Managing Social Relationships and Social Standing

For better or worse, chronic illness and disability necessarily alter relationships with friends, relatives, and others. Illness and disability can strengthen social rela- tionships, as friends and families pull together to face health problems, old wounds are healed or put aside, and individuals realize how much they mean to each other. Illness and disability, however, can also strain relationships. Friends and family of- ten help each other willingly during acute illnesses or the first few months of a chronic illness or traumatic injury but pull away over time. This is especially true for male friends and family, who are less often socialized than women to take care of others. Moreover, the growing burden of grati- tude can make those who have chronic illnesses or disabilities reluctant to ask for needed help. Problems are especially acute among elderly persons who have out- lived close relatives and friends and must rely on more distant social connections for help and support.

Relationships also suffer if individuals no longer can participate in previous activities. How do you maintain a relationship with a tennis partner if you no longer can hold a racket? How do you maintain a relationship with a friend when transportation barriers keep you from going to movies or restaurants? And how do you maintain a relationship with a spouse or lover when your sexual abilities and interests have changed dramatically—or when your partner no longer finds you sexually attractive?

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Declines in financial standing also strain relationships. An individual might, for example, have the physical ability to go to a movie with a friend but lack the money to pay admission. Women and minorities are especially hard hit because they typically earn lower wages and have more erratic work histories before be- coming ill or disabled, so they often qualify for lower Social Security benefits. At the same time, financial stresses can damage relationships with children, lovers, and spouses.

Managing Stigma Illness and disability affect not only relationships with friends and family but also less intimate relationships. Most basically—and despite the pre- dictions of the sick role model—living with illness or disability means living with stigma. Stigma refers to the social disgrace of having a deeply discrediting attri- bute, whether a criminal record, a gay lifestyle, or a socially unacceptable illness. The term stigma does not imply that a condition is immoral or bad, only that it is commonly viewed that way.

Some illnesses and disabilities produce relatively little stigma, but others are so stigmatized that they can affect even relationships with health care providers. Illnesses and disabilities are most likely to result in stigma when they are believed to be the fault of the affected individual and when they cause fear or dread; visible disfigurement; loss of bowel, urinary, or other bodily functions; ognitive problems; or behavior that mimics cognitive problems. HIV/AIDS, for example, elicits particularly high stigma because it is often interpreted as punishment for sin, is contagious (and thus frightening), and can cause wasting, facial sores, loss of bodily functions, and dementia.

Individuals with stigmatized illnesses and disabilities can use various strategies to manage that stigma. Many attempt to avoid stigma by hiding it or otherwise de- flecting attention from it. For example, a man who bumps into furniture because of failing eyesight might try to convince others that he is merely clumsy, and a woman who has arthritis might choose not to go out with friends on days when her symptoms flare up.

Conversely, others manage stigma by challenging the very basis of that stigma. Some disabled men, for example, become star athletes in part to reject the as- sumption that a disabled man can’t be “masculine.” Others challenge stigma more directly by fighting for civil rights. Still others fight for acceptance of their bodies by displaying their own proud acceptance or even appreciation of their bodies. For example, for medical reasons, Aimee Mullin had both her legs amputated below the knee when she was one year old. She now is a professional model, actress, and