Neil Vickers and Derek Bolton, "Being Ill: On Sickness, Care and Abandonment" (Reaktion Books, 2024)
Oct 5, 2024
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Neil Vickers, a Professor of English literature at King's College London, and Derek Bolton discuss their compelling book on the complex interplay of illness and social relationships. They explore how serious illness alters perceptions and dependencies in our relationships, highlighting feelings of isolation experienced by both the ill and their caregivers. Their interdisciplinary approach emphasizes the importance of community support and connectedness in fostering resilience. They also examine the concept of 'holding' in caregiving, advocating for empathy in the context of illness.
Serious illness significantly alters interpersonal relationships, often leading to isolation for both the ill and their caregivers due to societal discomfort.
The authors argue for a biopsychosocial approach, highlighting the necessity of communal support in fostering resilience and improving health outcomes.
Deep dives
The Interpersonal Experience of Illness
Serious illness extends beyond medical treatment; it profoundly influences the relationships and interactions people have with others. The dynamics of companionship often shift, as individuals may find themselves feeling abandoned during their illness journey, despite gratitude for those who remain close. The authors emphasize that healthy individuals tend to withdraw from those who are ill due to discomfort, societal stigma, or their own coping mechanisms. This isolation can lead to catastrophic outcomes, underscoring the necessity for robust social support in managing serious health conditions.
The WEIRD Framework and Its Limitations
Western, Educated, Industrialized, Rich, and Democratic (WEIRD) societies operate under the assumption of individualism, which shapes how illness is perceived and addressed. In these societies, a person’s illness is often seen as a personal journey rather than a collective challenge, leading to social marginalization. In contrast, in non-WEIRD cultures, communal support tends to be robust, creating environments where neighbors and family actively participate in caring for the sick. This lack of community support further exacerbates the isolation experienced by individuals undergoing serious health issues in WEIRD environments.
Embracing the Biopsychosocial Model
The biopsychosocial model advocates for an integrated approach to understanding health by considering biological, psychological, and social factors. Recent studies highlight how social determinants of health significantly influence individual health outcomes, indicating that psychosocial experiences can amplify biological vulnerabilities. This model challenges traditional medical perspectives that often isolate behaviors such as smoking or diet from societal contexts, emphasizing the importance of collective support in maintaining health. Consequently, addressing social isolation and encouraging supportive communities become crucial components of effective health interventions.
The Nature of Care and Intersubjectivity
Care is framed as a communal endeavor, where the dynamics of relationships shift significantly when a member falls ill. The act of caring often necessitates an intersubjective experience, where individuals collectively negotiate and understand the implications of illness. The authors highlight the concept of 'holding,' which illustrates how close relationships can provide comfort and stability during difficult times. Drawing on psychological research, the book discusses how these mechanisms facilitate deep emotional and social connections, which can greatly mitigate the sense of isolation often felt by those with serious illnesses.
A serious illness often changes the way others see us. Few, if any, relationships remain the same. The sick become more dependent on partners and family members, while more distant contacts become strained. The carers of the ill are also often isolated. This book focuses on our sense of self when ill and how infirmity plays out in our relationships with others.
In Being Ill: On Sickness, Care and Abandonment (Reaktion, 2024) Dr. Neil Vickers and Dr. Derek Bolton offer an original perspective, drawing on neuroscience, psychology and psychoanalysis, as well as memoirs of the ill or their carers, to reveal how a sense of connectedness and group belonging can not only improve care, but make societies more resilient to illness. This is an essential book on the experience of major illness.
This interview was conducted by Dr. Miranda Melcher whose new book focuses on post-conflict military integration, understanding treaty negotiation and implementation in civil war contexts, with qualitative analysis of the Angolan and Mozambican civil wars.