Decoupling shame and disease
There are some symptoms of an illness that people are uncomfortable admitting they have. That is often just because of embarrassment; historically, some conditions have a social stigma attached based on the way an infection was acquired, or a patient is loath to talk about the area of the body involved.
Mental health disorders have seen strong movements toward destigmatizing and greater awareness and understanding in recent years. A wider range of sufferers telling their stories is helping to normalize the experience, make patients feel less vulnerable, afraid, and alone, reduce discrimination, and encourage more people to seek treatment.
Illnesses related to the reproductive organs and related to digestion and elimination tend to be difficult for people to talk about. There are widespread social taboos around open conversation relating to the genitals and the bowel, so it comes as no surprise that polite conversation around IBS, and cancers of the colon, cervix, and prostate has been limited in the past.
Efforts to change that attitude argue that a lack of awareness leads to negative outcomes for patients. Early stage patients are less likely to recognize and seek treatment for troubling symptoms; funding for research and better treatments is less likely to be granted, and patients suffer in isolation and shame for no reason. Raising awareness, improving research funding, early screening, and treatments, and helping people feel more comfortable sharing their struggles is key to improving human outcomes.
The taboos around reference to reproduction and reproductive disorders contributes to the growing public health crisis of sexually transmitted diseases (STDs) in America. It may seem strange, since reference to and visibility of sex in the popular media is widespread, but people are uncomfortable talking about problems related to STDs, and lack of awareness, misinformation, and discomfort are causing STDs to spread at unprecedented rates.
There are multiple causes, of course. Sex education is perfunctory and is in the rather distant past for many sexually active adults. A lack of clarity around prophylactic efficacy is also at fault. People may feel that they are being diligent by using oral or internal birth control or condoms but often forget that protection against unwanted pregnancy is not effective against sexually transmitted diseases. In other cases, alternative forms of sexual activity that are unlikely to result in pregnancy are still a risk factor for STDs. Skin to skin contact and fluid transference in any variation runs a risk of infection.
Adding to the complexity is the reality that troubling symptoms may not crop up immediately after infection and changing sexual partners can result in unwitting transmission of disease. Asymptomatic carriers are one risk. Shame around seeking treatment for symptoms is another challenge. People are uncomfortable admitting to problems “down below” and may avoid seeing a doctor or acknowledging even to themselves or their partners that something’s wrong.
In either case, greater awareness and comfort around discussing STDs is key to fighting back against the spread of the illnesses. Sexual partners need to be comfortable bringing up the topic and asking about each other’s sexual histories and wellness. STD testing needs to become a regular part of healthcare and self-care. Centers around the country are available and offering easy access to STD testing centers is one step in the right direction. Since it’s possible to contract an STD and be a carrier without experiencing symptoms, all sexually active adults should regularly be tested, seek treatment, and share their results with sexual partners.
Destigmatizing STDs could help reduce awkwardness and resistance to proactively dealing with the problem. In the past, seeking treatment or bringing up the topic might have been taken as an accusation or admission of guilt. In the current cultural moment, the public health crisis is so widespread that STDs are being passed on to infants and are a simple fact of life for those engaged in multiple sexual interactions with different partners.
Communicable diseases are another problematic group. People fear that which could harm them, and a fear of disease can lead to a fear of those suffering from that disease. Improved treatments help to undercut that fear at the root, but there is still a place for destigmatizing those with communicable diseases and helping them to integrate with society in safe ways to keep them from feeling isolated and even rejected.
Shame needs to be decoupled from disease, and the question of fault or responsibility closed outside of the research lab to prevent patients from suffering from unnecessarily negative outcomes and social isolation. Greater comfort when discussing disease and symptoms without judgment is a practical and meaningful step toward improving patient outcomes.