clock menu more-arrow no yes

Americans tend to see disease as a personal failure. That’s a terrible way of thinking about it.

Americans have a history of linking disease with failure and blame. It’s happening again with the coronavirus pandemic. 

A FDNY paramedic unloads a patient from an ambulance near the Emergency Room entrance to the Brooklyn Hospital Center on April 23.
Mike Lawrie/Getty Images

For the last month or so, I’ve been reading about and following every pandemic precaution that health officials have prescribed — from wearing a mask and washing my hands multiple times a day to getting groceries delivered and staying six feet apart from everyone I see.

I’m a natural hypochondriac and live in a constant state of overreaction. But I also operate with the mentality that as long as I follow all these rules, I won’t get sick. And that’s a mentality I’ve recently learned can be helpful in protecting yourself from the coronavirus, but can also be counterproductive if sickness is thought about as a punishment for not following said rules.

Since the beginning of the pandemic, I’ve been talking to Anna Muldoon, a former science policy adviser at the US Department of Health and Human Services and current PhD candidate researching infectious disease and social crises at Arizona State University.

While our conversations have mostly covered lighter topics like sex and dating, they’ve all touched on one shared theme of blame, and the tendency so many of us have to view disease as a personal failure. It’s the inverse of the “follow all the rules and you won’t get sick” mindset: If you get sick, it’s your own fault for not protecting yourself the way you should have.

That mindset can be exhausting and mentally draining. But as Muldoon explains, American history, time and again, has shown that it can also be devastating when it’s used to justify ignoring communities like gay men during the AIDS crisis, or when it’s weaponized against immigrants and racial minorities — stories of Asian Americans facing racist attacks have risen during the pandemic. Approaching disease as a blame game or personal failure can be as harmful as the disease itself.

Alex Abad-Santos

So, disease as punishment or failure — sorry to be so bleak. Where do we start?

Anna Muldoon

I mean, here’s the horrifying thing. I would say that the idea of sickness as divine punishment goes way back. You can find that in discussions of the plague in Europe. It’s a really old conception.

Alex Abad-Santos

I mean, look no further than the Bible.

Anna Muldoon

Exactly. The plagues in Egypt are punishment for Pharaoh and for the Egyptians. And so, I think that is pretty embedded in a lot of Western cultures. I think some have moved further from it than others, but the fact that we had a National Day of Prayer [for Americans affected by the pandemic] indicates that at least some large portion of the US still sees disease that way. And Fred Phelps [the Westboro Baptist Church pastor who died in 2014] exists, and blamed homosexuality for AIDS, and said that AIDS is punishment for immorality within the country.

I’m dividing this history into two strands. One is the disease as punishment, and then the second one is individual behavior, because they intertwine in horrible ways, but they’re separate things that then twist themselves together.

Alex Abad-Santos

So if we’re talking about the US, specifically, and the idea of disease as punishment and something worthy of blame, what does that history look like?

Anna Muldoon

So, that idea has been present for a very long time, and you see it in the 1721 Boston [smallpox epidemic]. There are debates about whether you should inoculate people for smallpox because it’s divine punishment. You see it in New York in the 1830s and 1850s around cholera, with people asking, “Is cholera punishment for immigrant immorality?” — which obviously is also political, because immigrants become the people that they’re blaming for the entry of cholera, and also then blaming for their own illness for not behaving like the uptight Puritan leaders of the city — technically they were Dutch Reform, not Puritan by then. Just as uptight, though!

In the 19th century, really, you start to get this shift from punishment of a community to this idea of the early version of what we all call behaviorism.

Alex Abad-Santos

And that’s more about blaming sickness on behavior? And also thinking about getting sick as a personal failure.

Anna Muldoon

Right. It’s the behavioral turn in health discussions that begins to identify, in some cases helpfully, causes of disease that are controllable: heavy drinking leading to liver problems, stuff like that. But it’s also really focused on the idea that if people led good, clean, upstanding lives, they would never get sick. And that idea has really continued in America in ways that are sometimes useful: like smoking or eating food that isn’t good for us.

Alex Abad-Santos

In some ways, we’re not that far off than the way people throughout history have used gods and goddesses and folktales to explain stuff they didn’t quite understand. Do you think it’s so that people can put their faith in something like behavior, or the idea of divine punishment, as a coping mechanism? Do you think that behaviorism, in a sense, might make stuff easier to compartmentalize and cope with stressful or bleak stuff?

Anna Muldoon

Absolutely. So, I think in a lot of ways it is incredibly difficult for people to understand and cope with the ways in which a lot of diseases are random. Some diseases, like infectious disease, you come in contact with a person or an object that you get the disease from. Something like cancer is so often random, not always true with breast cancer — there are genetics there and with some forms of cancer, there are genetic predispositions — but a lot of cancers are effectively random to the best of our knowledge. And randomness is incredibly hard for people to cope with.

For example, when my stepmother had cancer, people sent her all of these things about how her high-stress lifestyle, or having anxiety, could cause stomach cancer. None of that is true. But they were very much like, “If you’re sick, you must have done something. There’s something in your life [that you can change].”

Alex Abad-Santos

That seems like it comes from a good place, but also yikes! But isn’t that our cultural mindset? “If you follow these rules, you won’t get sick.” And that fits a pattern with American culture in general: If you follow the rules then you will succeed, or be desirable, or be a good parent, or yeah, not get sick.

Anna Muldoon

There’s a book called The Protestant Ethic by Max Weber that talks about the ways that early Protestantism encourages this division of self from community, but also encourages a form of life where everything is controllable. I mean, there’s also weird stuff going on there where, like, man is supposed to control everything and yet predestination is real. So it’s complicated.

Alex Abad-Santos

It all just seems to go back to coping mechanisms. We all have our different ways, and all of history has had its different way, of coping with stuff that’s not easily explained. It’s easier to cope with something if you accept the idea that it’s something “I” did.

Anna Muldoon

Also, disease is frightening. It’s much easier if you can look at the other person and say, “They must have done something wrong. I don’t do that thing, so I’ll be safe.”

This logic is, of course, also used to stigmatize groups that have particular illnesses or have a particular disease. It has been used historically against Chinese Americans, against African Americans, against both originally gay communities and later African American communities with AIDS, against immigrant communities with cholera that were mostly Irish and Italian Catholic immigrants. There were all these stories about how communion wine causes cholera, because people are crazy.

Alex Abad-Santos

From a young age, my mom told me to stay away from communion wine. She’d give my siblings and me a look that said, “No. Don’t even try that. That’s so gross.”

Anna Muldoon

She’s totally right.

Alex Abad-Santos

Back to the behavior aspect. It can come from a place of good intentions, like getting people to wash their hands or live healthier lives, but it also seems to fuel some truly awful outcomes.

Anna Muldoon

Right. It has also been a tool for a lot of really, really ugly things. And it’s worth us having a cultural conversation about the ways that we blame people who get whatever disease for something that may or may not be within their control, and particularly for diseases that are seen as STDs.

AIDS is the classic example of all of this, and probably the most well-studied. A lot of the country was perfectly willing to completely ignore AIDS until hemophiliac children started getting it. And then it was a thing.

Alex Abad-Santos

I think I remember reading about Ryan White (a hemophiliac 13-year-old who was diagnosed with AIDS following a blood transfusion) when I was in grade school. I was Catholic, and that was the story we were allowed to read about AIDS. It wasn’t until later in college that I learned about the extent of the devastation.

Anna Muldoon

When I went to high school in New Jersey, we still had worksheets that had GRID [Gay-Related Immune Deficiency, the original name for AIDS] crossed out at the top with AIDS handwritten underneath it in the mid-‘90s, which was really horrifying, because we’re close enough to New York that most of us knew someone that had died of AIDS.

AIDS erased entire communities and worlds. The stigma of AIDS was so intense, and it was used as a tool to further marginalize gay communities, in particular, early in its discovery and its identification.

I’m saying gay, not LGBT, because it was in particular gay men that people went after during the AIDS crisis. So when AIDS became a thing in the public consciousness, it was attached to a community that was already stigmatized. And that made it in some ways very easy for people to make it a disease full of blame.

Alex Abad-Santos

I think when we talk about blame we often think about actions that are worthy of blame. But blame-worthy actions can even be a passive thing, like ignoring people who need help. There are probably some schools, like the ones I went to, where the AIDS crisis is glossed over. That shows the damage this mindset can do. What are we seeing so far with Covid-19?

Anna Muldoon

It’s important to remember that right now, Covid-19 stigma is a major problem and a growing one, but it is not being used in quite the same ways that it was during AIDS to fire people and stigmatize entire communities.

Alex Abad-Santos

Yeah. It’s very different in that it’s not as weaponized. But it’s still part of a xenophobic and racist dog whistle. The whole idea of calling it the “Chinese flu” or the “Wuhan flu” places blame for its existence on Chinese or Asian people.

Anna Muldoon

Absolutely. And I mean, early on [in the pandemic], out of pure happenstance, I had just been reading about and starting to write about the quarantine of Chinatown in 1905 in San Francisco, and how horrifying it was.

And I think it is important to remember, as we talk, the ways that Covid-19 is being used to stigmatize, exclude, and attack Chinese American communities, and of course, all Asian American communities.

The US has a long history of nastiness around diseases, in particular with the Chinese. This goes back to 19th-century views of Asia in general, but China in particular, and this strange fear that emerges at the end of the 19th century that there are so many Chinese people that they’re going to take over the world. There are all of these horrific novels [about that happening]. As a genre it’s called yellow peril literature.

But that kind of fear gets used to justify restrictions on the movement of Chinese Americans on the West Coast, and the Chinese Exclusion Act, and public health laws that target them. And then eventually, the quarantine of Chinatown, where they basically locked thousands of people into Chinatown with no access to jobs or food.

Alex Abad-Santos

I’m not that well-versed in American history and public health, but it seems like the common thread here is a blind spot. The history of just how hostile America has been to Chinese people, to gay people, to immigrants — we aren’t really taught this. And these actions are hard to conceptualize, I guess, if they aren’t directly affecting you or your community.

Anna Muldoon

It’s pretty much just been erased and people have forgotten. And I think that there are a lot of ways in which that is directly linked to the ways that America wants to pretend that racism is over and everything’s fine right now. And so they’ve erased the ways that public health and medical systems have discriminated against anyone, basically, that isn’t a white Protestant, for a very long time.

One of the things we do, a disservice to our current generations, and in ways of honoring the dead, is that we don’t talk about the ways these things have been horrible before, and that lets us forget them and make a happier story of America in a way that obviously excludes all the people that have been harmed.

But also, in some ways, that means we forget the lessons that we should have taken from those things, that we should be looking at those moments and saying, “We will never do things like this again. It is crucial that we build our systems and build a culture and build a national awareness in ways that no one could ever stomach that again.” You live in America right now, and you know that we have not managed to do that.

Alex Abad-Santos

Right now there’s a push in some states to open things up again — beaches, salons, restaurants, and other businesses. Do you think in these cases there’s a mentality that what’s affecting other people can’t affect me, because those people who got sick didn’t take the right precautions? Are people, again, ignoring the people this is affecting?

Anna Muldoon

In America, we tend to assign individual blame to avoid looking at structural issues. So by blaming the individual, or blaming the community, we avoid having to look at the ways our social structures, our economic structures, put people at risk and trap them in positions that make them more likely to get sick. Blaming those structural problems on the individual is a way to avoid having to acknowledge the structural problems.

One of the things that has been making me yell at the news recently is the discussion of how many black and Hispanic people have died from Covid-19, and the ways in which many of those articles are not acknowledging that these are long-term structural phenomena.

[Black and Hispanic death rates] are not [as high as they are] because those people are more susceptible, or because they’re doing anything wrong. That is because those folks have been historically excluded and discriminated against, and therefore are more likely, unfortunately, to be in positions where they still have to go out and work.

Long-term discrimination — whether it’s economic, social, medical — means that those communities are being put at greater risk by our social systems. And yet so many of those articles just hand-wave all of that away. And they’re like, “Well, maybe they’re more susceptible.” And that is not what’s going on.

Alex Abad-Santos

I was reading someone who tweeted, “Oh, maybe there’s more pollution in urban areas where these people live.”

Anna Muldoon

Seriously, the answer is long-term structural racism that has forced these communities into a situation where they are getting sick. And I think that in general, America does a lot of pointing at the individual to avoid having to look at ourselves and our national structures and our national values, and the ways in which they harm people and create danger for the people that are excluded. True for AIDS, true for any of the diseases that we’ve talked about, and true for Covid-19.

Alex Abad-Santos

So, I want to get to the bright side of this, to what you call “a culture of care and resilience.” What can we do today, on a personal level, to change the way we think about disease?

Anna Muldoon

I mean, obvious things that need to be said that I have no idea how to fix, like fight racism and fight for less structurally unequal systems. Those things have to happen in order for these differences in death rates [xenophobic attacks] not to exist. We have to fix our structures. If I knew how to do that, I would be doing it. I don’t know. I wish I did.

But I think that the first steps are, any time you see disease statistics where the death rates are different, try to dig into why that is. Don’t just say, “Oh, those people die more.”

Try to look at why and challenge your politicians, your reporters, your public health agencies to actually explain and look at what the reasons are, rather than doing the hand-waving away, whatever is going on at that moment. I think that’s crucial.

At the same time, cultural change has to happen both at the individual and at the structural level. So it is on every one of us to make sure that we’re taking care of the people around us, to make sure that we’re actually hearing them. And in this moment, that can mean taking care of the people in your house, taking care of the people in your community, making sure that if they can’t go outside, you help them. I think that real cultures of resilience and real cultures of care have to include building tightly knit communities.

Alex Abad-Santos

For me, it seems the issue is how damaging fear can be and then just how deeply it’s entrenched in our culture. And if we look at what that’s gotten us, there’s more to lose if we keep thinking like this.

Anna Muldoon

There’s more to lose.

Disease in some ways is a great leveler. Infectious disease can take anyone. The question is, does our society put some people on the front lines where the disease is more likely to get to them? Infectious diseases have killed everyone from kings to paupers. No one is magically safe. But that should mean that we’re interested in building a society where we have social and economic and health care structures that make all of us as strong and resilient as possible, rather than ones that only protect some of the population.

I have great hope that the social change that comes out of this will be an acknowledgment of the structural problems that we have in our society, because I think Covid-19 has made them really, really apparent. I can hope, right?

Alex Abad-Santos

I mean, you can hope. We can all hope, right? It’s just history tells us differently.

Anna Muldoon

Yeah, sometimes. After every infectious disease outbreak, there are some social changes, right?

Sometimes they’re good and sometimes they’re bad. But I think that if we all understand that social changes come out of situations like this pretty consistently, it gives us an opportunity to think about what this pandemic makes obvious to us, and what we need to push for to be ready for the next one.