I recently received two very different diagnoses in quick succession of each other. The first a running-related, bone and tissue condition that gave answers to short term, isolated agony. The second was a preliminary diagnosis for a chronic condition, a potential explanation for longer term, deep-rooted symptoms.
Both diagnoses came with a sense of affirmation, an acknowledgement that this isn’t all in my head. But swiftly after receiving them, the question tapping on my brain morphed from the ‘what’ is wrong with me, to the ‘why’ is this wrong with me - and the only explanation I could come up with was that this is something I did.
On the surface, I am to blame for my running injury. My knee buckled, I landed funny. The blame was rudimental: have I done too much too soon? Was I under recovering? They weren’t deep questions, but they meant I was constantly second guessing myself despite knowing that I had done everything right (I am an anti-running runner, so I was hyper-cautious about injury prevention tactics).
Seeing a physio helped remove some of that perfunctory blame. She explained that I’m hypermobile meaning my form was all off, causing lot of problems with muscles and joints that culminated in me bruising my foot bone and being unable to weight bear. But then the more personal self-blame spiral begun: I work in fitness, how didn’t I know this about my body? Has 10 years of training with unknown hypermobility fucked my body up? Why did I not do something differently?
These are the same questions I’m asking about my chronic diagnosis. I have trawled studies, read experts, ferociously googled [condition] + [any behaviour I’ve ever done in the past] to see if there’s a way to blame myself for my insides going wrong. There is not such an easy explanation.
Blaming women
Self-blame is a female condition. A 2022 study into 500,000 15-year-old girls found that girls are more likely, relative to boys, to attribute an academic failure to their own inability rather than to external factors. Society’s finger pointing also forces us to take on responsibility for things out of our control, whether it’s victim blaming in cases of sexual violence and abuse (‘what were you wearing?’, ‘why didn’t you say no?’) or a lack of ‘leaning in’ in workplaces that are designed for men.
In medical settings, self-blame is the result of individualistic society that tells us we are all in charge of and to blame for our health outcomes, rather than the more complicated truth which is that health requires a multi-pronged approach with some of the largest determinants being political, social, economic and environmental factors.
A lack of clear science about anything to do with a woman’s body doesn’t help - we have no language to explain what’s happening, leaving blame to default to the person at the centre of the struggle (as Elizabeth Day regularly explains, doctors discuss fertility struggles with phrases such as ‘your body is failing to respond to the drugs’ and ‘your inhospitable womb’).
The blame cycle
I talked to consultant psychologist Venetia Leonidaki from Spiral Psychology about how to shift my bodily self-blame in the midst of diagnoses. When she tells me that self-blame is a form of anger, I’m surprised. “Guilt is the emotion that is more on the surface, right? When people blame themselves, they are saying they have done something wrong. But underneath this, there can be anger directed towards yourself for not having tried harder to maintain your good health. Whether that is rational is a completely different question,” she says.
That could be why self-blame is a widely female experience. “Women tend to internalise anger and men tend to externalise it, and self blame is a form of anger directed towards self. But there’s also the individual and collective unconscious that links women more to the role of care givers. When we receive the message that good health is the result of taking good care of yourself and illness means an absence of looking after yourself, perhaps women are more prone to feeling guilty for their role in it,” says Leonidaki.
But there are better ways to form a sense of control than by ruminating over your past mistakes. “Focusing on all the things you could have done differently is a stress that can potentially impact your health now, when you’re already battling a very stressful condition,” says Leonidaki. The answer is - of course - the basics of self-care (exercise, eat well, de-stress, solid boundaries, etc) and letting yourself feel feelings that are bigger than anger. But, just like the cause of your pain is bigger than you, the the root to ending self-blame goes beyond the individual.
“How health care professionals deliver the news of a new diagnosis to the patients or let them know about investigations that they have to go through and whether they take the time to explain what could have caused this to correct any false interpretations is key,” says Leonidaki.
I saw my physio, Florence Penny at Flow Physio*, again today and asked her about the self-blame cycle of injury. That’s the wrong question, she said. According to Flo, it’s best to think of injury or illness time as an educational chapter. It’s not about what could have prevented it, but how much you can learn about your body in this time to prevent it in the future. She’s showing me things my body does that I would never have known before, in turn turning my blame into curiosity - and not just about my running injury.
Thank you for reading Gray’s Anatomy! If you enjoyed it, please make sure you’re subscribed and do share with someone who might enjoy reading it.
*gifted treatment as part of my role as a health and fitness journalist