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Hollywood broken leg theory [Jun. 10th, 2010|04:46 pm]
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One of my friends has posted a bit under friendslock about dealing with a health-related thing that is also a work-related thing; you can see why this would be understandably private and not the sort of thing I would be poking this friend to unlock. So I wanted to pull what I was thinking out here where I can poke at it and not poke at my friend's private issues as well.

The thing is, I think we are, as a culture, sort of in love with the broken leg model of illness, injury, and disability.

Here's what makes the Hollywood broken leg model so shiny.

With a broken leg, you:
*know what has happened.
*know when it happened AND
*know it right away.
*know what to do to fix it.
*know about how long it will take to heal.
*know that it will not suddenly get less healed for awhile in the middle and then jump back to more healed again.
*can easily predict which things will stress the injury.
*know that it will be completely fixed when treatment is done.
*have at least some theory of where the person experiencing it falls on the continuum of sinner ("What were you doing on top of that water tower at 3 a.m. anyway? You're lucky it wasn't your neck!") to saint ("Hit by a drunk driver while helping an elderly nun across the crosswalk? Let me fluff that pillow for you, you poor baby!").
*do not have any doubt as a casual passerby whether there is something wrong, or what.

Of course, not all of this is actually true of broken legs, even! (I have edited in a few spots to add "Hollywood," because I want it to be absolutely clear that I know that my friends' leg injuries to not come with these magical advantages.) It's just the assumption from people who don't have the said broken legs. But it is a mighty convenient set of traits for an illness, injury, or disability to have. And the farther from this model your actual illness, injury, or disability goes, the more frustration you are likely to face from other people, because their questions are likely to be centered around the broken leg model.

Why didn't you go in sooner? they will snap. Sometimes they don't even notice that they are snapping, and if you point out that they're snapping, you need to stop being defensive. But see: if you break your leg, there are bits of broken leg sticking out, and you are an idiot for not going right in, right now! But what if you wake up just exhausted one morning? Should you go to the doctor that morning? "How long have you been exhausted?" the doctor will say. "Since this morning," you say. Wrong answer. Get more sleep, or less sleep. Get more exercise, or less exercise. Eat differently. Change something up. What if you feel a little dizzy? If you're female, does this correlate with your menstrual cycle? Well, if you've only had it for one day, you can't really say, can you? Why didn't you go in sooner? Because some things are not a broken leg. And if you get a history of going in and mentioning things that have not really been a problem very long, if you're not very lucky, you get a doctor who writes down "hypochondriac" or "drug-seeking," and then when it's still a problem later, you've got that to deal with. The cardiac surgeon's memoir I read recently acted as though women could go in with fatigue and find out whether they'd had a heart attack every time they had fatigue, since fatigue is the main symptom of heart disease in women, and I laughed and laughed. It is not some feminine perversity that makes that not happen. Really, really not.

Why don't you take meds for that? they will ask. Because naturally there are meds for that in existence. And they work for you. And they don't interact badly with anything else you have to take. It's just spite that makes you not take them, or spite that makes you take them wrong so that they don't work perfectly. This is the twenty-first century! They can fix things! Who can? You know--They! They can! Them! They would have already if you had only gone in sooner! What these people mostly want is for you to have a big plaster cast on your kidney, your endocrine system, your ears, or whatever else is not working--in some cases your actual broken leg that was not perfectly fixed by divine fiat somehow, because the world does not magically work like that--so it can fix the thing, they can sign it, and then in a few weeks somebody can come along and saw the thing off and everybody can go skipping merrily along. Most of us want this too. It just doesn't happen to work that way.

I'm pretty sure I do this to people, because one thing I've learned in the last few years is that we are all really terrible at spotting the ins and outs of illnesses, injuries, and disabilities not our own, so one of my new self-checks before I open my mouth is going to be, "Am I trying to treat this like a Hollywood movie of a broken leg again?" Too many of the formal things we have set up for employment and compensation are working on the broken leg assumption. The least we can do is not perpetuate them when we have the option.
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Comments:
[User Picture]From: p_j_cleary
2010-06-10 09:54 pm (UTC)

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Thanks for writing this. I didn't even know it needed to be said until I read it.
[User Picture]From: ckd
2010-06-10 09:54 pm (UTC)

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[User Picture]From: zellandyne
2010-06-10 10:06 pm (UTC)

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Yes.

On the flip side, when people say to me, "Oh, I'm so glad I don't have that problem" - which, by the way, is not a particularly nice thing to say - I want to tell them that they very well might and they ought to check. And I run the risk of being overly emphatic and seeing my own condition in other people when it isn't there. Because I said the exact same thing once, and I turned out to be wrong.


[User Picture]From: mrissa
2010-06-10 10:09 pm (UTC)

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Yah, I can totally understand why people are glad not to have vertigo--I'm glad they don't have vertigo--and yet it seems a bit tactless to say it to me quite like that. It's not like my physics major, where it seemed tactless but at least it was something I had chosen for myself so I could be blamed for it if they felt blame was necessary.

But we also have had several runs of, "Here is a less easily detected/widely known about thing that we have found out about, and perhaps you should look into it," around here, particularly in family groupings. People don't always agree to. But I know the impulse.
[User Picture]From: coraa
2010-06-10 10:13 pm (UTC)

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Yes. Yes!

I particularly notice this with a type of cause-seeking (or, to put it less charitably, blaming) that sort of makes sense with a broken leg model but not so much with other things. For most people, leg bones don't just fracture on their own: even if someone has a predisposition to more-fragile bones, there's usually some physical trauma that casued a particular breakage. So it's reasonable (possibly overly-nosy, but reasonable) to ask how a break happened, because there's usually an answer like, "Skiing accident" or "car accident" or "tripped on the cat" or "slipped on the ice" or "attempted to create my own backyard high-wire act" or something.

(I won't say always, because there may very well be disorders that cause spontaneous bone breaks, but for most broken bones, there's a fairly clear proximate cause for the break.)

That isn't true, for the most part, of things like heart disease, or cancer, or depression, or autism, or whatever, but people insist on treating it that way. Did you eat the wrong foods, or did you not eat enough of the right foods? Were you too sedentary, or did you do the wrong kind of exercise? Were you stressed, or did you fail to have sufficient life goals to motivate you? And so on, and so on. That there must be a clear cause: you got X because you did Y, or you failed to do Z, or possibly because someone else did Q or failed to do R around you at the right, or wrong, time.

While I see this with other health issues I have, one of the simplest to explain is the fact that I have terrible teeth despite having great dental hygiene. I spent years brushing three times a day and flossing religiously and using all manner of fluoride supplement and avoiding soda and so on, and still having everyone from the dentist on down assume that there wasn't any possible way that I just had bad teeth: I must have done something bad to them, or failed to do something good to them. Until finally I found the dentist that I have clung to ever since, who noted quite reasonably that there's a genetic component to dental health, and some people just get unlucky. But the idea that All Mouths Start Off Perfect So You Must Have Done Something To Screw This One Up was so prevalent that it took years to get there.
[User Picture]From: mrissa
2010-06-10 10:21 pm (UTC)

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One of the most common ways of expressing health concern is not the neutral, "What happened?" but the accusatory, "What did you do?" This is often even skewed in its intonation: "WHAT did YOU DO?"

And one of the things it means is, "What did you do that I can avoid doing so that I can dodge this thing that happened to you?"

"What did you screw up that I can get right so that I can be okay where you are not okay?"

Even, "What happened?" assumes that there is an event, something you can point at. Even if it's that a bolt of lightning or a meteorite hit you while you were sitting innocently in your living room reading, something happened, and there is before, and there is after. Whereas with, say, food allergies, or depression, or many other things people I know deal with, there is less the bolt from the blue--even if we stipulate that it is the blameless bolt--and more the gradual awareness that not all is well, or at least not as well as it could be.

Story-seeking is a very human urge. It's just not always a very useful or appropriate one.
[User Picture]From: haddayr
2010-06-10 11:05 pm (UTC)

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My particular favorite is the accusatory: "Do you think stress brought this on?"

Because, of course, I purposefully had a time-consuming child, and I purposefully like to worry about money all the time because it's so fun for me, and I purposefully have family-of-origin issues, and I just ran out and courted sleep-deprivation brought on my slumlords and and and . . .
From: orbitalmechanic
2010-06-10 11:51 pm (UTC)

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My mother worked in a fertility clinic for years (in the 1980s), and every one of her patients was constantly hearing, "Oh, just relax, it's stress." She to me once, "That's why no one gets pregnant during wars! or during an economic depression! or in horrible relationships! Thank goodness someone noticed!"
[User Picture]From: mrissa
2010-06-11 12:02 am (UTC)

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That is some quality field research those folks are doing. For Science.
[User Picture]From: dichroic
2010-06-11 11:47 am (UTC)

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I know one person who actually did get pregnant after years of infertility, just a year or two after adopting a child. I think the only thing worse than "you should just relax! or adopt a baby, then you'll get pregnant!" would be hearing, "See, it worked!"

Particularly if the phrase "real daughter" is used somewhere in there.
[User Picture]From: mrissa
2010-06-11 07:25 pm (UTC)

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Yah, people who use "real daughter/son/child" are really invited to depart the premises. Honestly.
[User Picture]From: marydell
2010-06-16 08:48 pm (UTC)

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I get told a lot that I'll have no problem getting pregnant since adopting my son, apparently because infertility is just a form of hysteria.
[User Picture]From: mrissa
2010-06-11 12:01 am (UTC)

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YES, the stress of having to LISTEN TO QUESTIONS LIKE THAT ONE NEXT PLEASE.
[User Picture]From: swan_tower
2010-06-11 11:18 pm (UTC)

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Corollary: "What did I do?" In my case, why -- despite years of reasonable physical activity and almost never wearing high heels -- am I the one who gets a torn ligament and plantar fascitis and collapsing arches and all the rest of it, while these other women swan around in their stilettos without problems?

Which is false in so many ways, because a) I have no idea what problems any given woman may have or not have, and b) I know that swanning around in stilettos frequently leads to a great many problems, most of which I don't have. But it feels so bloody unfair.
[User Picture]From: mrissa
2010-06-12 12:10 am (UTC)

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There is a House episode I think has a completely brilliant moment, in which a patient who has spent the episode trying to convince the doctors that one particular habit is not to blame for his health problem--even though they associate that habit very strongly with the type of problems he's having--is diagnosed with lung cancer, and he blurts out, "But I don't smoke."

It is so very human.
[User Picture]From: haddayr
2010-06-10 10:59 pm (UTC)

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oh, this a thousand times this
[User Picture]From: cakmpls
2010-06-10 11:28 pm (UTC)

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That's an interesting comparison, the broken leg, because it's exactly the one my doctor made when I saw him yesterday. He deals with chronic pain himself, and we were discussing how people who have never had to do so don't understand how exhausting it is, and he said precisely that: "It's not like a broken leg," and for some of the same reasons you give.

(I do, however, have the "advantage" of my age--people expect those my age to be falling apart one way or another!)
[User Picture]From: magentamn
2010-06-11 01:16 am (UTC)

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This is BRILLIANT!

We have a "blame the victim" mentality in our culture, which is one of its great evils.
[User Picture]From: mrissa
2010-06-11 03:44 am (UTC)

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We also have a vocabulary such that it's hard to say this without casting somebody as a victim. In no way do I mean to criticize your phrasing, because I'm having extreme difficulty coming up with a way of saying it that doesn't mean the same thing anyway, without being completely clunky about it. "Blame the...problem-having person" is just not pithy.
[User Picture]From: hypatia_j
2010-06-14 11:19 pm (UTC)

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Sounds like the fundamental attribution error to me... http://en.wikipedia.org/wiki/Fundamental_attribution_error
[User Picture]From: redbird
2010-06-11 02:28 am (UTC)

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This is useful. Thank you.
[User Picture]From: reveritas
2010-06-11 02:42 am (UTC)

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Oh, goodness, yes.
[User Picture]From: jenett
2010-06-11 03:33 am (UTC)

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You are brilliant. (And I do hope to be making some posts less under lock about some of it, but am being sensible and waiting till the current work stuff is not on the table before I do.)
[User Picture]From: dd_b
2010-06-11 03:47 am (UTC)

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This is an entirely fine and completely on-target bit of rant.

In certain cases, it should be engraved on razor-edged steel sheets, folded to maximize the exposed edge, and, um, applied suitably to people who apparently are in need of a truly memorable experience on the topic.
[User Picture]From: timprov
2010-06-11 03:49 am (UTC)

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And then when people asked how they got their injury, they would have a ready answer.
[User Picture]From: mamculuna
2010-06-11 03:51 am (UTC)

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I actually just had a broken foot, and it was pretty much Hollywood variety. Having had other ailments that weren't at all Hollywood, I really loved how clear and simple it was,even while hobbling around in a cast. The doctor didn't doubt that I really had it. The cure was not worse than the injury. The insurance didn't question the need for a cast or even X-rays. It didn't make me look weird (I happen to think a purple cast is glamorous). It meant that I got lots of attention and lots of support, because everybody can see a purple cast. And I didn't have to worry about the long-term side effects of the treatment, since they've been splinting broken bones for a while now.

I suffered much more debilitating pain with a nerve injury that went through three doctors before even being diagnosed, and then just when I thought it was well, came back double-strength.I took drugs that could have done some bad stuff to my liver, and I was irritable and cranky for months. And I couldn't go around announcing "I'm in hideous pain, feels like a giant bird has its claws in my neck," so I had to pretend I felt just like everyone else at parties and meetings. The only good aspect was that I did develop faith in the appropriate alternate medicine, and that's helped me with other things since.

When I think about problems like the one you suffer with, I can't begin to imagine the psychological and social problems it creates.

ETA: I know your real point was the blame-seeking that attaches to so much illness. Sorry to hijack with a slightly OT rant of my own, but I'd just been thinking about this.

Edited at 2010-06-11 03:54 am (UTC)
[User Picture]From: mrissa
2010-06-11 07:28 pm (UTC)

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I don't think you were hijacky at all.
[User Picture]From: matociquala
2010-06-11 04:09 am (UTC)

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<3
[User Picture]From: dichroic
2010-06-11 11:50 am (UTC)

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The other thing they don't tell you with broken legs is that you'll heal faster (or at all) if you only maintain the proper chirpy attitude.
[User Picture]From: papersky
2010-06-11 01:08 pm (UTC)

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Wait, fatigue? Heart problems?

Actually I did go to the doctor the first day I had fatigue, largely because Z made me, but also because it's so unusual for me. And I did get seen by a cardiologist and he said my heart was fine. The causes and identity of my mysterious illness of June-August last year remain utterly mysterious. (It appears to have been cured by pu erh tea.)
[User Picture]From: mrissa
2010-06-11 07:27 pm (UTC)

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Yes, fatigue is supposed to be the most common symptom of heart problems among women. Although heart problems are not the most common cause of fatigue among women, not by a long shot. I'm glad they did make sure, and I'm glad the cure was so nice.
From: orbitalmechanic
2010-06-11 01:12 pm (UTC)

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Belatedly this occurs to me: the broken leg model is very good for talking to people who are ashamed of their illness, usually emotional/mental stuff. A friend was once deeply depressed and on medication after, get this, her reunited-childhood-sweetheart-fiance left her six weeks before the wedding, then quickly married a much younger woman he'd just met. My friend was so ashamed that she couldn't just power on through!

Of course it is NOT the same thing as a broken leg, but the nice thing is that when your broken leg hurts, of course you get whatever treatment you need, no one says you should use willpower and fortitude instead of a cast and a doctor and painkillers and PT afterward.
[User Picture]From: mrissa
2010-06-11 07:28 pm (UTC)

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Right, that angle of it works well.
[User Picture]From: swan_tower
2010-06-11 11:14 pm (UTC)

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Yeah, one of the first questions I get asked about the ankle is "how did you tear the ligament?" You'd think I would know, but I don't. Micro-tears over a period of years? Pressing deeper into neko-ashi dachi in karate, without realizing I fail at talar glide? That one time the nerve was twinging really badly in my ankle so I asked kniedzw to help me make the joint pop and maybe that was a really bad idea? All of the above?

And that is pretty close to a broken-leg injury, as such things go. But no, what happened was I had ankle pain for a little while, and then I had sensations that my foot was not as firmly attached as it should be, and then I went to a doctor -- some untold amount of time after the injury. So it goes.
[User Picture]From: astromachy
2010-06-12 05:51 pm (UTC)

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Yes.

Thank you for this post.
[User Picture]From: ruthi
2010-06-21 06:51 pm (UTC)

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I find value in this post.
[User Picture]From: mrissa
2010-06-22 10:56 am (UTC)

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I'm glad.
[User Picture]From: apiphile
2010-06-21 07:48 pm (UTC)

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This is a really clear and informative post.

[And I broke my back eight years ago in a suicide attempt; I don't go into the doctor for ANYTHING if I can help it because "attempted suicide" is on my medical notes several times and they act like I should be dead and stop wasting their resources] /wordvomitonastranger.
[User Picture]From: mrissa
2010-06-22 11:12 am (UTC)

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For all the internet has been good for Rate My Prof this and Amazon Feedback that, it has not yet devised a system for Rate How Doc, Nurse Practitioner And Phlebotomist All Treat Everybody As Humans, No Really, Everybody Dot Com. Which is a pity. And if it had, we'd be dealing with the same guy-with-a-grudge filtering problems as elsewhere, too. Sigh.

I have had no experience with being a patient advocate for someone whose injuries were the result of a suicide attempt, but some of my crappy experiences being a patient advocate in other circumstances lead me to extrapolate and say that I'm truly sorry for what those doctor visits must be like. Ooof.
[User Picture]From: puzzled_anwen
2010-06-21 07:51 pm (UTC)

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Oh hell yes. Thanks for this.

Also, re this: fatigue is the main symptom of heart disease in women. Fvck, I am going to Google this, my best friend has some heart dodginess and has been exhausted lately even after naps etc.
[User Picture]From: mrissa
2010-06-22 10:54 am (UTC)

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I am not usually a proponent of "If even ONE person has been helped by what I've said," because I feel the people who say things like that have not sufficiently considered whether ten people have also been harmed along the way of that one person being helped.

But in this case I am glad to have given you Google fodder, while I hope there is nothing additionally dodgy about your friend's heart.
[User Picture]From: flynnacatri
2010-06-22 07:09 am (UTC)

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...in an interesting coincidence, my brother currently has a broken leg.
[User Picture]From: mrissa
2010-06-22 10:55 am (UTC)

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I hope it heals indistinguishably from a broken leg in a Hollywood movie, but in the department of actually feasible hopes, I hope his physical therapy goes well.
From: swaldman
2010-06-23 09:59 pm (UTC)

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Thanks - a post that I shall probably refer others to in future.
[User Picture]From: dharma_slut
2010-11-24 06:12 pm (UTC)

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That is perfect. (Jennet on Dreamwidth just linked to this post)