Self-Care as Self-Blame Redux: Stress as Personal and Political

Chronic stress has a profound, and profoundly negative, influence on health outcomes; it is one of the mechanisms by which health outcome inequities are reproduced (Thoits 2010). Work on the social determinants of health has made it clear that social and political decisions regarding the basic organization of society are the main factors determining how much stress, and what kinds of stress, different parts of the population will experience. But, in both the technical literature and in more "popular" venues, there is an emphasis on the ways in which individuals can, through individual actions ("self-care"), reduce the harms associated with the stress that they are likely to suffer. As well-meaning as those projects may be, one result is that individuals, many of whom are already socially disadvantaged in a number of ways, end up being seen (and seeing themselves) as responsible for their own failures to adequately ameliorate the stresses that they suffer. Early criticisms of the self-care movement in the US stressed the ways in which it could be, in Sidel and Sidel's memorable phrase, "diversionary from struggles for radical change in both medicine and the broader society" (1981). Today, the diversionary attention to "self-care" grows alongside the growth of strong scholarship making clear that addressing the health inequities and poor health outcomes in countries like the US will indeed require radical social change.