I know a lot about disability, though I don’t know much about disability studies. I suffer from two seriously painful and sometimes very disabling medical conditions: osteoarthritis and major depressive disorder (MDD). But let’s start with the depression. After talking about that, I want to address obesity and homosexuality. I hope it’s clear that everything I say here needs further careful detailed qualification that can’t be made in a short blog post.
I get my depression genetically: my maternal grandmother was frequently hospitalized for it and given electroshock; my mother suffers terribly from major depression. I know the depths of this disease. It’s an all-consuming hell. I don’t even know how to begin to say what it’s like to suffer from it. I’m grateful for the existence of drugs which work very well for me. Thank you, Santo Lexapro. I’m grateful for the hard work that went into finding those drugs. I’m grateful that people thought MDD was an awful thing that needed to be cured. At least in me, MDD is a molecular dysfunctionality. It comes from a defective gene, probably one involving serotonin metabolism. Here being a materialist about the mind is a blessing indeed. I’m dysfunctional robot. Taking that perspective can lead to a functional robot. I don’t believe in immaterial minds; but I believe very much in molecular thinking machines.
Against the Augustinian-Cartesian metaphysics of disease and disability, I subscribe to a kind of Aristotelian metaphysics of human flourishing. My nature defines for me a certain ideal functionality (a kind of natural goodness, as Philippa Food might put it). I am bound to the ideal of human flourishing by the very fact of my humanity Relative to that idea, my MDD is an intrinsic natural defect; it is an inherent flaw in my functionality. Diseases, and the disabilities they cause, are natural evils. But they are not moral evils. I cannot be blamed for having MDD; I did not acquire it through the misuse of my free will or through original sin. My MDD is a natural defect, not a moral defect. If anyone stigmatizes me for my MDD, they are morally wrong to do so. Stigmatizing somebody for a disability is unethical. It’s wrong to shame somebody for any condition which originates in a natural misfortune.
On this roughly Aristotelian metaphysics of flourishing, my disabilities are not valuable; they are not positive conditions. On the contrary, they are negative conditions; they hinder or block my flourishing. Moreover, my ideal functionality grounds a system of obligations: I ought to strive to realize the eudaimonic ideal; I ought to strive to flourish. So my disabilities are not conditions to be valued; they are conditions to be fought against and overcome. On this Aristotelian picture, we all have a moral duty to improve ourselves. I ought to strive to overcome my MDD and to flourish. I ought to take the drugs that help me flourish. Diseases and the disabilities they cause are like natural disasters: they’re not (usually) the fault of anybody, but, after they happen, we are morally obligated to help the victims.
Perhaps someday there will be no social stigma or shame associated with MDD. That will be a great day. But if it comes, it will not remove the suffering associated with MDD. Using terms from Elizabeth Barnes, I’ll say that MDD isn’t just a “mere difference”. But should we refer to it as a “bad difference”? Helen de Cruz refers to a bad difference as a disability that is “inherently bad and something that ought to be cured, regardless of how the disabled person feels.” I’m reluctant to say that MDD is a bad difference. Badness sounds like a moral fault. And MDD isn’t morally bad at all – as a purely molecular disorder, it has no moral origin or cause. Nevertheless, it is, I say, inherently naturally negative. It’s a failure to flourish.
Before mental illnesses could be medically treated, they were sometimes valorized or romanticized. They were said to be the keys to artistic or literary genius. This view is deplorable. To adopt it is to reject the very idea of medical progress. I say we ought to deploy all our powers to eradicate every disease and consequent disability. It is a moral perversion to celebrate or value a disability. Here are some morally abhorrent statements: it’s good that John has Alzheimer’s; it’s good that Anne has multiple sclerosis; it’s good that James has adult onset type-1 diabetes; it’s good that Susan is deaf. If these were goods, then it would be wrong to try to cure them. But we are obligated by our very humanity to try to ensure that every human flourishes, and fully realizes as much of his or her human nature as possible.
Whenever it occurs, MDD ought to be cured; and, in certain cases, it ought to be cured through coercive force. It is public knowledge (it’s in her NY Times obituary), that the poet Rachel Wetzsteon died from suicide in part due to MDD. Rachel was a very close and very dear friend of mine. I knew she was suffering; I and others tried our best to help her. We did, I think, as much as we could have done. But it was not morally sufficient. I did not have the power to coercively force her into treatment. If I had the power, I would have used it. I would forcibly have taken her body against her will to a medical facility for treatment. Her suicide caused many other people (including myself) to suffer grievously. Nobody is alone in either health or disease. Our bodies are socially entangled in both ability and disability.
Some say obesity is a mere difference: if the social stigma of obesity were removed, it would be ethically fine to be obese. Of course it’s morally wrong to stigmatize obese people. It’s morally wrong because the Augustinian-Cartesian metaphysics is bogus. That metaphysics usually implies that obesity is the result of personal sin. It’s the result of moral weakness: the fat person just can’t stop eating. It’s weakness of will, an inability of the immaterial mind to control the material body. The obese person abuses his or her freedom. Augustine would say it all comes from lust – in this case, lust for food, namely, gluttony. And lust is a sign of the Fall. I reject that metaphysics. Obesity, like MDD, is a natural evil. It’s a non-moral misfortune. It’s molecular bad luck. Obesity cannot be morally bad, because it has no moral origin.
Nevertheless, as with MDD, obesity is inherently naturally negative. It conflicts with flourishing; it ought to be cured. It follows that obesity is not a mere difference. Even if all associated social stigma were removed, obesity would remain a hindrance to flourishing. I cannot imagine why anybody would valorize or romanticize it. It generally leads to enormous suffering; it brings in its train many painful conditions, like diabetes, stroke, heart disease, lower quality of life and shorter life. Perhaps there are extreme cases in which coercive force ought to be used to cure it. But, to say it again, obesity is not a moral failure; it is not a condition for which one deserves to be blamed or condemned. Obesity originates in our genes and molecules, not in any free will, not in any original sin, not in any divine retribution. At this time, sadly, many of the cures for obesity are as awful as the electroshock given to my grandmother. The costs often exceed the benefits. However, since we all have a moral duty to improve ourselves, it follows that if safer and more effective treatments become available, then an obese person is morally obligated to take advantage of them.
It may be helpful here to use homosexuality as a contrast case. Homosexuality, in my view, is a mere difference. You can fully humanly flourish as a homosexual. So homosexuality does not hinder eudaimonia. Homosexuality was not long ago classified as a mental illness; however, there is no physiological basis for any such classification. It is not a disease. Some people, usually conservative Christians, appeal to the Augustinian-Cartesian metaphysics to say that homosexuality is an abuse of free will; it’s a morally wrong choice; but that metaphysics is bogus. And those same Christians often say that homosexuality brings harms (it will harm children, or heterosexuals, or entire nations). Again, their reasoning is spurious. To be gay or lesbian, or to embrace a more complex gender identity, is a kind of variation that does deserve to be morally celebrated. There is neither any moral nor any natural ground for wanting to change a homosexual into a heterosexual. If there were a drug or genetic operation which could cause such a conversion, nobody would be morally obligated to take it. And the state would have no right to coerce homosexuals into taking it.
As a disabled human animal, I demand and deserve the same respect and dignity as any other human animal. My demand is grounded in the simple natural fact of my humanity. But I also demand a cure for my disabilities. My disabilities are not goods in any sense. Even if all social stigma and shame were removed, my disabilities would not be goods in any sense. They are not moral evils for which I am responsible. But they are natural evils. And the intrinsic value of full human flourishing entails that we ought to strive to eliminate them.