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Today is the first day of new resolutions for many – the turning over of a new leaf in the annual drive for self -improvement.
It can be quite a shock to the system after the Bacchanalian pursuits of recent weeks. And it may have an added sting for some.
Historians trace the tradition of New Year resolutions to Ancient Roman times, when citizens would make resolutions of good conduct to Janus, the two-faced deity for whom the month of January is named. Resolutions have psychological, cultural, and spiritual elements and are driven by our apparently ceaseless search for betterment.
Failure rates are high and this can be stigmatising
However, putative links to a two-faced deity are apt; making New Year health resolutions is a double-edged sword for some of us. Failure rates are high and this can be stigmatising.
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A colleague from the School of Medicine at Trinity College Dublin, Dr Barry Lyons (working with University of Exeter lecturer in medical humanities, Dr Luna Donezal) explores the issue of shame, stigma and medicine inThe Shame and Medicine Project. They feel that, in a culture that increasingly values self control and bodily perfection, being sick or even merely old can lead to feelings of shame and inadequacy.
“Any defects or difficulties can feel like personal failings, especially if they are linked to lifestyle, such as problems related to weight, sexual behaviour, smoking, addiction, alcohol or other substance use. People with these issues face being shamed for ‘unnecessarily’ using health or disability services, or welfare benefits,” they say.
What’s wrong with a bit of shaming? Haven’t we seen in reality TV series how being shamed can motivate some people to change their life or behaviour to something healthier? The problem is that for many people shame makes them want to withdraw and hide.
Research shows that experiencing shame in medical settings can be harmful. In a study conducted by the University of California, San Diego (UCSD), about 50 per cent 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 seek to avoid it even if doing so is bad for them. 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 diagnosis from family or friends.
“Health shaming is supposed to work by inducing people to change for the better. But there is little evidence that it works, or that people who are targeted are open to the kinds of transformation expected by health professionals,” Lyons and Donezal say.
“This kind of shaming stigmatises people for having the wrong desires or the wrong body. It makes them feel personally to blame for not changing their habits or lifestyle. The use of shaming and stigma by public health campaigns is not only morally dubious, it runs the risk of making people’s health worse rather than motivating them to live a better lifestyle.”
Unfortunately public health campaigns have form in this area. And a recent decision of the Hertfordshire clinical commissioning group must be one of the worst examples of shaming we have seen. It announced it would use a person’s body mass index (BMI) as a crude rationing tool by banning access to routine surgery until patients “improve their health”.
The time-frame for improving health was set at nine months for the obese; those with a BMI over 40 must reduce the number by 15 per cent over that time period, and those with a BMI over 30 are given a target of 10 per cent.
Since postponed, the initiative shows just how close we are to not just shaming people about their health but also using perceived lifestyle factors against them when providing basic medical services.
Meanwhile good luck with any personal resolutions.
And remember there is no shame in not succeeding.