It is your fault when you are sick.
There is something strange with our emotions in relation to disease.
When disease happens:
- We experience a loss of control
- We feel a deep sensation of “abnormal”
- We tend to become sad
- We might become fearful
Occasionally, this perception leads to feelings of guilt and sometimes triggers shame. This is especially true during adolescence.
Why is that?
We sense that disease just should not happen when we play according to the rules.
Within this mental concept, we only get sick due to our fault.
Being ill appears mentally to be linked somehow to being guilty.
This same link between illness and guilt happens in children as well as in adults. For them, becoming ill is often perceived as a sort of punishment.
When would it be “your fault”?
It is your fault when you are sick.
This perception of guilt and punishment is even stronger, when there is a clear link between our behaviour and the illness:
- Putting a foreign body in the ear or nose
- Giving in to any form of addictive behaviour (to food, alcohol, or drugs) and the physical consequences (obesity, pancreatitis, or hepatitis)
- The lack of exercise and the muscular weakness because of this
Because of this link, it is extremely difficult to talk, with:
- any obese patient, about their weight
- a patient with pancreatitis about their alcohol consumption
- someone with COPD about smoking
In those cases, where our behaviour causes physical problems, we know that we are guilty and consequently, we want to hide our shame.
What do we do with our guilt?
It is your fault when you are sick.
With this backdrop of guilt for the encounter, it becomes evident that any interaction between the doctor and the (paediatric) patient is loaded with tension.
And that happens even before we open our mouth.
Guilt and the doctor
This concept of disease and guilt also has an impact on the roles within the interaction:
The patient:
- see themselves either the perpetrator (for example the child with a nasal foreign body or the adult with smoking related COPD)
- Or perceives themselves as the victim of external uncontrollable forces
- Or seeks to accuse another “guilty party”
The doctor:
- Is either the judge of the patient’s behaviour and who will execute the judgment
- Or is the one who must provide justice for me against my perpetrator
Flip the image and step in their shoes
Just place yourself in the position of a child on the way to the doctor.
It is your fault when you are sick.
Can you imagine what mood you would be in, when you expect to go to the judge because you are “not OK”?
You would be anxious, frightened, scared.
You would know that you are not in control. For this reason, you would resist the impending experience.
Very likely, you would refuse to cooperate with the stranger who is about to deliver your judgment.
Where do you get your guidance?
As a child, you would look to your parents for guidance. In this case, you would notice the tension of your parents and their anxiety. This all would tell you,” This is not a good day” even before you reached the examination room. And as I wrote before, “Our examination room is their dungeon”!
How do you see yourselves in this situation?
It is your fault when you are sick.
Younger children see themselves as either completely healthy or ill. When they have symptoms, they are not only physically “not OK”, but also as a person “not OK”.
Children, at 9 years of age, can understand the concept of partial health.
Going to the doctor in this sense really has the same emotional hue as going to the judge, who will tell them what is wrong with them, not merely with their body.
And next to the judgment, they expect punishment for being “not OK”.
Can the “culprit” trust “the judge”?
It is your fault when you are sick.
Because of everything mentioned above, it becomes very challenging to gain the trust of the “culprit” when the “disease” is a foreign body in either nose or ear.
The knowledge of having done something they shouldn’t have done, will increase in them the wish to hide the problem. To get them to cooperate with us for any treatment, while not making them feel blamed, is the tricky balance we need to chase.
Another typical example in my practice is, when parents present their child and tell me that the child is snoring.
At this moment in the conversation, the child typically protests and claims, “I do not snore!”
Children (like everybody) hate to be the object of these kinds of conversations.
In a nutshell:
The fear of being guilty as a cause of the disease triggers the wish to hide the fault rather than to seek help.
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