Cheating death

Here’s a sobering story in the NYT about a man who almost missed the signs of a heart attack until he remembered reading about the suddenness of the late Tim Russert’s death. Fortunately, the author made it to the hospital in time to get effective medical attention — and he found that he’s not the only middle-aged guy paying extra attention to his heart these days. It’s a poignant article — but I’m sure Shapelings will notice the rhetorical patterns I did: the many references to weight in the article (and, implicitly, the dangerous effects of assuming heart attacks only happen to fat, sedentary people); and the nickname for the author’s cycling club: the Cheat Death group.

This article, which is written from a personal perspective and is (I think) an effective use of anecdata, reminded me of two other things I’ve read recently. The first is Kate’s post on Broadsheet about the fact that heart attack symptoms are different for women than they are for men. If you haven’t read it yet, please do — it serves as a stark reminder that the “default” body of Western medicine is male. And while you’re at it, take a refresher course in the signs and symptoms of a heart attack. A key quote:

As with men, women’s most common heart attack symptom is chest pain or discomfort. But women are somewhat more likely than men to experience some of the other common symptoms, particularly shortness of breath, nausea/vomiting, and back or jaw pain.

Not to be morbid, but please, if you even begin to suspect that you might be having a heart attack, call 911 (or your country’s equivalent) immediately. Don’t try to talk yourself out of it: time is crucial when it comes to treating heart attacks. In the meantime, it’s not a bad idea to get certified in CPR and first aid, which you may be able to do at your place of employment (that’s what I did when I worked for a big corporation). If you work in a big office building, there might be an AED in your building somewhere, which should come with instructions and is surprisingly easy to use. Find out where it is, and make sure your coworkers know too.

Now onto more abstract musings. I read Susan Sontag’s classic essay Illness as Metaphor last week, because I’m cheerful like that, and the “Cheat Death” club reminded me of a passage I wanted to share with you all. Sontag, who had cancer herself, examines the ways in which grave, incurable illnesses (particularly cancer in the 20th century and TB in the 19th) get appropriated as metaphors for moral conditions, political events, and the like — and then the negative connotations associated with those metaphors are extended back onto the people who actually suffer from the disease. Cancer becomes a sign of moral weakness, of the wrong kind of personality, instead of a physical ailment that could happen to anyone. Sound familiar, anyone? Physical illness is psychologized to shift “blame” — from environmental hazards, the inadequacies of medical knowledge, and just plain chance — onto the individual. Here’s the passage that really struck me:

Moreover, there is a peculiarly modern predilection for psychological explanations of disease, as of everything else. Psychologizing seems to provide control over the experiences and events (like grave illnesses) over which people have in fact little or no control. Psychological understanding undermines the “reality” of a disease. That reality has to be explained. (It really means; or is a symbol of; or must be interpreted so.) For those who live neither with religious consolations about death nor with a sense of death (or of anything else) as natural, death is the obscene mystery, the ultimate affront, the thing that cannot be controlled. It can only be denied. A large part of the popularity and persuasiveness of psychology comes from its being a sublimated spiritualism: a secular, ostensibly scientific way of affirming the primacy of “spirit” over matter. That ineluctably material reality, disease, can be given a psychological explanation. Death itself can be considered, ultimately, a psychological phenomenon…

At the least, there is the promise of a triumph over illness. A “physical” illness becomes in a way less real — but, in compensation, more interesting — so far as it can be considered a “mental” one. Speculation throughout the modern period has tended steadily to enlarge the category of mental illness. Indeed, part of the denial of death in this culture is a vast expansion of the category of illness as such.

Illness expands by means of two hypotheses. The first is that every form of social deviation can be considered an illness… The second is that every illness can be considered psychologically… These two hypotheses are complementary. As the first seems to relieve guilt, the second reinstates it. Psychological theories of illness are a powerful means of placing the blame on the ill. Patients who are instructed that they have, unwittingly, caused their disease are also being made to feel that they have deserved it.

The impetus for Sontag’s discussion here is the idea of the “cancer-prone personality” that was gaining traction when she wrote the essay, but I think her analysis can shed light on the OBESITY EPIDEMIC OOGA BOOGA, too. The medicalization of fat bodies is clearly an example of her first hypothesis (every form of social deviation can be considered an illness), and the relentless attempt to use shame as a weight loss motivator is a clear example of the second. First, we’re told that our fat bodies are a danger; then we’re told that your body is the legible sign of the inner you, some secret personality that’s just not disciplined enough to lose weight. This double blaming leads not just to personal fat shame, but the tragic instances of fat prejudice in medicine, which often arise from the idea that fat people cannot be trusted to describe the reality of their bodies, and that they don’t deserve adequate medical care anyway. They deserve illness, because they are fat — and if you’re fat, you’re ill by default.

Sontag begins her essay with a stunning metaphor:

Illness is the night-side of life, a more onerous citizenship. Everyone who is born holds dual citizenship, in the kingdom of the well and in the kingdom of the sick. Although we all prefer to use only the good passport, sooner or later each of us is obliged, at least for a spell, to identify ourselves as citizens of that other place.

Illness is a fact, not a manifestation of your morality. Fat is a fact. Mortality is a fact. You cannot cheat death by joining an exercise club any more than you can cheat hunger by eating only carrot sticks. What you can do is try to listen to your body, both its pleasures and its pains, and live a life that is healthy for the body and the mind that you are.

109 thoughts on “Cheating death

  1. Not to be morbid, but please, if you even begin to suspect that you might be having a heart attack, call 911 (or your country’s equivalent) immediately.

    And for those of you (I’m sure I’m not the only one) who don’t follow the allopathic/surgical medical tradition, a largish dose of cayenne (capsicum) extract is espoused by naturopaths as brilliantly effective in stopping a heart a attack (by opening up the arteries). If you haven’t any on hand when a crisis strikes, the powder (i.e., chili powder) in hot water is a good substitute.

  2. Yeah, this hits home after my dad’s near-heart-attack. And unlike the author of the article, he didn’t even have weight or body shape risk factors – he had no risk factors whatsoever. But even if he had had all the risk factors we know about, and did nothing active to try to prevent getting sick, he still wouldn’t be morally culpable for it.

    We get sick and it happens. I wish people saw it that way.

  3. A few weeks ago, right after Tim Russert died, I was feeling awful. Heart palpitations, shortness of breath, nausea, chest pain, arm pain… I remember reading all of the comments on Shakespeare’s Sister about heart attacks and decided I couldn’t take a chance. Too many people count on me for me to buy the farm at 43. So off to the hospital I went.

    The doctor who came in to see me (after I was set up in the ER) rattled off my list of risk factors – family history of heart disease, type II diabetic, high triglycerides, obesity… well, I must have given her a look because she did not mention obesity as a risk factor again. It did not appear that I was having a heart attack but she admitted me as I’d never had a stress test and she wanted to run tests through the evening.

    Turns out my heart is in really good shape. I did feel like the world’s biggest dork for panicking, but my doctor reassured me that I did the right thing. Better to go in and be fine than to stick it out and be wrong.

  4. This is a great post. I did want to add, though, as somebody who has had panic disorder for almost 15 years and who has had every heart attack symptom in the book about three million times, and it turned out to be a panic attack each time, the chance of a (relatively) healthy woman in her 20s or 30s–which seems to be most of the readers of this blog–having a heart attack are very slim. Ignoring symptoms is never a good idea, but heart attack symptoms can also be symptoms of other things, especially panic attacks, and if you’ve been checked out and deemed healthy, it’s probably best not to stress too much.

    That’s something that drives me crazy about the idea that I feel like we’re surrounded by, that if you have a BMI over 25, you are unhealthy and destined for a heart attack. That’s a great thing for a health-but-overweight women with a history of panic disorder to hear. My panic attacks are all about fear of something going wrong with my body, and affirming that I’m healthy and strong is something I need to do. It’s sad that, no matter how many good doctor’s check-ups I have, no matter how consistent I am with my exercise, no matter how good I feel, women’s magazines and news shows and random internet posters feel the need to tell me that I’m unhealthy, and that it still makes me doubt myself and my own body.

  5. Yes, yes, and YES. Everybody pees, everybody sneezes, everybody dies. I’m just glad I’m lucky enough it’ll probably be from a heart attack in my 60s, and not a stray bullet in a war zone. (uh, knock wood!!)

  6. That final quote from Sontag reminds me of the saying that people are only temporarily able-bodied, when considering disability rights. Startlingly well-put.

  7. “a largish dose of cayenne (capsicum) extract is espoused by naturopaths as brilliantly effective in stopping a heart a attack”

    Please don’t do that. It won’t work. Please just call an ambulance and start CPR.

  8. And let’s pretend that instead of “disability rights” I said something accurate like “equal access for people of all abilities” instead of something inaccurate and sort of stupid, okay? *sigh* Long day.

  9. Ugh. I’d never really educated myself about heart attacks before and I can only agree with Iori – I’ve had those symptoms about three million times, sometimes due to panic attacks and sometimes for other reasons. In fact I have almost all of them right now, haha. But that’s just normal for me! How am I supposed to tell if it’s really something serious? Then again, I don’t think I have any of the risk factors aside from stress … and I’m young. Hmm.

  10. wow — thanks for the sontag shout out. i read the essay years ago and you reminded me that it’s time i go back and re-read. i DO think that the physical, emotional, spiritual and psychological are all intermingled and it’s not so easy to delineate what’s what. that said i think we run into trouble as a society when we try to “explain away” pain, chance, and other stuff we can’t control. one of the biggest flaws of the medical system is that it doesn’t take into account the whole picture of people’s lives. it’s a narrow template, a small lens … not a compassionate one.

  11. My mother had to talk me into going to the ER not too long ago. I was having stomach cramps so bad that I couldn’t sleep and could barely stand up. Also they were concentrated to the right side. She thought it was appendicitis, but I kept insisting they’d pass (I didn’t want to make my dad drive me their and stay up all night – because these things ALWAYS happen at night, lol). Luckily it turned out not to be, but I’m still glad I listened. Despite the $4000 bill I just got for the CAT scans they took (thank you, lack of health insurance – if that’s not an argument for universal health care I don’t know what is). I could have just as easily needed surgery.

    She also reminded my of this guy I knew in high school who actually had his appendix rupture. He missed months of school and almost died.

    I guess my point is, it’s not just heart attacks – don’t be shy about going to the ER if you think something is seriously wrong. And vote for candidates who are in favor of universal health coverage, lol.

    Also, since no one’s mentioned it, sometimes heart attacks have different symptoms in women than men. I forget the exact differences but it’s nothing a quick trip to WebMD won’t solve.

  12. I recently lost my grandfather to congestive heart failure, but really it was age. And this is the other thing. Everyone must die of something. He was a really old guy – healthy, right up until the end, active and vital. Died in the night, still at home, just as he wanted most. I think the sad thing about illness as moral failure is that it blames us all, shames us all, because we will all die, someday, of something.

    Something I didn’t know until I did work in bioinformatics: cancer is an almost inbuilt end of life condition. We each have telomeres on the end of our cells, little “caps” that protect the data in our chromosomes. When cells replicate, these telomeres get — decremented. (I’m a computer scientist, so that’s the comp sci way of looking at it.) Eventually, they run out. When the data gets hit, a likely outcome is cancer.

    Which is of course just a way of saying “hey! we age!” — but seeing that it’s really built in there, that disease is OF us, IN us, it’s not just something that HAPPENS to us, that our lifespans are, to an extent, an evolutionary tradeoff — well, that really changed something in me. We’re built, eventually, to get cancer or heart disease or diabetes, because we’re human.

  13. Academigasm!

    Also, I totally understand the “hey, I always feel like that” factor, but I think caution is still warranted, especially for those who are not in their 20s and 30s anymore. My stepmother died of a heart attack in pretty much the same way Tim Russert did, at the same age — there was no warning. A bystander did CPR, but by that point it was too late. It’s better to have a false alarm and get prompt medical attention than it is to hedge your bets and not be able to get help when you need it.

  14. The nerd in me fat activist body is having an academigasm.

    arrrrrrr me fat activist body!!!

    (sorry, I couldn’t resist. Also, heehee academicasm, i have those all the time!)

  15. So much well written truth. Great job, SM.

    (I must confess; before I submitted this comment, I had to scroll up and make sure I was giving credit to the right person for this post!)

  16. Yes, yes, yes! Great post.

    And check out this sad story:

    http://seattletimes.nwsource.com/html/localnews/2008026806_triathlete01m.html

    “Donald Findlay said the family is stunned by the news and described his son as athletic and in ‘perfect condition.’”

    ‘He swam for years. He had no fat. He was in great shape, just tall and lean,’ his father said.”

    Being “in shape” or outwardly thin does not mean you are immune to heart attacks. I hear about athletes who seem to be in excellent condition who die of sudden, unexpected heart attacks every year, often during or just after strenuous training or competition.

  17. It’s also another reason to get annual checkups, or at least biannual checkups. My grandfather had no symptoms at all, but went in for the normal visit and found that his bloodflow was only at 15% of what it ought to be – he had to get a quintuple bypass. If he hadn’t, it would just have been a matter of time before the heart attack hit, and he had absolutely no idea.

  18. I’ve been reading Fat Acceptance blogs for about 6 months now, and haven’t posted on any of them, but I feel like I have to put my two cents in here. My dad died of a heart attack when I was in high school. He had one heart attack, ended up in the hospital, and about a week after he was released, had another in his sleep and passed away. He never felt any chest pain. (There is a chance he did and just ignored it, but my dad was a pretty pragmatic guy. I think he would have gone to the hospital if he’d had chest pains.) He had flu-like symptoms- fatigue, sweating, maybe a little shortness of breath. He was diabetic, and he thought that he had a cold or flu that was exacerbated by the diabetes. After about a week, he went to the doctor and found out he’d had a heart attack. They sent him to a hospital in an ambulance. I’m rambling here (I’ve been drinking a bit, sorry if I’m not making the most sense in the world) but I guess my point is, if you feel really crappy, and you can tell something is wrong, go to the doctor. My sister (a nurse) thinks that his diabetes was worse than the doctors thought (he was on pills, not injections) and that he had enough nerve damage to make the chest pains not happen. She’s not a doctor, and neither am I, but maybe that’s something to think about if you’re diabetic. Again, sorry if this is rambling or pointless. I probably shouldn’t have made my debut post while drunk.

  19. Being thin or ‘fit’ (whatever that means) does not buy you health. Unfortunately, that is the ‘deal’ that is sold to us: fat = death, thin = immortality.

    I’ve been a first aider in our workplace for over 10 years, and the only heart attack I’ve ever had to attend was someone who met none of the supposed risk factors; she was young (I’d say around 25), thin, fit and (duh with the pronoun) female. She thought I was mad when I called the ambulance for her ‘heartburn’ with referred pain down her arm, not to mention clammy skin. I wasn’t taking any chances though, and just as well as our OHS dept confirmed to me later that it was a heart attack.

    Physical illness is psychologized to shift “blame” — from environmental hazards, the inadequacies of medical knowledge, and just plain chance — onto the individual.

    Yep. Illness as moral failure. Don’t know you the only reason people die of cancer is because they are carrying undealt with anger and didn’t de-tox enough? I had some moron try and tell me this at my mother’s wake of all the inappropriate times. Bitch was lucky my glass was empty or the contents would have been upended on her head.

  20. Something I didn’t know until I did work in bioinformatics: cancer is an almost inbuilt end of life condition. We each have telomeres on the end of our cells, little “caps” that protect the data in our chromosomes. When cells replicate, these telomeres get — decremented. (I’m a computer scientist, so that’s the comp sci way of looking at it.) Eventually, they run out. When the data gets hit, a likely outcome is cancer.

    And it is not just the shortening of telomeres. Even if we could modify our bodies so all our cells would express telomerase (the enzyme that builds up telomeres) we still would eventually die of cancer if no other disease or injury would kill us first. We are all exposed to a number of natural mutagens – even in an unpoluted environment. And our DNA replication mechanisms are not perfect (although they are pretty good). So over a lifetime random DNA mutations will occur in our cells and eventually some of them will cause cancer.

  21. And by the way, telomeres are repeated DNA sequences at the end of chromosomes, not at the end of cells. (Arwen, I am sure you know this and meant to say this – I just wanted to clarify.)

  22. Anecdotally, the Hubby and I are living proof that thin doesn’t always equal healthy.

    I’m fat (duh), and the only health problem I have is very mild asthma – so mild that I can count on one hand all the attacks I’ve had in the last 5 years. And I’ll have fingers left over. My blood pressure is just about perfect, heart rate is good. I don’t think my cholesterol has ever been tested, so I can’t say for sure about those numbers, but still. I’m pretty damned healthy, overall.

    Hubby? Is so thin he’s underweight. And he has arthritis, recurrent pericarditis, and is constantly unwell. To the extent that he’ll stay in bed for an entire week at a time, unable to breathe properly (he’s been checked out, and the doc says it’s just a recurring virus). (Oh, and he’s only 31.)

    I do realize that anecdote =/= data, but I still see us as a living example of the statements “thin doesn’t always equal healthy” AND “fat doesn’t always equal UNhealthy”.

    But I never quite understood how someone could be blamed for getting ill. So these babies that are born with leukemia… how is it their fault? Or my best friend, who quite literally might be dying right now. (Honestly, the thought that somebody might be blaming HER for getting leukemia pisses me right the fuck off.) That’s like blaming somebody for dying when they’re sitting in their own house and a piece of debris from an airplane falls through their roof and crushes them. Oh, they shouldn’t have been sitting there. They should have been over THERE instead. Yup, all their own fault.

    Puh-leeze.

  23. I’m reminded of the fallacy of the “Fibromyalgia Personality,” which stated that people with fibromyalgia were more likely to be Type-A, highly driven, organized-to-the-point-of-neurosis, and unable to “relax” or “settle down.” In other words, the patients brought it on themselves and if they’d just learn to relax, all their symptoms would *poof* into oblivion. Which now, thankfully, is widely recognized to be bullshit – if fibro patients are more organized or tenacious than the general population, it’s because only the ones with the highest level of stick-to-it-iveness were able to get a diagnosis.

  24. if fibro patients are more organized or tenacious than the general population, it’s because only the ones with the highest level of stick-to-it-iveness were able to get a diagnosis.

    OT, but this reminds me of an article I read a while back (can’t remember where) about how mothers who become activists for disabled children are sometimes misdiagnosed as having Munchausen by proxy. You know, because they know so much about their children’s conditions, read medical literature obsessively, and insist on going to different doctors and hospitals if their children’s complaints aren’t taken seriously.

  25. Vidya: And for those of you (I’m sure I’m not the only one) who don’t follow the allopathic/surgical medical tradition, a largish dose of cayenne (capsicum) extract is espoused by naturopaths as brilliantly effective in stopping a heart a attack (by opening up the arteries). If you haven’t any on hand when a crisis strikes, the powder (i.e., chili powder) in hot water is a good substitute.

    For a while, I’d let this sort of thing slide, because any literate adult who listens to a naturopath can get what’s coming to them as far as I care, but I later realized that people actually apply this bullshit to children, so I won’t ignore this. If capsicum were proven to treat heart attacks, that’s what they’d use, but it’s not proven, because it doesn’t work, and if you use it, you will probably die. If you think you’re having a heart attack, get mainstream (aka real) medical treatment as fast as possible.

    Which is of course just a way of saying “hey! we age!” — but seeing that it’s really built in there, that disease is OF us, IN us, it’s not just something that HAPPENS to us, that our lifespans are, to an extent, an evolutionary tradeoff — well, that really changed something in me. We’re built, eventually, to get cancer or heart disease or diabetes, because we’re human.

    But those things are still some aspect of reality that we’d like to adjust to our preferences, just like, say, HIV. The fact that the problem is from one place instead of another (our genetic copy mechanism instead of some virus) doesn’t meaningfully change my perception of the situation. It just means that more extreme measures will be required to fix it.

    Not all DNA is a fragile as ours, you know. The genetic durability of kineococcus radiotolerans would be very useful, but never developed in most organisms because most organisms don’t have the pressure of intense ionizing radiation to deal with. If it can survive nuclear waste, it would surely let us improve our average time between cancers by quite a bit.

  26. As repugnant as I find the blaming of the individual for “bringing on” or causing their own diseases, I do sort of understand it. In Psych 101 terms, it’s a defense mechanism. Our brains can’t cope with the knowledge that we are susceptible to random, fatal forces, so we latch onto an explanation that puts control (theoretically) back into our hands. The sense that “If I do A, I will NOT succumb to B,” makes us feel so much better than “B could happen to anyone, anytime, anywhere, including me.”

    It’s the same psychological, self-protective process that makes us think wrong-headed things like, “I would never go out walking alone at 3:00 am, ergo, I would not have been raped like she was .” Or “I would never take my eyes off my child for a second in such a public place, ergo my child would never have been snatched by a predator like that other child was.”

  27. Sorry, Arwen, I forgot your name at the beginning of your quote. Also, the last sentence of my post should read, “If such a mechanism can help something survive nuclear waste, it would surely….”

  28. Loveandlight, oh, well, if Dr. Christopher said it. And if one dude tried it and three people think it worked. Your anecdata has won me over!

  29. Hospital bills would sink this family for good. When I get chest pains, I call my husband home from work so he can sit with me, in case we have to say goodbye. Better I die than we both do.
    His job offers him health insurance, but it would eat half of his minimum wage paycheck. Rent eats 70%, having a roof over our heads beats both of us living to see 40.

  30. This is a really important post. I am always saddened by how quickly people are willing to attribute illness to a character flaw. Hell, my dad boasted how he hadn’t been to a doctor in 15 years. Yeah, and when my brother finally bullied him into going he had a melanoma removed from his forehead. Yeesh.

    I remember discussing the death of Ryan Shay who collapsed during this year’s Olympic marathon trials and who was obviously in fantastic shape. Even though they KNEW he had a heart problem since birth, many of the folks I were talking to took it as gospel truth that it was obviously performance enhancing drugs because no one who could run that much could just drop dead–he must have done something… And it annoys me even more when people badger me to badger my S.O. to lose weight for his health. He has a genetic condition that affects his connective tissue and epilepsy. Neither has a damn thing to do with weight. But it is comforting to think that these things are under his control rather than just the product of crap luck. Health is not a reflection of an individual’s moral character. A failure to provide health care is a reflection of a society’s moral character, though.

  31. Concerning cayenne pepper as a treatment for heart attack – I had never heard about it, and I certainly would not rely on taking cayenne pepper and doing nothing else when I thought I had a heart attack. But if cayenne pepper does indeed cause bloodvessels to dilate (and there seems to be some evidence for that) than it is possible that it would be of some use. After all, nitroglycerine acts by being converted to nitric oxide which in turn is a vasodilator that acts on the coronary blood vessels of the heart.

    There are quite a number of plants with medicinal uses who have active ingredients that actually work and who still have been investigated in controlled studies only recently and it is likely that there are other plants with useful compounds that have not been formally investigated yet. St. John’s wort, for example, does act as a mild antidepressant, and has been used for this purpose for a long, long time, but it’s effects have only been investigated in formal studies fairly recently.

    Some people who prefer naturopathic medicine seem to forget that just because something grows in nature doesn’t mean it is good for you – in fact, many plants contain potent poisons and chemical compounds in plants are still just that, chemical compounds. On the other hand, some people who don’t believe in the effectiveness of naturopathic medications forget that many medications were originally isolated from plants but are now synthesized in a lab.

    The only advantage of taking medicines synthesized in a lab other than that the respective active ingredients are usually better studied is that they always contain an equal quantity of the active ingredient.

    In short: Don’t look down on naturopathic medications, a lot of them do work. On the other hand, don’t think medications made from plants or other natural ingredients have necessarily fewer side effects.

  32. Queendom, your comment is very diplomatic and thoughtful — but I still think that when you’re in a life or death situation, in which every minute counts, going with the more studied route is the way to go.

  33. This is the very thing that killed my husband on April 6th of this year. He had NO symptoms, other than being stressed out from trying to finish his Ph.D dissertation. His artery closed off and he died in bed in less than 5 minutes.

    If I can offer words of advice: if you, or someone you love complains of anything out of the ordinary, get them to the doctor or hospital IMMEDIATELY. I’m going through hell right now and this is not a place I can recommend for anyone… :/

  34. Lynette, I am so sorry for your loss.

    I was worried when I wrote this post that is might prove triggering for some readers (hell, it probably would be for me if I hadn’t written it!), and I’m sorry if you experienced it that way. God knows I don’t want to add to the distress you are feeling right now.

  35. queendom: On the other hand, some people who don’t believe in the effectiveness of naturopathic medications forget that many medications were originally isolated from plants but are now synthesized in a lab.

    It’s not a question of the power of plants, but of the scientific method. Without the sort of double-blind experiments that get substances into mainstream medicine, someone promoting the effectiveness of something has no reasonable basis for doing so because they can’t control for the placebo effect, which is usually what naturopathic effects are due to. If they think it works, then they won’t mind having some rigorous studies done on it to prove it.

    The thing is, though, they usually do mind, and when studies get carried out anyway that turn out to not support their beliefs, they ignore them and keep prescribing their ineffective preparations (I won’t dignify them by calling them “medicines”) anyway.

    In the case of heart attacks, it is possible that cayenne pepper can help, but why settle for something that might help when we have something that does help, aspirin?

  36. Lynette, I’m so sorry about your husband.

    In the case of heart attacks, it is possible that cayenne pepper can help, but why settle for something that might help when we have something that does help, aspirin?

    That’s what I was just going to say. I don’t think it’s a matter of take your cayenne pepper/ aspirin OR go to the hospital. But if you’re still standing and waiting for an ambulance to arrive, taking aspirin isn’t going to hurt and might help, and it sounds like cayenne is meant to serve the same purpose. I’d just choose the aspirin, personally.

    Again, sorry if this is rambling or pointless

    It’s not, romanos! My mom was diabetic and died of a heart attack, too — I actually mentioned that diabetic neuropathy can make people fail to recognize heart attack symptoms in that Broadsheet post SM linked to. It’s an important point.

  37. Sweet Machine – in general, I agree with that. However, if you think you might have a heart attack and you have already called 911 taking a table spoon of cayenne pepper in water while waiting for the paramedics is probably not going to harm you and therefore would not be irresponsible – and some of the earlier posts sounded as if it would be completely irresponsible to take cayenne pepper in this situation.

    Anyways – I once had a massive ear infection. While it was in no way dangerous it hurt like hell, and since it got really bad on a weekend I went to see the doctor on call. He only gave me pain medication and told me to put warm onions on my ear – something that left me pacing up and down crying in my room once one pill stopped working but I couldn’t take the next one for a couple of hours because I would have ended up with a too high daily dosis of pain killers. The same doctor also asked me “with whom I was having a problem” (apparently ear infections always have a psychological cause *snort*). He also looked at me and told me that I had to change a lot in my life if I wanted to become healthy, a remark that I am pretty sure referred to my weight.

    Granted, I had just gotten the news that my grandma had died and I was in the middle of my finals at the time – so psychological stress might have played a role by effecting my immune system. But for me this guy remains the perfect example of irresponsible use of psychological explanations of illness, fat prejudice, and irresponsible application of a naturopathic treatment – and I was lucky that I only saw him for a relatively harmless problem like an ear infection. (Uh, and although I did get prescribed antibiotics and anti-inflammatory ear drops the next Monday from the ear, nose and throat specialist my family doctor sent me to after taking one look at my ear I still had reoccuring ear infection for several months.)

  38. queendom, I think the worry was that the cayenne was being recommended for people who “don’t follow the allopathic tradition” — which sounds dangerously like “take the cayenne and don’t call the ambulance.” Combined with the inane FOAF justification, that’s something that needs to be challenged. I agree, though, that cayenne in addition to taking immediate medical action can’t hurt — fuck it, if I’m waiting for the ambulance for a heart attack I am taking the aspirin and the cayenne, and at the very least the suckiness of eating cayenne will distract me. (Snorting cayenne up your nose when you have a sinus infection also works great… I don’t know if it has anything to do with vasodilation, but the pain is distracting, the resultant endorphin rush is pleasant, and the violent nose-running clears you out.)

  39. Awesome post SM!!

    OK so here’s the thing that I never seem to hear people talking about. There are two kinds of heart problems – I have a construction background so I describe them as a pluming problem which leads to a “heart attack” (i.e. the pipes are clogged) or an electrical problem which leads to what is called “sudden cardiac arrest” which most of the time leads to “sudden cardiac death”.

    When you hear of someone who suddenly died from a “heart attack” (ala Tim Russert) and they had no warnings or symptoms or were “too young” its almost always an electrical malfunction (cardiac arrest) not a true heart attack. If you have an electrical malfunction and dont have a defibrillator at hand to shock the rhythm back, all the cpr in the world wont save you. Thats why you are seeing them (defibrillators) pop up in public places everywhere.

    I’ve been morbidly obese my whole life. I’ve also had anxiety and panic attacks since I was a teenager. I never went to the hospital for them though since I have a puke phobia (thanks to an evil nun in 1st grade). If I had gone to the hospital they MIGHT have discovered my electrical malfunction – I just dont know.

    I had no symptoms except that I almost passed out once at work. I was stressing to get stuff done the day before vacation. I figured it was a panic attack. I was light headed and thats about it. After vacation, I started doing a few tests – EKG, Holter monitor. My doc sent me to a cardiologist who sent me to an arhythmia specialist. I wound up in the hospital having an angiogram (plumbing test) and an EP study (electrical function test). My plumbing was just fine (I was 38) but I coded during the EP study. And they had trouble reviving me with CPR. I was dead for about 15 minutes. The doc brought me back by kneeling on the paddles. So I got a defib implanted the next day.

    Soooo – long story short… (I know…too late) – cardiac issues are nothing to mess around with. If you feel an irregular beat – get it checked out. There arent many people with electrical problems who survive. The defib support group at my hospital (called Shock Absorbers *grin*) only has two of us who are under 65. Doctors dont take people seriously.

    The really best thing about HAES is that it is helping people learn to trust their bodies and intuition.

    Thanks for listening!
    jen

  40. fuck it, if I’m waiting for the ambulance for a heart attack I am taking the aspirin and the cayenne, and at the very least the suckiness of eating cayenne will distract me.

    I’m going to make some cayenne-covered aspirin.

  41. queendom: …and some of the earlier posts sounded as if it would be completely irresponsible to take cayenne pepper in this situation.

    Oh, that’s not really the problem. The problem is why cayenne pepper was recommended in the first place. It won’t hurt you to take cayenne pepper during a heart attack, but once you do that you might get the idea that naturopaths know anything about medicine, and that will hurt you.

  42. Lynette, I’m so sorry. Is there anything that random internet strangers can do as far as support? (I hope that’s not insulting — maybe you have a stellar support network — but if I knew you IRL I would want to drop by and run a load of laundry or make dinner or something.)

  43. I obviously took too long to type my last comment… once I published it there were a number of other comments so sorry if it was somewhat outdated. Hoever, just to clarify: I am not saying don’t take cayenne pepper instead of aspirin (by the way, aspirin works by thinning your blood, cayenne pepper sounds like it would work by vasodilation, so they don’t work the same way – it might be even safe to take both). But I for one rarely have aspirin at home, since I hardly ever need pain killers and the pills would probably be past the date of safe use until I used them all up (although I am not sure how much storage time affects aspirin).

    And I don’t think that the only reason naturopathic medicines are often less investigated than other substances because isnaturopaths don’t want them to be studied – I think it is sometimes also because drug companies wouldn’t be able to gain a lot of money with them. However, I agree that it is irresponsible to continue to prescribe something that has been shown to have no effect whatsoever.

    I also do think that there are some methods in alternative medicine who are complete, unscientific crap – the best example is Bach flowers, something my mum absolutely believes in, but which has failed to produce any results in controlled studies. Plus, considering the way they are prepared I don’t see how they could contain enough of any substance to have a medicinal effect. Still, they might have a placebo effect, and a placebo effect can sometimes be actually quite useful in treating real illness.

    (And Lynette: I am really, really sorry. Having one of my loved ones die suddenly is my worst night mare and I cannot begin to comprehend what you are going through.)

  44. But for me this guy remains the perfect example of irresponsible use of psychological explanations of illness, fat prejudice, and irresponsible application of a naturopathic treatment – and I was lucky that I only saw him for a relatively harmless problem like an ear infection.

    Good grief! I suppose you gave yourself an ear infection because you hate yourself, like all fat people. What a douche.

  45. I’ve got an idea: cayenne donuts. They’ll save our lives and kill us at the same time!

  46. Actually, fillyjonk, cayenne donuts sound good to me… until a few years ago I was a very “traditional” German in that I truly believed hot and sweet wouldn’t go together. Then I tasted Indian food – my all time favorite – and completely changed my mind ;o)

  47. First, my condolences to Lynette… I cringe to think how I would cope with the loss of my spouse, and I’m so, so sorry you have to endure this. :(

    Secondly, let me join my voice to Jen Smith’s up there. I have problems with atrial fibrillation – where the atria of the heart doesn’t pump properly and sort of flutters, instead. It’s happened many times since I’ve been an adult, and it runs in my family, so I thought nothing much of it. Last October, I had an episode that ran for 27 hours before my husband talked me into going to the hospital. (And let me say, a heartrate of 180 will get you through a crowded ER waiting room in no time!) After the delightful experiences of being awake while they stopped the electrical impulses across my heart, and the big oval “sunburns” caused by the defibrillator the next day, the doctor had me come into his office to get an ultrasound of my heart. (Which is in marvelous shape, I am delighted to report, despite my morbid obesity.)

    My point in telling this story is… it may be a financial wallop… but most medical providers will work with you. And it’s worth knowing that it’s nothing serious… or even that it is! Obviously I didn’t rush to the hospital, but not doing so was a big risk. Gambling with my life was stupid. Don’t do it. Go to a doctor, go to the hospital. If it’s nothing, great. Maybe it costs a lot… but think of how awful your SO would feel if you died and your cause of death could have been prevented.

  48. I am a longtime, anonymous reader of this site, and am in my late 30s. I had my first heart attack at 16. I was, at the time, a weekend athlete in great physical condition, with no family history of heart trouble, and completely out of the blue had a heart attack following a bout of mono, and then I had a few more over the next decade of my life.

    When I was in cardiac intensive care, I was surrounded by women. Women who had had several untreated heart attacks – women in their 30s, 40s, 50s, who had not known the symptoms of heart attack in women and had ignored them, or more strikingly, had gone to a doctor or an ER and been told that their physical symptoms were from untreated mental illnesses – depression, stress, etc. These women walked out of doctor’s offices and Emergency Rooms in the middle of, and directly after, having a heart attack because they were diagnosed with a case of ‘its all in your head’, or being told the problem was that they could not handle stress.

    And because they were denied early care, the damage to their hearts continued, until one day they just fell over in full blown cardiac arrest and ended up sharing a room with me, in a cardiac watch-ward.

    They died, in the beds next to me. All of my roommates in the hospital – and in my late teens and twenties, I spent long periods of time in the hospital – they all died. All women. And I watched them die. I watched them while the crash cart teams came to revive them ,and I watched those efforts be in vain, and I watched some of the medical students watch their first patient die, and I saw some of them cry when the efforts ended, and I was deafened by the silence that follows and unsuccessful resuscitation.

    Because they were not treated in time, because they eschewed science for cayenne pepper, because ‘everybody’ knows that young women don’t have heart problems, and that young women includes all women under 50, because when they complained of chest pain they were told to lose weight instead of being evaluated, because they were taught that women’s hearts are not as valuable as their male counterparts’ hearts, not treated with the same care and worry and concern, they all died. Moms, grandmothers, sisters, friends, all women, all gone now. All told it was in their head, that it was their fault (for being fat, obviously, was the subtext), that they were somehow hyperchondriacs who should know better, and the underlying premise of all of that men versus women heart stuff is that men are more at risk because they work harder, have more responsibility, whereas the little women stay home, have a smaller sphere of influence and less responsibility.

    Please, even if you think you are not at risk, read the Heart Healthy Women site: http://www.hearthealthywomen.org/
    If it doesn’t pertain to you, it might help you save the life of a woman you love – your mom, your sister, your friend, your daughter.

  49. “Moreover, there is a peculiarly modern predilection for psychological explanations of disease, as of everything else. “

    It isn’t a modern predilection. It’s been around for aeons. In fact it probably predates modern medicine considerably. The idea that God(s) only visit harm on those who deserve it.

    And Lynnette, I’m so very sorry for your loss.

  50. Geekgirlsrule, that’s a spiritual/moral explanation, not a psychological one. I mean, it has similar effects, but part of what Sontag is getting at is that since psychology has a weird status of being both medical/public *and* personal/private, there is a special kind of stigma attached to the psychologization of illness. Sontag does talk about pre-modern ideas of illness as God’s wrath, but she points out that these were often conceptualized as plagues — i.e., societal illnesses — rather than individual failings.

  51. Very interesting post, and I never knew about this issue. I can’t believe I’m 22 years old and no one has yet explained to me that symptoms can be so different in women.

    The comments over on Kate’s post are really fucking depressing, though. They remind me why I so often skip reading comments on other forums/websites.

  52. Anonymoose, what a powerfully moving comment. Thank you for delurking to share it.

    and the underlying premise of all of that men versus women heart stuff is that men are more at risk because they work harder, have more responsibility, whereas the little women stay home, have a smaller sphere of influence and less responsibility.

    Absolutely. And this is why the default medical body has been male for so long.

  53. Alice – I totally understand your perspective, although for me, I hope to wait to shuffle of the mortal coil sometime in my 80s, but wouldn’t really want more. There’s only so much storage in my head, anyway: already, the years are getting shorter.

    It’s my understanding is that our DNA egg timers are to protect the evolutionary payoff that the kineococcus doesn’t need — mammalian tendancies that take a lot of overhead and need exponentially higher levels of cooperative organization, which really break down over a longer time frame because of the complexity of the system. Easier and less upkeep for a hammer (or bacteria) to work for a thousand years than a car (or mammal). Maintaining all the organs necessary and protein cascades and hormonal cascades in peak condition over a longer time window is a different ‘problem’ than maintaining a bacteria, and there’s little payoff evolutionarily. Although us AS mammals constructed out of these genes might have a different perspective.

    Of course, I’m thinking of it from a gene’s perspective, what with the bioinformatics. But on that order, grandparents are useful for genes to survive (lower infant mortality rates) but great-grandparents are more work than necessary. Encouraging sexual reproduction for gene proliferation allows for wider biodiversity but makes the animal reproducing irrelevant after a certain point, AND pregnancy in
    is massively costly. I mean, even if we lived to 3000, our bodies couldn’t handle THAT many pregnancies, even if our eggs weren’t utter genetic mush by that point. (And we’d likely kill each other anyway. Plus end up mating with our great great great grandchildren. Buh.)

    So our genes match our uteruses and our bones and our hearts and our temperments.

    Of course, teh medical folken will have a different outlook and be looking for the cure. I just found something really peaceful in understanding that regardless of what we might WANT, the way our bodies and our diseases go together all make sense in relation to every mammal that ever had sex, made ancestors, or died. We are timed to expire – and perhaps we will rage against the dying of the light – but we are timed to fail all together, our parts roughly exhibiting similar “best before” dates.

    It’s stunning, and it’s beautiful. To have that perspective of disease was really a gift, to me.

  54. Sontag does talk about pre-modern ideas of illness as God’s wrath, but she points out that these were often conceptualized as plagues — i.e., societal illnesses — rather than individual failings.

    Concerning “societal illness”: Particularly when it comes to cardiovascular health there is plenty of evidence that psychological wellbeing is actually quite important, and although psychological health does not seem to affect cancer a lot, it certainly does affect other aspects of health. But here is the thing: Psychological wellbeing is to a large degree influenced by social factors. It’s all good and well to learn stress management techniques, and if you cannot leave a stressful situation the best thing you can do is to learn to live with it as good as you can. Yet if you live in permanently stressful circumstances stress management is only getting you so far. I am a social psychologist myself (well, a social psychology grad student), and granted, that probably makes me a bit more focussed on social and societal influences on people. But one thing I hate about a lot of psychological research, particularly about clinical psychological research, is that it often assumes that the cause of the problem lies in the individual, not in his or her environement or the interaction of the two. (Perfect example: I have seen papers on the long term effects of bullying that were going on and on that there maybe something that makes people predisposed to being bullied. This might be the case, but going on and on about it is pretty close to victim blame.)

  55. Physical illness is turned into a psychological and moral failing. Mental illness starts there.

    As someone with a chronic[1] mental illness, I wind up with a lot of assumptions being made about my psychological and moral health. Given my mental illness is chronic endogenous[2] depression, quite a few of these assumptions are incorrect by default.

    Here’s a bit of a quick debunker’s guide to “common-sense” mental health diagnoses.

    * Suicidal impulses are not universally fatal. I’ve suffered from them for years. I’m not using a ouija board to write this.
    * Depression cannot be resolved by telling the sufferer to “cheer up” or “be happy”. Comments of the sort are similar in essence to someone telling a drowner to “breathe water”: superficially helpful, but physiologically unlikely.
    * Most mental illnesses do not harm the person’s capability to think or reason. They may mean the input gets a bit scrambled, or that certain emotional datums receive higher weighting than normal, but the processes themselves aren’t impaired.
    * The majority of mentally ill people are not idiots, and will not appreciate being treated as such.
    * Mental illnesses come in varying varieties and strengths, rather like physical illnesses. Not everyone who has them requires the padded cells and the jackets with the extra-long arms.
    * Taking medication for a mental illness is no more an expression of moral weakness than taking medication for an endocrine imbalance (eg hypothyroidism, diabetes).
    * Mental illness is generally not contagious.

    Finally, being mentally ill is not a sign of being posessed by demons, being morally weak, being mentally infirm, or being somehow psychologically or spiritually incomplete, any more than a sprained ankle indicates a person requires an amputation at the knee.

    [1] In the medical sense, “chronic” means “ongoing”. “Acute” means “severe” or “life-threatening”.
    [2] endogenous /En”dQdZIn@s, In-/
    · adj. technical of or relating to an internal cause or origin. Often contrasted with exogenous.
    – DERIVATIVES endogenously adv. (from the Concise Oxford English Dictionary)

  56. Arwen, what a lovely comment. I love that there are science geeks here other than myself. And a well-written explanation on genetics and evolution makes me so hawt. Rraawwrrr.

    You’ve really got to wonder, all these people who are crazy-making themselves in order to “be healthy” and “live longer” and “prevent heart attacks/diabetes/cancer” etc…..I mean, sometimes I really sit there and wonder: What do these people think they are going to die of, in the end? Do they really see this romantic vision of quietly passing away in their sleep of “old age” (which of course, is usually a euphamism for heart attack/diabetes/cancer) at the ripe old age of 102?

    And I love how it’s always this great vision of how, at 102 they’ll still be in great fucking shape because they “exercise and eat right.” Like that’s some sort of magic formula, and the day before they die quietly in their sleep they’re gonna be out running marathons and working the fields and working at a soup kitchen and winning a Nobel Prize, before retiring to bed surrounded by loved ones, reading their greats-cubed grandchildren a bedtime story, and then dying. As opposed to, you know, not being able to walk, having no control over their bowels, and dealing with crappy nursing home staff in their last days.

  57. Thank you, Meg Thornton. It seems crazy that those things still need to be said, but so many people still misunderstand. I also have major depression with suicidal thoughts, but I’m still kickin’, and even have a rather nice life. And it wasn’t until I let go of what I call the “gym coach mentality” (“You can beat it!! And if you’re not trying to beat it, then you want it, you deserve it!!”) that I was truly about to learn to cope, to learn to live as a depressed person.

    My other pet peeve, which relates to some of the talk on chronic physical ailments: if I am in a good mood, or feeling happy, people seem to automatically assume that my depressed has been “cured,” that I’m all better, and hey why am I still taking those meds anyways? It’s like, um, I’m depressed, but that doesn’t mean I’m depressed every moment of every single day. It’s like, because of my particular mental geography, I happen to have a river of depression running underneath me. At this point I’ve been able to build a bridge across it, and sometimes that bridge runs closer to the water than at other times. Sometimes I am so far above the water I almost can’t even hear it anymore, and all I can feel is the sun on my face. But I can’t let myself forget that it’s there, and I’m certainly not going to dismantle that bridge just because I happen to currently be on a high point, you know? That water is always there, bubbling underneath…..

    Oh, must stop the rambling. Must get back to work. Nooooo!!!

  58. grave, incurable illnesses (particularly cancer in the 20th century and TB in the 19th) get appropriated as metaphors for moral conditions, political events, and the like — and then the negative connotations associated with those metaphors are extended back onto the people who actually suffer from the disease. Cancer becomes a sign of moral weakness, of the wrong kind of personality, instead of a physical ailment that could happen to anyone. … Physical illness is psychologized to shift “blame” — from environmental hazards, the inadequacies of medical knowledge, and just plain chance — onto the individual.

    Ah, thank you for articulating this so beautifully. Bookmarking this post for the anti-magical-thinking-blame-the-victim-cancer-is-a-moral-failing-The Secret-really-works files.

    And Kate’s Sister J – you, too:

    it’s a defense mechanism. Our brains can’t cope with the knowledge that we are susceptible to random, fatal forces, so we latch onto an explanation that puts control (theoretically) back into our hands.

    I agree, and simultaneously consider it my responsibility as a critically-thinking human being to understand this need for an illusory sense of control while simultaneously holding people accountable for using their fear as a weapon against others – because it’s never, ever appropriate or useful or acceptable (comprehensible as an externalized fear of death/lack of control or not).

    Super-relief to read this today, for a number of reasons/deaths/cancers close to me/victim blamings etc.. Thanks again.

  59. This may be a thread hi-jack, but the NY Times article made me think of an article my uncle wrote for the SF Chronicle: Tim Russert’s Death Hits Too Close To Home.

    My uncle had a heart attack last year and was, understandably, scared shitless by it. After he had recovered a bit, he decided to make my overweight father his “project”; my uncle’s logic was if he, a normal-weight man who eats well and doesn’t smoke, could have a heart attack, well then my father, an overweight smoker, must be on death’s doorstep. It was awful… he sent intrusive letters to my father that said things like, “if you love your wife and daughter, you’ll lose weight and not put them through the hell of dealing with your fat-related illnesses”.

    Last month, after the linked column was published, he sent it to the overweight people in my family (me included). He’s been a journalist all my life, and I’m a bloody journalism student and he’d never bothered to send me one of his columns before. Until he wrote one about fat killing people.

    It really makes me happy to know that he sees me and my dad and my husband and my fat cousin as nothing more than walking piles of flabby heart attack.

    Sorry for hijacking the thread… I just needed to get that off my chest.

  60. And I love how it’s always this great vision of how, at 102 they’ll still be in great fucking shape because they “exercise and eat right.” Like that’s some sort of magic formula, and the day before they die quietly in their sleep they’re gonna be out running marathons and working the fields and working at a soup kitchen and winning a Nobel Prize, before retiring to bed surrounded by loved ones, reading their greats-cubed grandchildren a bedtime story, and then dying. As opposed to, you know, not being able to walk, having no control over their bowels, and dealing with crappy nursing home staff in their last days.

    EntoAggie – I can’t completely put my finger on why, but this part of your comment makes me uncomfortable. I agree that a lot of people seem to somehow think they will “get old without ageing” if they just do the “right” thing. On the other hand, your comment somehow sounds like being old is somehow a miserable, pittyful state. And that’s not true either. Very few people will be in the physical shape to run a marathon when they are in their 80s or 90s, and yes, they might eventually even lose control over their bowel movements, but I have seen all of my grandparents age and finally die in their late 80s and early 90s from very close by (I lived in the same house) and for the most part I think they still had a good life. (The exception was my mum’s mum who had a stroke five years before she died and who subsequently became terribly depressed – not so much due to the brain damage which was more motor skills related, but due to the fact that despite my mum’s efforts it seemed that she did not really find a sense in her life anymore after she lost her ability to do many of her usual activities and especially after her husband died.)

    Ageing does not have to be terrible and old people have a lot to contribute to society – although their contributions might be different from what young people can contribute. And yes, this is even true for demented people. I have worked with some old people in the past, and some of them have given and taught me things I never could have gotten from a younger person. (And crappy nursing home staff is a societal problem that has to do with how we treat old people, not a problem that naturally comes with ageing.)

  61. queendom, I reread my comment and I realize how insensitive it was. I’m very sorry it made you (or anyone else) feel uncomfortable. I think I was letting my ire at the people who treat “eat right and exercise” as a magical incantation get away with me, inspired by the theme that’s been mentioned that our bodies are simply made in a way which it is nearly impossible to avoid health problems as we age, no matter what actions we take. But in the process I used language and an attitude that I shouldn’t have.

    FWIW, I absolutely agree with everything you’ve said about ageing and the elderly. And I’m not just saying that in an attempt to backpaddle myself out of the eddy I find myself stuck in.

  62. Arwen: I just found something really peaceful in understanding that regardless of what we might WANT, the way our bodies and our diseases go together all make sense in relation to every mammal that ever had sex, made ancestors, or died.

    Yes, that is the beauty of evolution. But equating the natural to the good is… questionable.

    EntoAggie: And I love how it’s always this great vision of how, at 102 they’ll still be in great fucking shape because they “exercise and eat right.”

    Probably not, but they might hope to be in great shape until the age of 60 instead of 40, even if they end up dying at 80 either way. That seems worth the trouble to me.

  63. Arwen,

    Yeah, like I said to queendom, my comment completely didn’t say what I meant it to say. I’m still kind of reeling that those dumbass words actually came out of my mouth. Er, fingers.

    You’re right, attempting to eat right and exercise to your ability is always an admirable goal, no matter your age. I should have made it more obvious that my irritation was directed at those who think it will make them immortal, or at least flawless up until their dying day, and (most importantly) think that they should impose their lifestyle choices on others through guilt and shame.

    (continues to pry foot out of mouth)

  64. When Tim Russert dies of a heart attack, everyone’s like “OH IT WAS BECAUSE HE WAS OVERWEIGHT.” When Jim Fixx died of a heart attack, nobody suggested that it was because he was at the “ideal weight”.

  65. @EntoAggie: I didn’t say anything! I think that’s Andrea. I understood what you were saying – although I also appreciate the input from everyone else – but I had some sense of where you were coming from.

    @Alice – I’m not arguing Natural=Good. That’s a meaningless statement based on some other construction of good. What’s good? For lemurs, all humans disappearing entirely might be good. For volcanos, what we do is meaningless. You have to have some context for “good”.

    I am resituating value – which is a very different thing, a philosophical difference I think I’m not communicating. I’m saying disease has value in biological history, as opposed to the individual. We fight our whole lives against disease as individuals, but it really is – as we are constructed by evolution – as much a part of who we are as our eyeballs. I’m not claiming human eyeballs are “good” either. They simply are of us. Bees eyeballs might be “better”, although I actually have a fair amount of faith that if we needed ‘em, we would have evolved them, but that bees eyeballs just cost too much for what humans need. Hell, same with FAT – fat just IS. It’s all this moral crap we stick on it that ends up making the picture ridiculous: we evolved fat.

    Now, we can argue whether people’s brains are better at creating systems than 15 million years of evolutionary biology, which is what I’m saying — see, not natural=good, but evolution=superior creator of systems and wow! a lot of shit is there for a REASON! — but my choice is already made. It’s why I studied bioinformatics – because I know how evolution stores data (elegant beyond my own limited comprehension) vs. the way humans store data in computers (learning, but awkward, and sorta dull in their simplicity).

    Science has a big picture, too. And if we step outside our individual frame of reference, we can see the value of that which irks us. This is a very different comment than saying that dead-stop Organic St. John’s Wart is better than Paxil.

  66. Regarding the elderly, just to throw in some more anecdata: my grandmother survived skin cancer, TB, and a heart attack to live a fairly happy life into her 90s. Whereas my mother, who has had some moderate health problems (diverticulitis, sinus surgery) but nothing as major as cancer, TB, OR a heart attack — let alone all of them together — is now suffering from severe dementia in her mid 60s. You can’t control this shit. You can take care of yourself in the way that seems most kind to you, but you don’t get to decide whether you keep your mental and physical faculties for an extra 30 years or not. It is not a matter of will.

  67. Oh, well, then I guess I’m convinced SM. Would you happen to know someone who lived into their 90s who smoked? Because I’ve always wanted to smoke save for the health risks, but if you could find such a person, that would disprove the idea that smoking is bad for you!

    More seriously, the implication of what you’re saying, SM, is that all problems related to age are or are close to 100% genetic, and that environmental factors for the multiple decades leading up to old age have no meaningful influence on long term health. I doubt that life expectancy has risen from 30 to 70 because our genetics are just that much better now.

  68. Alice, that’s not what I said. I’m responding to the conversation around EntoAggie’s comment (which she apologized for):

    And I love how it’s always this great vision of how, at 102 they’ll still be in great fucking shape because they “exercise and eat right.” Like that’s some sort of magic formula, and the day before they die quietly in their sleep they’re gonna be out running marathons and working the fields and working at a soup kitchen and winning a Nobel Prize, before retiring to bed surrounded by loved ones, reading their greats-cubed grandchildren a bedtime story, and then dying. As opposed to, you know, not being able to walk, having no control over their bowels, and dealing with crappy nursing home staff in their last days.

    I’m not trying to “convince” you to do anything except forgive your body for not always being perfect.

    I doubt that life expectancy has risen from 30 to 70 because our genetics are just that much better now.

    Where you get the idea that I’m suggesting anything of the sort from my example of contrasting experiences of being “elderly” is totally beyond me. And, hey, thanks for the snark in response to me talking about my dead grandmother and ailing mother.

  69. Alice, I’m pretty sure things like vaccines, antibiotics, access to clean water, nutrition, medical care (especially of infants and through childbirth), and understanding that microbes exist did more for the 30-70 jump than did power walks and tofu. It’s not that we can’t care for ourselves, obviously. We can and do. But a lot of those environmental factors are things like medicine and medical devices.

    Sedentary is a health risk, as is smoking, sure. Not compared to infant mortality pre-medical intervention, though. I mean, seriously, my mom wears coke-bottle glasses; even if smoking related cancers had taken her out at forty, without glasses she probably would have had a hard time making it out of her twenties. She was (before they realized she needed help), obviously sighted, but very, very prone to accidents.

    30 years is usually NOT something we’re doing, as individuals, on average. There are studies everywhere that show that. It has a lot to do with our environments, sure, but our wealth and schmancy technology and pharmacology is a big part of that environment. Heck, I doubt I’d be alive today if it weren’t for Modern Medicine ™ – I had an emergency c-section. The labour would have taken my son and I both out, and prevented the next one. (And so evolution would favor humans who have less strangly umbilical cords.)

  70. Loveandlight, oh, well, if Dr. Christopher said it. And if one dude tried it and three people think it worked. Your anecdata has won me over!

    Note that the guy in the anecdote went to the hospital.

    And I don’t think that the only reason naturopathic medicines are often less investigated than other substances because isnaturopaths don’t want them to be studied – I think it is sometimes also because drug companies wouldn’t be able to gain a lot of money with them.

    Yes.

    However, I agree that it is irresponsible to continue to prescribe something that has been shown to have no effect whatsoever.

    Word.

  71. Alice, it sounded like she was saying that risk factors are about, well, probability, which means nothing is a sure thing. In many cases when people are so worried about risk factors, they’re talking about tiny numbers, as well – obesity might double your chance for some illness, but if the risk of developing that illness is 1 in a gazillion, who the hell cares? But even with larger numbers, knowing about risk factors is basically a good way to remember to be *watchful*.

    Risk factors for the illnesses being discussed might be hugely genetic, yes! And that has basically nothing to do with our increased lifespan. Preventative care in the form of routine tests, and treatment in the event things are going seriously wrong, are so much better now than they used to be. But more importantly, we now are SO MUCH more able to treat injuries and diseases that used to kill people long before most of them would have died from heart disease or cancer. I mean, for fuck’s sake, we have ANTIBIOTICS. We also have more readily and cheaply available food, even if its quality isn’t great, so more people are fed enough to survive that long.

    I think the preventative benefit of eating “right” and exercising “right” is there, but it’s only become much of a benefit because we’re better at dealing with so much other shit now. And yeah – my skinny, pretty fit, lowest-cholesterol-and-blood-pressure-ever dad with no family history of heart disease had a near heart attack and a stent put in last month. His test results had been normal the week before. Anecdata like these run counter to the statistical trends, and that is USEFUL for reminding us that our ability to control everything is false. We can’t fix the fact that we live in an existence full of CHANCE.

    I also really don’t understand why the suggestion that we can’t fix the universe is making you so angry.

  72. And in the future I should stop being so nervous about posting and stop editing and re-editing and just hit Submit, because now i’m late to the party!

  73. Note that the guy in the anecdote went to the hospital.

    Making it even more useless as anecdata for the effectiveness of cayenne.

    Alice, if you’re planning to snark about Lynne’s dad’s heart now, you can just nip that in the bud.

  74. Aw, after her ridiculously nasty statement that anyone who is desperate enough to turn to a naturopath gets what they deserve, I’ve been kind of itching for a fight!

  75. Aw, after her ridiculously nasty statement that anyone who is desperate enough to turn to a naturopath gets what they deserve,

    It is certainly indicative of the classic control-freak mindset: “Anyone who lives and thinks differently from the way I do deserves to be punished!”

  76. I have to bow out of this discussion. In the process of writing a response I’ve noticed for the first time in my life that everyone I’ve ever cared about who is dead got that way due largely to human error. Every funeral I’ve attended has been preventable, and not in the sense that heart disease is preventable, or that murder is preventable, but in the utterly trivial sense that death due to lack of seatbelt is preventable (which was the cause of one of them), by people who you’d expect to work to prevent such deaths, either doctors, family members, or the person themselves.

    This makes me wonder if that is the reason why, as Lynne put it, I get so “angry” about the defeatist attitude characteristic of many people’s attitude toward death. I will have to reflect on this.

    In the mean time, I apologize if my snarkyness was excessive, and in regards to naturopaths, Lynne is right. The existence of people who go to them is more a failure of education than of the patient.

  77. Well, I just tried a cayenne pepper toddy to see what would happen. Fillyjonk was right, the endorphin buzz is nice! (And yes, that’s pretty much the reason I decided to sample the recipe. I am far from averse to “altering my state”.) I was disappointed that it didn’t clear up the congestion in my left nostril, but it is allergy-related congestion, and sudafed seems to be the only thing that works for that. (Tried saline spray: Made the problem worse. Bummer.)

  78. Making it even more useless as anecdata for the effectiveness of cayenne.

    The patient did indicate that it provided him with an apparent relief that his usual nitro didn’t. But having just experienced the mild psychoactive effect, perhaps the endorphin-rush helped him get a grip on his panic. Getting completely and totally freaked out raises your blood pressure, so I can see how such a reaction would make a heart attack worse and how dampening that reaction could bring improvement enough to get the patient to the hospital alive.

  79. The existence of people who go to them is more a failure of education than of the patient.

    You’re neglecting the category of people who are victims of negligence, oversight, neglect, and outright malpractice by the medical establishment and who have either no trust in doctors or essentially nowhere left to turn. Reading up on everything they can themselves and going to someone who at least gives them the time of day and has some ideas about things to *try* is better than sitting at home with a chronic illness and no treatment. And no one who isn’t highly trained can just pick up medical science literature and understand all the nuances involved – that level of education is impossible for the public.

    Fwiw, I got some genuine benefit out of self-treatment and help from a well-rounded naturopath (she had a science background and had a really good handle on herb dosage, side effects, etc.), at a time when I was not able to see a local specialist and was dealing with a flare-up of my chronic disease following some very bad doctoring (very careless prescription of a medication that was questionable for someone with my illness). I’m literate and educated and not an idiot. She was well trained, smart, and did me a lot of good.

    Less defensively on my part, Alice, I’m sorry you’ve had to deal with so much tragedy, and yes, a lot of deaths are due to errors and mistakes and that can be really sad and frustrating. But the timing and manner of deaths are due to chance as well – wearing a seatbelt is an easy preventative measure, but failing to wear one isn’t usually fatal because accidents usually don’t happen. I guess I feel like knowing about danger and taking reasonable precautions is a good idea. Fearing and constantly obsessing over the prevention of death, however, is not useful or mentally healthy for most of us. And I don’t think it’s a defeatist attitude to accept that we are ALL GOING TO DIE.

  80. Alice, I’m sorry for your losses.

    This makes me wonder if that is the reason why, as Lynne put it, I get so “angry” about the defeatist attitude characteristic of many people’s attitude toward death. I will have to reflect on this.

    How is acknowledging that death will happen to you even if you do everything “right” defeatist? Death is the end of life; life contains death. My whole point with this post is that while there are some very pragmatic things you can do to preserve your life — like calling 911 when you recognized heart attack symptoms — it is unrealistic and unfair to yourself to think that death only happens to the morally weak.

  81. Sweet Machine: …it is unrealistic and unfair to yourself to think that death only happens to the morally weak.

    Oh well if THAT’S the point you’ve been making then yeah, I agree. One is tempted to ask ,”There are people who don’t?” There are, of course, but still…

    But you used much more absolute language in your post, “You can’t control this shit.” What bugs me is that you seem to go from the fact that you can’t control it absolutely to saying that you can’t even influence it.

    The defeatism comes into play when you have people who seem to be happy with living till 80 and leaving it at that, because that is as far as they can imagine themselves living. Surely we know that if people around 100 years ago in America accepted the present state of the art, it’d be giving up prematurely, but we only know that in retrospect. Since anyone in the past who looked at the current state of medicine and thought, “This is as good as it gets” was wrong, I think it’s a bit early to do the exact same thing for our own time.

    I don’t expect to live forever, nor do I even expect the eventual existence of things that live forever, simply because the inevitable heat death of the universe will ultimately render all of space a featureless void occupied only by light too low in frequency to detect. But death, like control, is a matter of degree. If nothing else, the longer you live, the more you get to see how things turn out.

    Lynne: Fearing and constantly obsessing over the prevention of death, however, is not useful or mentally healthy for most of us.

    Hmm, I don’t think I fear death. Or rather, I don’t fear being dead. It’s the dying that’s the hard part! After that, what’s there to worry about? We all know what it’s like to be dead, and we all know it’s not a particularly bad state to be in, as before we were born we’ve all been dead for billions of years without the slightest inconvenience.

  82. What bugs me is that you seem to go from the fact that you can’t control it absolutely to saying that you can’t even influence it.

    Alice, I’m already really fucking pissed at you for how insensitive and aggro you’ve been acting. So I’m not going to bother to explain to you why you’re completely missing the point, but you don’t even know what “it” refers to in this sentence. NO, YOU CANNOT INFLUENCE IT. THE “IT” THAT EVERYONE ELSE IS TALKING ABOUT IS DEATH. IT IS GOING TO HAPPEN.

    And personally, I think not fearing it is fucking idiotic. But you don’t deal with that fear by convincing yourself that you can dodge it completely if you only do everything right.

  83. I am truly sorry for your losses, Alice.

    Surely we know that if people around 100 years ago in America accepted the present state of the art, it’d be giving up prematurely, but we only know that in retrospect.

    As individuals, the folks of 100 years ago had about as much control as we have now, though: it is medicine and medical research doing most of the heavy lifting in our mortality rates. I don’t think anyone here is suggesting that all the medical research shuts down. (Although I bet a lot of people here would have something to say about it being pried apart from the profit motive, and policed for influences like, oh I don’t know, selling “obesity cures”.)

    Preventable deaths are things we can effect, but our entire society – whether mainstream (OMG OBEESITY!) or alternative (OMG ANGER AND WHEAT!!) – has overblown our ability to control these things by such a large degree that we’ve put the onus on the individual. And it’s both not that simple and I think it’s has broken our society’s compassion. Now, when someone suffers high blood pressure, what do we think? We think “tsk hitting the salt too much there?” or diabetes “whoopsy got a problem with the chocolate there do you?”

    I think here’s the issue – you express: One is tempted to ask ,”There are people who don’t?”

    Just pick up a New York Times, a Cosmo, a health section on anything, and you’ll find hundreds of articles that show us if we’re “good”, for some value of good, we’ll live longer. Your cake is a sin, a devillish treat, you’ll be ‘good’ tomorrow….

    And when it comes down to it, on average, we don’t really have that much control. Doing it “right” isn’t a guarantee – more often than not, we are just trying to join a population that has a slight tendancy to live longer, and the causation’s not even really shown or understood – and doing it “wrong”‘s not a death sentence.

    But our minds, and the people marketing to us are in collusion to make it seem like we have far more control than we do.

  84. I think here’s the issue – you express: One is tempted to ask ,”There are people who don’t?”

    Yes, and the very next thing I said was that there are such people who don’t believe that. The point was that it’s inherently ridiculous that this is the case.

  85. Except that it’s the zeitgeist, which is why Susan Sontag thought to write about it and why this post exists. It is the reason that we’re talking at all. To challenge the zeitgeist.

    If that geist of zeit doesn’t affect you, if you are shocked there are people who find good health to be more “moral”, then obviously this thread will be meaning free for you.

    And since you were re-introducing the personal, you appeared to be performing a mild version of what Sontag, was challenging:
    Patients who are instructed that they have, unwittingly, caused their disease are also being made to feel that they have deserved it.
    Unwittingly, mind. Like maybe they didn’t power walk and eat enough tofu. Or maybe they were too angry or ate too much wheat.

    You appear to be persuing the personal choice side rather aggressively, which is a flip side of the position that Sontag and Sweet Machine were critiquing.

    So. If it is abundantly clear to you that illness is not moral, and you wonder why we’re talking about it, then I suggest you consider further how Sontag links personal responsibility and the addition of morality to the discussion of health.

    It’s a good essay.

  86. Alice, what FJ and Arwen said. I suggest you reread this post, starting with the fucking title.

    If that geist of zeit doesn’t affect you, if you are shocked there are people who find good health to be more “moral”, then obviously this thread will be meaning free for you.

    As will much of our blog.

  87. And also, not that FJ didn’t take care of this sentence already, but if you can point to the place where I said anything that implied this: What bugs me is that you seem to go from the fact that you can’t control it absolutely to saying that you can’t even influence it, I will eat a hat made of baby donuts.

  88. mm delicious hat. so much tastier than wheat.

    occupied only by light too low in frequency to detect. yeah, you’ve been angering enough for me to quibble and say that this isn’t called light.

    anyway, i agree with FJ that fearing death is normal, but being consumed and completely motivated by that fear is not a good thing. assigning blame for each person’s death is also something a lot of people do, and it’s understandable because of the overwhelmingness of loss – but it’s ultimately a futile mental exercise. death happens. at best we can put it off for a few decades by a combination of preventative action and dumb luck – but obsessing over the minutae of those possible preventative actions is not helpful or healthy and gets in the way of actually *living* that life in the meantime. i thought that this was kind of the point of SM’s awesome post?

  89. The thing about death, for me, is that it is so very inevitable and so very personal. When you talk about death, you are talking about the end of someone’s physical life, and so you are talking about yours, and your parents’, and your siblings’, and the end of everyone you know. You’re talking about the moment when someone’s body is no longer operative for life: the heart stops beating, the brain seizes, blood vessels burst.

    Current medicine holds that we can die from these, but not permanently; that our deaths can be averted. Our deaths are averted by medical care and competent doctors and good equipment. They are not averted by ‘exercising right’, or ‘eating right’. Correlation is not causation, etc cetera.

    The only thing ‘exercising right’ or ‘eating right’ averts is your doctor’s half-guilty thought of ‘they weren’t taking care of themselves anyway’ in an attempt to comfort themselves as to the reason for your death, the attempts of your friends and family to make you diet your arse off in the hopes of it not happening again under the mistaken belief the size of said arse had something to do with it, and your own sense of having done what you desperately could to stop the reaper from coming for you. The ugliness of these thoughts is not averted by exercising right and eating right, and that is because they are a product of society, not the individual.

    The only responsibility we have to ourselves is to live well, whatever that means for the person in question. Saying that we have a duty to struggle futilely against death by ‘exercising right’ and ‘eating right’ because it is the ‘morally right’ thing to do is the same thinking that surrounds dieting: as fat people, it is our moral responsibility not to be fat. And if we can’t do that, then we should at least be trying.

    I call bullshit. Mountains erode. Trees fall. Rivers fail. People die. Even if you live to be a thousand, you will still die. Even if you have yourself frozen cryogenically in the belief that one day there will be the technology to revive you, you will still die. Even if you eat all the wheat in the world and can deal with anger in minus three seconds and eat right and exercise right, you will still die.

    If you don’t want to do all that, then don’t. Don’t do all that to make yourself miserable in the hopes of being miserable for a few more years. It’s a waste of the time you deem so precious.

  90. Hey guys–thanks for all of the thoughts and well wishes. I really appreciate it!

    David exercised, not like a maniac or anything, but swam three times a week. We are well (most of the time), he quit smoking 14 years ago just after we met and his cholesterol was 150 WITHOUT medication. He was diabetic but that was well under control. Yes, he was a big guy but he was a healthy big guy. If you’d like to see some pictures of him (and a couple of me too), they are here:

    http://www.mem.com/ViewImages.aspx?ID=2386202

    The best we can do is to take care of ourselves (and those that we love). I know that life is really random so live it to its fullest and don’t sweat the small stuff. A lesson I am learning…

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