In the Kingdom of the Sick: A Social History of Chronic Illness in America
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Thirty years ago, Susan Sontag famously wrote, "Everyone who is born holds dual citizenship, in the kingdom of the well and the kingdom of the sick . . . Sooner or later each of us is obliged, at least for a spell, to identify ourselves as citizens of that other place." More than 133 million Americans now live with chronic illness, accounting for nearly three quarters of all health care dollars and untold pain, disability, and heartbreak. Patients with diseases as varied as HIV, cancer, or type 2 diabetes have been stigmatized, accused of causing their preventable illnesses through their lifestyle choices. People with irritable bowel syndrome and female patients with chronic fatigue syndrome have been told their symptoms were due to anxiety; and millions of people with chronic pain have faced skepticism from physicians and the public alike. What The Noonday Demon did for people suffering from depression, Laurie Edwards does for those who are chronically ill, championing their cause and giving voice to their lament.
might be construed as giving up. “This is an unfortunate tendency: first because it reinforces the stigma against people who do view themselves as disabled, which is just an ugly thing to do in any case; but second, and more perniciously, it creates an expectation that we should conform to the norms for healthy persons.” “To tell somebody with active Crohn’s or lupus or even diabetes that they’re expected to behave like someone without that disease is absurd and cruel,” Cross says. “And we do it
reproduction or chronic pain and influences the treatment of women across the disease spectrum. Dr. Sarah Whitman, the psychiatrist who specializes in working with men and women in pain, thinks some of the reason that women are treated differently from men is directly linked to this lack of knowledge. “For example,” she says, “women’s symptoms of a heart attack are different than men’s; if an M.D. doesn’t know that, they’ll miss a lot of heart attacks in women. Another example is that we used to
treatments available. I can think of maybe a few instances, but in general I think this is greatly overstated,” says Duncan Cross. As an example he uses depression, a condition that typically went untreated in previous generations. “Now we have lots of pills that we can take, and to some extent this has encouraged us to view as pathologies what are in fact some very normal moods and feelings. But the fact is, previous generations were no better off for untreated depression. I know that in my
year; pursued a graduate degree; and got married. I spent four long years trying to have a child and made it through a medically intensive, complicated pregnancy to deliver a healthy little girl. I work full time and have freelance work. These are the extremes that characterize life with chronic illness, and almost 130 million Americans contend with them to some degree.1 Much about chronic illness has changed since I was a child. People with cystic fibrosis, a disease similar to my own lung
pollution and are affected by it, the fact that racial and ethnic minority groups are more likely than whites to live in urban areas means they continue to experience a larger impact from it. Although heart disease cuts across racial and socioeconomic lines, black men and women are much more likely to die from heart disease than whites; and coronary artery disease and stroke, the leading causes of death in our country, represent the biggest discrepancy in life expectancy among blacks and whites.