A good friend of mine had a heart attack the other day. She did everything right — went to the ER right away when she had the first mild angina, she’d been taking care of herself with exercise and controlling her weight. In other words, pretty much the opposite of what my mother did two years ago.
It turned out to be mild, and she was given a stent and is rehabbing now. There were, however, two things that very possibly contributed: her blood sugar was elevated into “pre-diabetic” ranges and had been for years, and her blood lipids, cholesterol and the like, were pretty elevated.
So, now as well as doing the cardiac rehab routine of mild exercise, she’s starting to manage her blood sugar, and she’s on a statin drug for the lipids.
So we were talking about it this morning and she said something that struck a chord.
I bet you will identify with how much I cringe at the word diabetic. It is so associated with not taking care of yourself because of the media.
That really struck me, because I have noticed the same thing: I’ve found it very difficult to come out and say “I am a diabetic.”
Movies and fiction about people who recover from alcoholism pr drugs usually have this dramatic, climactic scene where, after hitting bottom in some dramatic and more or less disgusting way, the main character has the “moment of clarity” and stands up in a meeting and says “I am an alcoholic.” (Two great examples, by the way, are an under-appreciated Michael Keaton film Clean and Sober, and the Matthew Scudder books by Lawrence Block.) It’s an important moment in recovery because it marks the point at which you are — at the risk of sounding like I live in Boulder — taking ownership of the problem. Your wife isn’t driving you to drink, if it’s genetic it’s still your problem, and however you got there, that’s where you are now and you have to deal with it.
It’s also really hard to say because of the social stigma: socially, we see drunks as morally flawed. Same thing with obesity, with depression, and with drug addiction. Theodore Dalrymple has an instructive, if in my opinion mistaken, piece on this in PJM, where he questions whether we’d think of having “Arthritics Anonymous” where someone stands up and says “I am arthritic.”
I’m going to look at this in greater detail soon in a science column, but the very short answer is this: first, both formal research and anecdotal experience show that alcoholism and drug addiction don’t occur uniformly across the population. Lots of people drink a little bit without becoming alcoholics, and — contrary to a lot of mythology — there are plenty of people, as much as 90 percent of the population, who can use drugs recreationally without becoming addicted. There are a lot of possible reasons for addiction, but with that evidence the one thing that’s pretty certain is that the root cause is not alcohol or drugs themselves. (For more on this disease question, you might look back on my piece on whether obesity should be classified as a disease.)
So why don’t we have “Arthritics Anonymous”? I think there are two reasons: first, you can’t stop being arthritic by choosing not to have arthritis, you can’t just say “okay, knee, stop indulging yourself in that inflammation.” Second, and I think this is really important, almost no one will tell you “you have arthritis because you are morally flawed.” So people “go into denial” — rather than admit to this thing that society thinks is a moral flaw, we hide from it.
By hiding from it, we deny ourselves treatment.
This kind of denial isn’t always because of social stigma — although, there’s a lot of it, even in diseases like cancer. Anyone with cancer can tell you about friends who stayed away after the diagnosis. There’s the second part, which is that we don’t like to think about mortality. Admitting to diabetes means admitting that you have a life-threatening illness, and one that can’t be cured (damn it) but must be managed.
This column is dreadfully late because, basically, I had another column in the works when this struck me, and I think this is too important to wait.
By hiding from type 2 diabetes, we deny ourselves treatment.
And that can kill you.