamed.
This offhand comment on my part loosed a passionate flurry of anecdotes from my students, who -- it turned out -- had felt shamed by all kinds of people who were supposed to be helping them. There was a series of stories about people at health clubs doing body-fat or BMI measurements resulting in a label of "obese." My students had strong, articulate opinions about why BMI measurements are inherently faulty, especially for anyone whose weight is primarily bone or muscle, rather than fat.
One student, who used to be anorexic but has successfully overcome her eating disorder and attained a healthy weight, talked about how miserable she was when a personal trainer at a health club told her she was fat. ("Fat," by the way, is the last word I'd use to describe her.) "They'd taken a health history. They knew I'd had an eating disorder, but they still told me I was fat. How could they do that?"
One of the most disturbing stories came from a student who has a medical condition that makes her gain weight, and also makes it difficult or impossible for her to lose that weight even on a restricted diet. "So my doctor told me I had this condition, right? And then I went back the next month or whatever, and he told me I was too heavy. And I was like, 'But you know why I'm heavy! You diagnosed it!' And he told me I had to eat less, and I told him I'd hardly been eating anything, only one small meal a day. And he said, 'No, no, that can't be true, or you wouldn't weigh this much.'"
Medical professionals live in the same culture that has shaped their patients' attitudes towards food, health, and beauty, and no doubt many of them struggle with body-images issues of their own. But it seems to me that shaming patients violates the prime medical directive of "First, do no harm." Shaming patients about something they can't -- or shouldn't -- change is counter- productive at best, and simply cruel at worst. Even when change is medically mandated, there must be healthier ways to motivate patients to achieve it.