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To emerge from the shadows

· The World Day of the Sick ·

The World Day of the Sick serves to refocus everyone’s attention on a fact: illness exists. Unfortunately Western society has such confused ideas on this subject that the actual definition of the word “health” is still being argued about.

“The British Medical Journal” recently published the step forward that a Dutch working group, coordinated by Machteld Huber, has taken with an interesting suggestion: that “health” no longer means “a state of complete physical, mental and social well-being and is not merely the absence of disease or infirmity”, as defined by the World Health Organization. Rather, it is “the ability for self-adaptation and autonomy”. The first part of this definition which emphasizes that health is the ability to manage one's own life, to control it and come to terms with it without implying a utopian perfection, is interesting. The current definition of health de facto debars people with chronic illness from feeling that they are “in good health”, even when they succeed in living with their infirmity. It is not so easy to agree with the second part of the definition provided by Huber because it places the stress once again on two aspects: “health” and “autonomy”. However, it is not right to deny that an elderly person, dependent on others for various needs, or a disabled person, who is not at all autonomous, can feel “healthy”.

In short, the confusion on what illness is continues and many people feel ill (or at least not in perfect health) even if they are well, and, bewildered by the onslaught of advertising, seek to remedy supposed defects that are purely aesthetic. The result of this confusion is that people do not pay proper attention to serious illnesses and end by letting endemic conditions that afflict entire peoples, such as malaria or tuberculosis, pass as normal. They also end by treating the forgotten tragedy of rare genetic diseases with abortion, that false means of prevention, or with pre-implantation diagnosis which, instead of preventing illness does away with the sick person who has already been conceived and is alive.

The World Day of the Sick, however, reminds us not only that sickness exists but also that sick people exist: because in this competitive society, those who cannot measure up to others become invisible. The media speak very little of illness. Yet sick people exist, but they remain on the periphery. The websites of associations for the disabled are full of initiatives and innovations but no one talks about them. The disabled are invisible to the media, just as the mentally disabled are invisible to the health-care system, since doctors are ever less able to deal with people who cannot express themselves and are not autonomous (“The Lancet”, August 2008). Then in these times of crisis moreover — as was reported by the English Association Mencap, which launched the campaign “Don’t Cut Us Out” — there is a risk that those with less visibility and strength are affected by the main repercussions of the budget cuts that various countries are obliged to make. This would be unacceptable: a country is civilized to the extent it thinks of the weakest first.

Furthermore, this Day obliges us to note that in Western society there is a new illness: the sick desire. It is a sort of loss of delight in things, due to the unlimited satisfaction of desires and to the pressure of messages that in order to sell something offer to satisfy any caprice. The French psychiatrists Marc Valleur and Jean-Claude Matysiak, in the book Le desir malade hold that a hundred years ago the ability to satisfy certain desires seemed a conquest of freedom but today has become a boring banality. “And this is a problem” they write. “It is desire itself that is sick, since we are inured by gratification. Perhaps today people suffer less from the removal of desire, however hysteria has been replaced by two more illnesses: depression, from which people suffer who no longer have the energy, in the competition for pleasure, to defend their part of the booty and dependence” (on gambling and various substances of abuse). The sick desire, ensconced in non-existent needs, no longer reveals the true needs, nor even its own. It is an epidemic that opens the door to chaos, to pure boredom that no longer knows what to ask and what to fight for. And it makes people close their eyes to the real needs, to sickness and to the sick person: the misfortune of a century which could well have had the means to treat more people, although perhaps not always to cure them, but certainly to treat them all.

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