By Meaghan P. Ruddy
When we speak of addiction, there is a lot we can say. We can talk about stigmatization, how stigma is a mark, a signifier of something often associated with shame and disgrace, which in turn are responses to things deemed problematic by dominant cultural narratives. We could focus on historical usages of stigmatizing practices, how we come to know disgrace and feel shame by observing how others, particularly those who are in helper roles, respond to our marks, and how all of this negatively impacts healthcare. And we could, as we often do, speak about it from the safe, professional distance of the theoretical.
But there is a simpler truth here.
It is the truth expressed by the civil rights movement, the equity in marriage movement, and women’s suffrage. It is the truth that fuels both political correctness and the fight against it. It is the truth that language matters.
Think about it. If it didn’t matter, we would never take offense, never laugh at a joke, never tear up at a well-delivered line in a film or speech. No one would bristle at terms with historically racist or fascist overtones.
Yet, we do.
Except. Except for one challenging, and unfortunately swiftly growing population.
Yeah, but c’mon, someone might say. They are seeking drugs. They’re a huge problem! They should know better.
When we think we know the reason for an illness and the healthy answer seems so simple, conditions suddenly become the results of poor decision-making and the people who have them deserving of shame. Launching stigmatic narratives becomes as easy for us now as it was for people in the European Dark Ages to launch claims of possession against the mentally ill. (How often do we still say someone is wrestling with their demons?) Yes, people with challenging, complex illnesses like addiction are hard to help. Where causes seem simple and controllable we jump to conclusions about what ought to be happening and we miss the opportunity to better understand and better respond. These people are human beings in pain, people will illnesses, reduced to their behaviors and conditions.
It’s so embedded in the culture of health care that attempts to change the narrative are met with eye rolling or blank stares. I was once in a situation where a valued faculty person was lecturing on alternatives to opioids, or ALTOs, which is an important topic. This person worked in an emergency department that was becoming a go-to for a lot of people struggling with opioid addiction. The patients were numerous and disruptive, and in almost every instance the faculty person called them drug-seekers. Afterward I attempted a corrective, asking if the term hit anyone’s ear harshly, but I ended up being the target of criticism. But they are addicts, they are drug-seeking. They need to get clean. All of this language is incredibly value-laden and it is pernicious when used by a faculty member. There is nothing more that learners want than to be accepted by their discipline and one of the rights of passage to acceptance is learning the language. But they are addicts, they are drug-seeking. They need to get clean. Imagine the power of a faculty member saying, no – they are people with an illness, they are human beings seeking help. They’re not dirty. They need help to succeed in recovering.
We isolate, and are isolated by stigma. It is dehumanizing for everyone.
Stigmatizing narratives create walls between the good and the bad, between the healthy and the ill. Stigma is the new institutionalism. Mental health and addiction remain largely behind the bars of stigma and patients know it. One recent study found that people struggling with these issues are hesitant to disclose their concerns to physicians for fear of being judged. They know that the stigma of mental health and addiction will cause them to be lumped into clusters of lazy depressives and criminal drug-seekers who clog systems and reduce productivity.
But other patients won’t want to be in the waiting room with them. Providers don’t want to be saddled with their care. They’re non-compliant. Nothing but problems, those people.
The potential power of the healthcare community to change this cultural narrative as it is doing with cancer, HIV, and diabetes is incredible. Given the need for people with stigmatized illnesses to get ongoing, compassionate care, it is a gut punch to know that healthcare is often failing to teach the next generation of care providers to think before they speak and recognize how much language matters when trying to work with this patient population. There is nothing theoretical about it.
Meaghan Ruddy, MA, PhD is the vice president for academic affairs and director of medical education at the Wright Center for Graduate Medical Education. She is an adjunct assistant professor of clinical science at AT Still University School of Osteopathic Medicine in Mesa, AZ and a Coaching Fellow with the Institute for Healthcare Improvement.