All posts by s.e. smith

About s.e. smith

s.e. smith is a recalcitrant, grumpy person with disabilities who enjoys riling people up, talking about language, tearing apart poor science reporting, and chasing cats around the house with squeaky mice in hand. Ou personal website can be found at this ain't livin'.

Ableist Word Profile: Idiot

Welcome to Ableist Word Profile, a (probably intermittent) series in which staffers will profile various ableist words, talk about how they are used, and talk about how to stop using them. Ableism is not feminism, so it’s important to talk about how to eradicate ableist language from our vocabularies. This post is marked 101, which means that the comments section is open to 101 questions and discussion. Please note that this post contains ableist language used for the purpose of discussion and criticism; you can get an idea from the title of the kind of ableist language which is going to be included in the discussion, and if that type of language is upsetting or triggering for you, you may want to skip this post.

Following on yesterday’s profile of “cretin,” I thought I’d tackle “idiot” this morning. This is another word which is commonly used to denote low intelligence, and it’s also a word which many people are unaware is ableist in nature. “Idiot” is also closely tied to ideas about intellectual worth, and attitudes that people with intelligence which does not meet an arbitrary standard are somehow lesser human beings.

“Idiot” is a very old word. It’s derived from Latin and Greek roots for “ordinary person,” which came to be used to refer to unskilled labourers, and eventually to people who were ignorant or who lacked education. Interestingly, the word also has roots in lack of civic participation; in Ancient Greece, participation in society and the democratic process was a virtue, and people who did not engage with society were regarded as suspect. This attitude is mirrored in some branches of the modern activist movement; people who don’t engage in the “right kind” of activism are sometimes referred to as “idiots,” for example.

This word appears to have entered the English language around 1300, in reference to people who lacked reasoning skills and were poorly, if at all, educated. In the 1800s, “idiot” acquired a new nuance, as it started to be used as a diagnostic term in reference to people with severe developmental delays. An “idiot” medically speaking was someone with a “mental age level” of less than three years, or an IQ under 30. It was, quite literally, a diagnosis of mental inferiority, as decided by the medical community. I would like to point out, for the record, that people with this diagnosis were subjected to indignities like institutionalization and forcible sterilization, with no less a figure than Oliver Wendell Holmes once saying “three generations of idiots is enough” when defending the forcible sterilization of Carrie Buck in Buck v. Bell in 1927.

And before you leap to say “well, that’s old,” I would like to point out that the word “idiot” was used in a diagnostic and medical context in my home state of California as recently as 2007, when the penal code was finally amended to remove this word from the law books. This illustrates that “idiot” had a dual and widely accepted usage through the 19th and much of the 20th century; laypeople used it to refer to anyone they believed was lacking intelligence, while members of the medical community used it as a diagnostic term.

So, we can see that “idiot” is ableist from several perspectives. It’s yet another word used to denigrate lack of intelligence, and it’s a word with a history as a specific diagnostic term. So, what can we use as an alternative to “idiot”?

Many of the ableist words which reference “inferior intelligence” are actually used in settings when people want to say that someone is being thoughtless, reckless, irresponsible, or rude. So, those are all good words to use as alternatives to “idiot.” One of the things about exploring ableist language is that it forces us to think about the actual meaning of a sentence; when you find yourself wanting to refer to someone as an “idiot” or something as “idiotic,” pause and think about the meaning of what you are trying to say.

“Idiot” is also used in rhetoric to talk about someone who is uninformed about an issue or someone who is unaware of the complexities of a topic. In this sense, a value judgment is being made about someone’s intelligence on the basis of the fact that this person is not familiar with the fine and nuanced details of everything on Earth. It’s worth noting that we all came into this world with no knowledge of anything, and that all of us were uninformed about topics we now consider ourselves knowledgeable about at some point. In this case, rather than using “idiot,” a better word choice might simply be “uninformed.”

Ableist Word Profile: Cretin

Read a Czech translation of this post, prepared by Vera!

Welcome to Ableist Word Profile, a (probably intermittent) series in which staffers will profile various ableist words, talk about how they are used, and talk about how to stop using them. Ableism is not feminism, so it’s important to talk about how to eradicate ableist language from our vocabularies. This post is marked 101, which means that the comments section is open to 101 questions and discussion. Please note that this post contains ableist language used for the purpose of discussion and criticism; you can get an idea from the title of the kind of ableist language which is going to be included in the discussion, and if that type of language is upsetting or triggering for you, you may want to skip this post.

The word “cretin” is often used to describe someone of limited intelligence, often with the added connotation of being irritating. “That cretin didn’t change the brake pads properly, and now I have to resurface the rotors!” “That Bobby in accounting is such a mouthbreathing cretin!”

“Cretin” is an ableist word. It’s one which shouldn’t be used by people who consider themselves allies to people with disabilities. Many of the synonyms the dictionary so helpfully provides (idiot, moron, mongoloid, imbecile, fool, half-wit for example), are also ableist.

Let’s talk about the word origins of “cretin” first, shall we? The first recorded use of the word dates to the late 1700s, when it was integrated into English from an Alpine French word, crestin, in the sense of “a dwarfed and deformed idiot.” (Incidentally, who wants to play “spot the ableist language” in that dictionary entry?) The word appears to have its origins in the Vulgate Latin word for “Christian,” which may be, depending on which authority you believe, a reference to the suffering of Christ, the humanity of people with disabilities, or a fetishization of innocence, the idea being that people with disabilities can’t sin, and are therefore Christlike. Other authorities suggest that this etymology is wrong, and that the word may be derived from the same root for “creature.” No matter which etymology you prefer, the roots of this word are clearly rooted in ableist thought.

It’s not really clear which medical condition the Alpine French were describing, but English speakers used it to refer to people with hypothyroidism or iodine deficiencies, two problems which were apparently common in the French Alps. Cretinism, as it came to be known, was associated by members of the public with low intelligence, and as a result, people started using the word to refer to people whom they thought were unintelligent, even when those individuals did not have the medical problems the word was originally coined to describe.

By the 20th century, the medical community was abandoning this word to describe an actual medical condition, since it had acquired such a pejorative connotation, although the word can sometimes be seen in some medical texts. The continued use of “cretin” in English speaks to the ingrained ableism in the language, and also to ideas about intelligence and elitism which are very common in many people. The judgment of intelligence as a value which can be quantified, and the idea that people with lesser degrees of “intelligence” under objective testing are unworthy, are distressingly common. (They’re going to come up again and again in this series, too.)

So, what can you use instead of “cretin”?

Well, the first thing you need to do is examine the word the setting is used in. Let’s take the two examples above.

In the first example, our speaker is bemoaning the actions of a careless mechanic who failed to do a job properly. Surely, in this case, words such as “thoughtless,” “careless,” or perhaps “poorly trained” would be a better fit. “That thoughtless mechanic didn’t change the brake pads properly, and now I have to resurface the rotors!”

In the second example, the context is a bit unclear. Not knowing the speaker, we don’t know if Bob from accounting works slowly, is a bit pedantic when it comes to processing reimbursement claims, or what. It becomes necessary to examine what it is about Bob which so infuriates the speaker. That examination may uncover other words which would be not only more appropriate, but more accurate.


I happened to be standing in line at Big National Chain Bank the other day when all sorts of things started going awry for the tellers. First, one had her computer crash. Then, the other had what seemed to be some sort of problem with a cashier’s check which involved a lot of furtive muttering and consultations with the other tellers. The third teller had a customer who appeared to be depositing approximately eight million checks into four million different accounts.

So, I realized I was going to be there awhile. The people in the line behind me (including the man who first tried to cut in front of me because he “didn’t see me,” because I guess being fat really does make you invisible), started grumbling and grousing and complaining. Which always seems odd to me. I mean, sure, no one wants to stand in line at the bank, really, but I fail to see how moaning about it is really going to help.

And, while I was standing there, I had a sudden flash of awareness. I thought, “man, this would really be uncomfortable and unpleasant for someone with a disability like chronic fatigue syndrome.”

See, the thing is, the bank is totally accessible in terms of the letter of the law. The doors are wide and ramped, there’s a counter low enough for customers in wheelchairs to use. But I started looking around as I was standing in line, and I realized that the bank actually has a lot of accessibility problems. Like no chairs in or around the area for the line for people with disabilities to use while they are waiting, which means that someone with a condition like fibromyalgia or chronic fatigue might walk in the door, see the long line, realize that they will have to stand in that line for a prolonged period of time, and either grit their teeth and suffer because they need to get their business done that day, or leave, making the effort of the trip a total waste of time and energy.

Like a floor which is kind of rough, and while probably navigable with a wheelchair, might catch a walker, a cane, or an unwary foot. As if the flooring isn’t bad enough, there are random rugs which also represent a tripping hazard. And that low counter with space for a wheelchair? There are two chairs crammed right in front of it, which means that a wheelchair user can’t just roll right on up to it and get down to business.

And what about the narrow doors into the carrels the bank uses for private business? I’m not positive a wheelchair would fit through one of those, and once inside, it would be difficult to maneuver. And, of course, there are chairs wedged every which way from sideways in all of those carrels, and the chairs would need to be moved to accommodate a wheelchair user, someone with a walker, a scooter user, someone on a ventilator, someone who needs supplementary oxygen.

It was an important flash of insight.I’ve always been interested in accessibility, but it was only recently that I started making the leap into examining spaces to assess them for accessibility from an actual usability perspective, not just a legal one. And, from there, to think beyond “wheelchair user” and to start thinking about people with other disabilities. Disabilities I would not have thought about if people weren’t writing about them and sharing their experiences with me.

And, you know, as a society, we are doing a pretty crappy job when it comes to making even basic accommodations for people with disabilities. Like, say, making sure that sidewalks don’t randomly end. Or making doors wide enough. Or keeping bathrooms on the ground floor so that people can access them. Or making counters low enough for wheelchair users, older adults with severely bent spines who cannot straighten up, or people with dwarfism. Putting up grab rails where they are supposed to be. We can’t even comply with the law when it comes to accommodation, and the law is woefully shortsighted.

Accommodation is not just about complying with the law. It’s something that needs to be thought about from a lot of different angles when designing and laying out spaces. Clearly, this thinking is not going on, and this means that people with disabilities are forced to ask for accommodation. Sometimes, they are forced to ask a business to just comply with the law, and they aren’t even requesting that people think outside of their own bodies for a moment and consider ways in which they could make the lives of others easier. People with disabilities should not have to be asking business owners to do this. Business owners and members of society should be able to figure out how to make spaces accessible; they should be able to evaluate a space and ask, not only “is this space legally compliant,” but “how would this space be to use, as a person with disabilities?”

We need, in short, more awareness.

Originally posted at this ain’t livin’.

Devaluing the Disabled Body

Two separate posts about disability issues have had me thinking lately about the way in which our society systematically devalues the disabled body. One, on Feministe, about a casting call for someone to play a disabled character, and another, on Hoyden About Town, about a shameful chapter in the right to die debate. The very word “disabled” is devaluing, although as Amandaw at Three Rivers Fog has pointed out, it’s difficult to come up with less problematic language; the way our language is structured, people who are ablebodied and neurotypical are the “normal” and people who are not are “abnormal,” with the implication that they are also lesser.

One of the problems with having discussions about disability issues is that people with disabilities are not out there, in public, in the same way that other subsets of the human community are. This is because of the fact that society has devalued people with disabilities, creating a vicious cycle in which people with disabilities are erased so that we can feel comfortable continuing to marginalize them. The assumption often seems to be that life with a disability is not worth living, and therefore any measures taken to promote quality of life or community engagement are useless (much like disabled bodies themselves, in the framework of a society which fears disability).

As a society, we have not placed a high emphasis on accessibility. We have not created a society which is friendly to people with disabilities, which as a consequence makes it very difficult for them to engage with the world of the ablebodied; even people with economic clout who have access to numerous tools and resources face struggles with simple tasks like navigating a street, because society is primarily structured for the benefit of the ablebodied. For people living in poverty, or people of colour, it’s even more difficult to get basic support, and this can lead to situations in which people are trapped in homes or residential treatment facilities. Not because they are disabled, but because society has refused, in any way, shape, or form, to accommodate them or to recognize that they are human beings who have a right to be part of our society.

I regularly see business owners complaining about ADA regulations and other measures which are designed to make the world more easy for people to navigate when they can’t walk, because apparently, if you can’t walk, you don’t deserve to be an active member of society. I regularly see people with disabilities marginalized everywhere from public transportation to traffic law; it is viewed as unreasonable that people using mobility aids and other assistive devices should expect to be able to negotiate the street, ride a bus, or even safely navigate the side of the road. I regularly see people with disabilities marginalized in careless language, from the President of the United States making derisive comments about the Special Olympics to friends who routinely inform me that things they don’t like are “lame.” And for people who are bedridden or unable to leave their homes for other disability-related reasons, there is nary a hint of suggestion that support could be provided to make life more enjoyable, more full, more rich. After all, if you’re bedridden, what do you have to live for?

This is a society in which the lives of people with disabilities are not highly valued. The post on Hoyden About Town just about broke my heart, with the description of a disabled man who has been marginalized and forced into a position of such utter misery that he would rather die than go on living. He doesn’t want to die because he’s disabled. He wants to die because his living circumstances are deplorable, because he’s trapped in a bed in front of a television set. Apparently, actually providing him with things which would improve his quality of life is so pointless that it would be better to just let him rot. The ruling to allow him to refuse nutrition is, as the author points out, not a “win” by any stretch of the imagination, and it amounts to little more than the government doing a terrible job from the start and being grateful to pass the buck.

I believe in the right to die with dignity, but the Hoyden About Town post made me realize that I prioritize the right to live with dignity. I believe that all people have a right to live rich, happy, excellent lives, and we as a society need to make sure that they are provided with the tools to make that happen. The ablebodied, who control much of society, need to break themselves of the beliefs that life with a disability is tragic, not worth living, and inherently lesser than that of our own lives. We need to promote the idea that all people should have equal access to society, equal value in the eyes of society, and the equal potential to contribute to society. It is not for us to decide when life is and is not worth living, nor should we pat ourselves on the back when someone society has thrown away decides to die rather than enduring a restricted and grim existence.

If someone decides that ou wants to die rather than enduring several months of pain and misery in the end stages terminal cancer, or feels that ou does not want to live through the end stages of a severe neurological disease, that is their right, and they should be provided with the tools to do so. But people should not be asking to die because society has made their lives miserable. And we should not be providing such poor treatment and support to people with disabilities that they want to die rather than go on living; we should not be devaluing life to the point that people come to believe that they are worthless or have no hope.

The devaluing of the disabled body leads to assumptions. Like “all people with disabilities are miserable and longing to be un-disabled.” Or “people with disabilities don’t have sex.” Or “people with disabilities can’t lead normal lives.” Or “all people with disabilities are heroic/romantic figures.” Society collectively silences people with disabilities and would prefer that they be shut away somewhere where people don’t have to look at them because they make people uncomfortable, and society expects people with disabilities to adhere to its own views and opinions of disabilities, to behave gratefully when society throw them scraps from the table, to be brave and cheerful when society tells them with a patronizing smile that there’s “only so much we can do, really.” In all of this, members of society never stop to examine their own assumptions, nor do they stop to consider the fact that they are being every bit as foul as the racists and misogynists of the world.

We are at a point in society where most people are offended and upset if they are called out on racist and misogynist behavior, because while racism and misogyny are still widespread problems, we collectively believe that race and sex should not be used as grounds for discrimination, and that the history of discrimination and abuse against women and people of colour is wrong and shameful. We have come to believe, in other words, that devaluing people on the basis of sex and race is wrong.

We haven’t yet reached that state with ableism, and I want to know why. Why is it that people raising questions about problematic language in the sphere of disability issues are accused of being “too PC”? Why does society expect people with disabilities to strive for as close a simulacrum of “abled” life as possible, and why does society get offended when people with disabilities are proud of their disabilities, or reject things which are supposed to make them more “normal”? Why are people angry when people with disabilities ask for basic dignity and respect? Why is it that people routinely think it is acceptable to devalue people because their bodies or brains are not like theirs?

What is normal? What is abnormal?

(Thanks for the links, Lauredhel and Anna Winter!)

Originally posted on this ain’t livin’.

Why Inclusionary Language Matters

Read a Czech translation of this post, prepared by Vera!

I was saddened but unsurprised recently to encounter a discussion on a feminist website in which commenters were bemoaning the appearance of content about race, gender, disability, class, and other social justice issues on feminist sites. “Why can’t feminism,” commenters asked, “just be about women?”

Feminism is useless, in my mind, if it fails to recognize an overlapping and intersecting collection of injustices. Even if all that you care about is “women,” I sincerely hope that you mean “all women.” As a movement, feminism is primarily focused on issues which involve white, Western, able-bodied cis women. Some of the gains for women accomplished by feminism, as a movement, have also benefited women outside this narrow category, it’s true, but a lack of understanding about the fact that all women experience life quite differently and may in fact have different priorities and concerns is exclusionary. And, again, if you care about all women, this is a problem, because it means that you are hurting other women when you do not consider things like race, gender, disability, and class to be “women’s issues.”

Which brings me to the topic of inclusionary language. When you are a white, cis gendered, able bodied, Western feminist, you have a lot of safe spaces to go. Pretty much any space dedicated to “feminism” is safe for you, because there’s a very high chance that the people in charge of that space are like you and/or that many of the people in the site’s community are like you. When you are are a person of color, a person with disabilities, a person who transcends the gender spectrum, a person who is not from the West, a person of low social class, you have far fewer safe spaces to engage with if you are interested in feminism. In fact, the safe spaces of others may be directly damaging and harmful for you, as people who proclaim to care about “women” proceed to talk about people like you in a disparaging way. And, tragically often, to actively oppress you.

Racism, ableism, classism, cissexism, transmisogyny, transphobia, sexism, sizeism, and heterosexism are all problems in the feminist community. Many people who identify (or would like to identify) as feminists are victims of these problems. These are problems which some white, cis, middle class, able bodied, heterosexual feminists have recognized and are trying to fight, and some of these feminists identify as “allies” and try to include oppressed people in their feminism, to advocate for social justice, to recognize the need for justice for all people, not just for heterosexual white cis ladies.

Even people who are trying to be good allies mess up, though, and use exclusionary language. Many become extremely defensive and lash out when called on exclusionary behaviour. Others recognize that they have done something hurtful (sometimes doubly so in being exclusionary and then in being reactive to questioning from people who raise concerns). Some allies even feel bad about this, and apologize or make an effort to avoid making such mistakes in the future. The ally thinks that ou has done the right thing by doing this, but the ally does not necessarily recognize the harm that has been done. For the ally, it’s a slip, the use of a “bad word” or the failure to recognize a community of people in a supposedly inclusive discussion. For the person who has that word or phrase used as a slur every day, as a weapon every day, who is constantly deliberately excluded, seeing a supposed friend do it is a stab to the heart.

A not entirely unexpected stab to the heart, but still.

What do all of the following words or phrases have in common?

Bitch. Cripple. Grow a pair. Lame. Cunt. White trash. “He/his/him” as a generic when the gender of a subject is not known. Ballsy. Harpy. Whore. Female impersonator. Jewed. Real woman. Retarded. Slut. Dumb. Natural woman. Harridan. Witch. Idiot. Man up. Biological sex. Crazy. Tranny. Invalid. Psycho. Step up. Asexual (not in reference to someone who identifies as asexual). Breeder. Shrew. She-male. Gay (not in reference to sexual orientation).  Moron. You guys as a generic greeting to a mixed gender group. Skank. Mankind. “Man” as a generic for “people.” Gyp. Halfwit. Insane. Schizo/schizophrenic. “Disabled” as in “the disabled.” Women born women. Ungendering by using “he” as a pronoun for a trans woman or “she” as a pronoun for a trans man. Fat/fatty (as an insult, not an adjective).

They’re all exclusionary. Some of these words are actively used today as insults, and some of them have a historical context of use as insults which oppress, silence, and marginalize large groups of people, some of whom happen to be women. Some of these terms are racist, some are sexist, some are classist, some are cissexist, some are heterosexist, some are ableist. (I deliberately haven’t used speciesist terms here because, while I think that there is a clear intersection between animal rights issues and feminism, others may disagree, and thus, may not think that using speciesist language is exclusionary.) Many of these words are a common part of the vernacular; I use “bitch” all the time, for example. Many are examples of subconsciously exclusionary terms, in that people use them thoughtlessly, without realizing what they are really saying.

All of them should not be used by people who claim to be feminists, if feminism for them is about advocating for all women and improving conditions for all women. I include myself in this admonition. Every time we use them, we engage in othering. We exclude The Other, and make it clear that we don’t actually care about the issues that other people may experience. We make it clear that our claims of ally status are just lip service.

At its core, feminism should be, to my mind, about justice. Justice for all women. Not just women who fit into a very narrow set of categories. And this is why we need to use inclusionary language. This is why we need to cultivate spaces which are truly safe for everyone. This is why we need to own our actions and apologize for them if they are hurtful. We cannot repair the damage we have done to other human beings, but we can work to prevent it in the future.

Lots of people like to defend exclusionary language. They say that they like using a term, or can’t come up with a good alternative, or don’t really see why they should have to change. “The word doesn’t really mean that anymore,” or “but I’m not really [pick your poison]ist, so it’s ok.” But, here’s the thing. Even if the word doesn’t mean that anymore, that doesn’t mean that it does not carry very negative implications. Even if someone thinks that the word is being used in a positive sense, it is still loaded with negative meaning. It does not mean that the word does not have a very loaded history. It does mean that every time you use it, you are unconsciously enforcing a system of oppression. You can participate in and even perpetuate a system of oppression without actively subscribing to it.

People who dislike being told that they should not use exclusionary language are often people who have something to lose if actual justice is achieved. If we ever live in a society where trans hatred doesn’t exist, everyone who is cis gendered will lose privilege, for example. As the old saying goes, “we all like to see our friends get ahead, but not too far ahead,” and this appears to apply to social justice issues as well, though you would be hard pressed to find someone who openly admits it. Being informed that you are hurting people with your actions threatens people when they have something to lose in this fight. This is why people push back so strongly when they are informed that their word usage is hurtful. This is why people become defensive when they are asked why they failed to include different perspectives in discussions. This is why people get angry when they are called on their privilege.

You can believe with all your heart that sexism is terrible and evil, but when you call a woman a bitch, it kind of undermines your point. You can think that people with disabilities are oppressed and marginalized by society, and that this is wrong, but when you call something “lame,” you’re saying that you think it’s ok to continue oppressing people with disabilities. When you say that someone should “step up,” you are unconsciously erasing everyone in the population who cannot step, like wheelchair users and people who are bedbound. When you refer to someone or something as “insane” or “crazy,” you are using mental illness as a slur.

So stop it. Stop using exclusionary language. Start including people.

And stop trying to defend it. If you’re too lazy to find a better word or phrase to use, that’s your problem, not society’s. If you can’t be creative enough to think of a different word or phrase, a word or phrase which does not exclude or silence someone, you apparently have not heard of a thesaurus.

Crossposted on this ain’t livin’

It’s Your Fault: Socially Acceptable Disability and Popular Causes

Read a Czech translation of this post, done by Vera! Thank you, Vera!

In the furor of discussion on my post about breast cancer awareness campaigns which use exclusionary tactics, several commenters brought up some important points when we talked about why breast cancer has become such a high profile cause. Anna pointed out that breast cancer awareness started as a grassroots movement among women who were angry about the lack of awareness and the large numbers of preventable deaths going on, many commenters (including myself) pointed to the potential monetary gains to be reaped for companies which support charitable causes in order to be seen as socially responsible, and both kaninchenzero and Amandaw referenced the fact that breast cancer is a form of “no fault” illness, in the sense that people who get breast cancer are presumed to be innocent victims. The cancer, in other words, is not their fault.

This is not another post about breast cancer.

But it is a post about why some medical conditions become popular causes, and others do not. Because, in America, we definitely have ideas about what makes a good cause, and what does not, and a lot of those ideas are rooted in the idea of personal responsibility. This concept has deep roots in American culture and society, and it has pernicious and lingering effects which continue to this day.

The entire nature of American social policy is specifically structured around the idea that we can determine who is at fault for everything, that specific individuals can be faulted for things, and that those individuals should not be helped. Take the American approach to the poor. Despite ample evidence to the contrary, many people seem to believe that people should be held personally accountable for their poverty. Even though poverty is a classic example of an intersectional social issue in which the class one is born into, one’s race, and one’s gender all play a role, people persist in thinking that if poor people “just worked a little harder” or “showed some initiative,” then they wouldn’t be poor. I actually had a sociology professor tell me once that if the poor “weren’t so lazy, they wouldn’t be poor.”

Lung cancer was specifically brought up as a great example of “it’s your fault”  in action. Lung cancer is the deadliest cancer in the United States, in terms of numbers of people who die from it each year (so says the American Cancer Society). However, it is not nearly as popular, as a cause, as breast cancer. Why is that? Because only icky gross people who smoke get lung cancer.

That’s right. Did you know that people exposed to carcinogens due to their jobs/social class/homes, second hand smoke, particulates in the air which cause cancers, asbestos, etc, don’t get lung cancer? Only smokers do. Fact! And that means that lung cancer can safely be ignored, as a cause, because people are personally responsible for getting it. I’ve known a few people with lung cancer in my day, and every one of them has had some version of this conversation over and over and over again during diagnosis, treatment, and recovery:

A: “I have cancer.”

B: “That’s terrible, what kind?”

A: “Lung cancer.”

B: “Oh.”

A: “…”

B: “Do you smoke?”

Cardiovascular disease is another example of a very serious medical issue which involves huge numbers of people and is not highly publicized. Sure, the American Heart Association has some PSAs out, and some branded products of questionable usefulness, but many people are not aware of the scope of cardiovascular disease and its causes. Screening, prevention, and treatment are not as freely provided as services to support people with more palatable conditions. Why? Because only gross fat lazy people get cardiovascular diseases, so it’s their fault, therefore, it’s not a social cause.

Diabetes, again, another condition which is deemed to be the fault of the person who has it. If you are diabetic, it must be your fault. In addition to displaying a limited understanding of diabetes and how diabetes works (hey, did you know that there are different forms of diabetes?), this is also not terribly beneficial when it comes to actually dealing with diabetes.

The list goes on. You get the point. If a medical condition can safely be blamed on the person who has it, we can safely and collectively ignore it, as a society. If we were to admit that these conditions should be social causes and should be addressed, that would be tantamount to saying that we should provide support to people regardless of fault. And that, as we all know, is socialism.

AIDS, strangely, is a condition associated with personal responsibility which has become a cause, to some extent, although not on the same level as breast cancer. I think that this is in part due to some serious grassroots lobbying on the part of very diverse folks. But at the start? AIDS was written off as “gay cancer” and ignored. It was only after people realized that things like a tainted blood supply, needlestick incidents at hospitals, and heterosexual sex could be vectors of transmission that AIDS started enjoying some popular attention. AIDS was also furthered as a cause when prominent members of society openly discussed the fact that they had AIDS, humanizing the cause. Yet, AIDS continues to be a highly stigmatized condition. Fundamentalist preachers continue to rant about how the gays are getting their compeuppance, for example, and people with AIDS are usually assumed to have gotten it because of risky sex or drug abuse (in all fairness, IV drug users are a huge risk group for AIDS, in part because social programs like needle exchanges are severely limited, because Americans are not interested in providing intervention for preventable diseases which are deemed to be the fault of reckless or morally unacceptable behavior).

Fibromyalgia is, I think, another great example of how Americans cannot deal with medical conditions when they cannot attribute fault or find a causative agent, bundled in with some serious sexism. Although it affects all genders, it is often assumed to be a specifically “female complaint,” and it’s laden with the double burden of being a “faker’s disease” in the eyes of the American public. Who are apparently incredibly knowledgeable about medical issues, especially treatment options, judging from the ever-helpful advice they provide people with all the time. When you can’t point to a causative agent of a condition, people are less likely to accept that the condition actually exists. Even when they are confronted with people who are obviously experiencing that condition.

Mental illness also falls into this category. Because we can’t point to something on a microscope slide, mental illness is assumed, on some level, to be fake or not real. And people with mental illness are assumed to be, in some part, responsible. They must be faking it, because the alternative explanation is that people can be sick without any clear cause, without any neat treatment or cure, and that is unacceptable.

In order to be an acceptable cause to support, a medical condition must be pure and untainted. Victims cannot in any way, shape, or form be responsible for their condition and the condition must have a clear and obvious cause. Thus, awareness campaigns and research and so forth ignore a panoply of serious medical issues, because they do not meet these criteria.

This means that numerous very serious medical issues in this country go underfunded and underaddressed. When education about issues is limited to issues which are considered blameless, people are missing out. Including people who may be at risk. When funding is limited to no-fault conditions, it means that serious issues are allowed to be ignored, and people with conditions linked with personal responsibility have a hard time getting respect, let alone treatment.

This disproportionately impacts some of the most vulnerable populations, like people of low income, who can exercise little choice when it comes to issues like medical conditions caused by occupational exposure, nutritional deficiency, and living in polluted communities.Like people with disabilities who could actually really benefit from, you know, funding for supportive programs.

The thing is that even conditions which can be clearly attributed to lifestyle choices are still intersectional in nature. Plenty of people smoke and do not get lung cancer, for example, just as plenty of people who do not smoke and do not have any other obvious risk factors in their medical histories do get lung cancer. Yet, the failure to even dedicate a little bit of time (comparatively, I am aware that there is ongoing research into lung cancer and that there are educational campaigns) to funding and awareness means that useful information about these conditions remains undiscovered or undistributed.

I was thinking about this lately during the flurry of outrage over domestic violence being listed as a preexisting condition. Domestic violence is another thing which is linked with some sort of personal fault or action on the part of victims. Where’s the outrage about numerous other things being listed as preexisting conditions? Why aren’t we angry about the fact that basically any medical issue/medical history under the Sun is considered a preexisting condition? The very idea of a preexisting condition is exclusionary and repulsive and disgusting.

It doesn’t matter how, why, when, or where the origins of a medical condition or disability lie. What matters is providing the appropriate intervention. To say this, however, is to undermine one of the cornerstones of the American belief system, which is why you so rarely hear it said in the mainstream.

Cross posted on this ain’t livin’