Healthism: an introduction
For those unfamiliar with the term & how it applies to wellness culture
Illness, whether temporary or chronic, is one of the most common, ordinary things. As Susan Sontag stated in “Illness as 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.” Unless you die before having health issues, you will experience them at some point. No magic juice cleanse or supplement will change this.
We live in an ableist society. Ableism impacts people with physical disabilities, sensory disabilities, intellectual disabilities, developmental conditions, mental illnesses, chronic illnesses, and more. Because that ableism can look different depending on which groups of disabled people are targeted, there are sometimes more specific terms used to describe these experiences of discrimination and ostracization. For example, to describe ableism towards people who are considered to have psychiatric disabilities, the term “sanism” is at times used. Another example is a term coined by Robert Crawford in 1980, “healthism,” which can impact anyone society considers “unhealthy,” such as chronically ill people, elderly people, or anyone society labels “overweight.” Able-bodied is considered the ideal, “sane” is considered the ideal, and “healthy” is considered the ideal, and we are expected to live up to these ideals and punished if we don't.
Even though more people are starting to realize that chronic illnesses are disabilities, I find that many people are still completely unaware of the fact that we are impacted by ableism. I have watched the confusion people experience when told that masks are accessibility requirements for many people or that it's eugenics to treat chronically ill people dying in pandemics as an inevitability that we shouldn't care about. A lot of people not only have narrow views about what counts as a disability, but also narrow views about what ableism is. I believe the term “healthism” really illustrates the underlying views many of us hold that make this world inaccessible, cruel, and insensitive towards chronically ill people. And I don't believe we can ever be liberated from ableism until we work on unlearning these views and refusing to tolerate the discrimination that they so often lead to.
Healthism exists everywhere in society. It exists in hospitals, in medical schools, in workplaces, in our education system. In “Healthism and the Medicalization of Everyday Life,” Robert Crawford mostly discussed the ways it shows up in our society’s obsession with achieving “wellness.” Because ableism in “wellness culture” is something I am very interested in right now, and because that's the context in which the term was originally coined, I will focus on healthism in wellness culture here. According to Robert Crawford, healthism is “the preoccupation with personal health as a primary-often the primary-focus for the definition and achievement of well-being; a goal which is to be attained primarily through the modification of life styles, with or without therapeutic help.” He adds “Healthists will acknowledge, in other words, that health problems may originate outside the individual, eg. in the American diet, but since these problems are also behavioral, solutions are seen to lie within the realm of individual choice. Hence, they require above all else the assumption of individual responsibility.” Crawford also theorized that healthism “reinforced one's feeling of being deviant” and added to the feeling of an endless need to compensate for whatever they feel they're “lacking.” With the focus on individual responsibility and the ability to control one's own health, those who are not “healthy” are deviant outcasts who lack the willpower and discipline to “prioritize wellness” and fight off illness.
In wellness culture, the pursuit of health and wellness is considered the ultimate goal. Wellness is an individual pursuit that if you're lucky, and if you follow every rule correctly, you will achieve. Painting “wellness” as an achievement also means that one's lack of health is viewed as a “failure.” If health is something you can achieve through miracle cures, restrictive diets, practices such as yoga, and so on, that means anyone who ends up with a chronic illness failed to do those things (or failed to do them correctly). In “Unhealthy Disabled: Treating Chronic Illnesses as Disabilities,” Susan Wendell describes how the concept of blame and responsibility for our health can impact people with chronic illnesses: “Even when our disabilities are considered genuine, there is often suspicion about our role in causing them.” According to Wendell, we are blamed “not only during the process of seeking a diagnosis, but also during every relapse or deterioration of their condition, which they are expected (by doctors, loved ones, employers, and the general public) to control.” Wellness spaces are rampant with this blame. Every illness is portrayed as if it's caused by a careless diet, a lack of self-care, or laziness.
I understand the anxiety that we collectively have around health. Our health impacts our lives so profoundly, and yet throughout history, it has been something we have extremely little control over. Before vaccines and antibiotics, an epidemic in your town meant surely you would lose a family member or friend if not your own life. We may not be quite as vulnerable as our ancestors in that regard (though we certainly still face the threat of pandemics), but we still face a level of vulnerability that makes us anxious and causes us to convince ourselves we have more control as a way of coping. Despite understanding the anxiety about health and illness all too well as someone with multiple chronic illnesses, I find the fearmongering about “disease” under the guise of “helping people achieve wellness” to be a great example of healthism. It is one thing to care about your health, but another thing entirely to fear disease so much that you cut out entire food groups and develop anxiety around ingredients the way some wellness influencers insist that you should. You will hear them warn about foods that cause diabetes, autoimmune disease, arthritis, and so on. As someone with a thyroid condition (Hashimoto's Disease), I notice pretty frequently that people are warning about foods that supposedly “cause” thyroid conditions. While I firmly believe more people should talk about thyroid health, it is very unlikely that my diet caused it. Having my condition presented as a scary scenario that people should completely change their diet to avoid is a trend I find very disturbing. The way certain conditions are talked about by wellness influencers makes it sound as if our lives are pitiful, meaningless, and not worth living. If that is truly the way one feels about a particular condition, I feel their time would be better spent getting involved with an organization that seeks to improve the quality of life of patients with that condition. But of course, that would not be in line with the individualism that is so essential to wellness culture.
There is a common trend in this “fear of disease” that you will see almost every wellness influencer use. This is language about “inflammation,” “toxins,” and “detoxing.” Inflammation is a vague term they can allude to as the cause of all diseases, and they can use the fear of inflammation to fearmonger about entire food groups and promote certain diets, supplements, and wellness practices. Inflammation is certainly a thing that does exist - many of us with chronic illnesses have had blood tests that check for inflammation. But these wellness influencers will tell you that you should obsess over inflammation and significantly alter your diet - often without any evidence to back up their claims. There is also the trend of “detoxing” through various cleanses that they claim will have the benefit of healing your body and/or protecting you from disease. Language about “inflammation,” “detoxification,” and “toxins” are ways these influencers fearmonger about disease and keep you constantly worried about what is going into your body and increasing your vulnerability. The underlying message is that a “diseased” state is inferior to a “healthy” one and that we have the ability to choose whether we're unhealthy or not.
Ironically, despite the fear of disease and putting “perfect health” on a pedestal, many within “wellness culture” are against scientifically proven ways of preventing disease. These are the same people who will often promote drinking raw milk, oppose vaccines, and oppose any use of medicine that isn't considered “alternative.” Many will also treat viruses as if they are not something to worry about and belittle you for worrying about them and trying to protect yourself. Even worse, they will say the reason they're not worried about a deadly, disabling virus like COVID is that they have a “good immune system.” This is a eugenicist, survival-of-the-fittest mentality to hold in the face of a pandemic that has killed so many people and continues to do so. It's what leads people to say we shouldn't worry about COVID because it “only kills elderly people and immunocompromised people” (which is not even true), because they view those who die from the virus as at fault for their “inferior” health. However, despite their “superior immune systems,” you may still find them promoting pseudoscientific immune-boosting supplements they swear by every year. It seems even their “superior immune systems” are not enough, but they'll try every immune-boosting supplement before putting on a mask or getting a COVID booster.
The assumption that everyone needs the same thing in order to achieve health and avoid disease is another example of healthism in wellness culture. We know that some ingredients, such as gluten or dairy, will be harmful to certain people and beneficial or neutral to others. We know that some people have certain vitamin deficiencies that require supplementation or dietary changes. We also know that the amount of exercise or sleep that people need in order to feel energized can vary. Yet somehow, every wellness influencer is convinced they know the secret every single person needs in order to be as healthy as possible. In their minds, all our bodies are exactly the same and there is no room for any differences. Not only does this erase our differences and cloud the reality of how diverse our needs are, but it can also be dangerous. When people are trying to convince you to buy supplements, they rarely mention the fact that we should talk to our doctors before trying a new one. I know that the medications I'm on and my thyroid condition make certain supplements unsafe for me. I am not telling others what to do, but I also try to limit my supplement use because there are lots of issues with the supplement industry - a fact I wish was talked about more, but I'm not surprised wellness influencers will never tell you that.
The obsession with quick fix miracle cures is another way that healthism manifests in wellness culture. As a chronically ill person, I totally understand wanting pain and discomfort to end. I am still trying to figure out how to manage multiple symptoms I deal with on a regular basis. The first issue I have with these cures is that they are often false promises that become a way to exploit chronically ill people. Many of the “cures” you'll find are unlikely to work on many of us. Just like the wellness influencer who treats all bodies as being in need of the same thing, these miracle cures treat chronically ill people as a monolith with the same triggers and biology. Miracle cures, whether in the form of a fad diet or a supplement, within a culture that treats health as an responsibility/achievement and lack of health as a failure/moral failing is bound to lead to a sense of failure in chronically ill people who do not find any benefit from them. Instead of assuming it just wasn't right for them, or that maybe the product or diet were ineffective for most people beyond the placebo effect, people will feel they were at fault for the cure not working. Finally, my issue with these cures is the rhetoric I've seen used to promote them. They often come back to assumptions about qualities of life with chronic illnesses - if you want to get back to “living your life” as it is meant to be lived, you must take these “miracle cures” that eliminate all your pain and discomfort. And in the disability community, we know all too well that there is an assumption that we are inferior if we are not cured.
When scrolling through Tik Tok, you'll find a number of wellness influencers who want to diagnose you with a condition you had never thought about before. Popular ones for this include mold toxicity, candida overgrowth, adrenal fatigue, hormonal imbalances, high cortisol. The symptoms they list are usually symptoms that could be due to a wide variety of causes. Often, they'll insist that they have what you need to treat the condition - a supplement, an herbal remedy, an online course they've put together, an ebook. They'll usually still throw in a disclaimer that “this is not medical advice” despite literally giving you medical advice. And since you have just been told what you need to do about the condition by a charismatic charlatan, you might not even see the point in seeking medical care, possibly leaving an actual underlying condition undiagnosed and untreated. Suddenly you are worried about a health problem you might not even actually have. I am not saying these problems are not real or that we can't use the Internet to learn more about our health problems, but that these influencers exploiting our pain and discomfort should not be the ones guiding us when it comes to our health. They contribute to healthism by fueling our paranoia about illness and sending the message that our health is always in our hands (and in the hands of social media influencers and wellness companies).
You might be thinking that healthism is nothing more than biased thinking about health rooted in a lack of understanding of illness and the many factors that contribute to it. But in its most extreme form, it becomes health supremacy. As Maarten Steenhagen defines it, “Health supremacism is the idea that someone who is deemed ‘healthy’ is superior to someone who has some form of impairment to their health; any form of perceived illness or presumed health impairment — on this line of thinking — makes you a categorically ‘inferior’ person. Health supremacism says that those who are healthy have a natural privilege to dominate others in society.” And when you think of health as something you've achieved, as something that says anything about your morality, or as a matter of “individual responsibility,” eventually your thinking will very likely lead to that supremacy. You can challenge healthism and health supremacy in yourself and others by changing the way you think about health and by fighting for societal changes that will benefit us all - like universal healthcare, paid sick leave, disability justice, and combating climate change, income inequality, and racial inequality.
Resist this healthist / health supremacist culture that treats chronically ill and other “unhealthy” people as disposable burdens, deviant, and at fault for their own lack of health. Unlearn the idea that you are immune to illness just because you have been lucky so far, and that you are superior because of this. Stop chasing “perfect health” through dangerous dietary restrictions and wellness fads. You will save yourself and others a lot of grief in the process.
Sources
Crawford, R. (1980). Healthism and the Medicalization of Everyday Life. International Journal of Health Services, 10(3), 365–388. https://doi.org/10.2190/3h2h-3xjn-3kay-g9ny
Sontag, S. (2002). Illness as Metaphor. Penguin Books.
Steenhagen, M. (2023, April 16). Loathe fascism? then don’t be a health supremacist. Medium. https://msteenhagen.medium.com/loathe-fascism-then-dont-be-a-health-supremacist-c8841acdf69
Wendell, S. (2001). Unhealthy Disabled: Treating Chronic Illnesses as Disabilities. Hypatia, 16(4), 17–33. https://doi.org/10.1353/hyp.2001.0062