Shameless

Aren’t you ashamed of yourself?

Most of us can still remember those words of admonishment from our mothers years ago. And many of us berate our kids with that phrase now.

When what we do is bad — when we violate the Golden Rule — the innate sense of shame that all normal people have can lead us back to ethical behavior. This normal human emotion can bring us to maturity in our actions.

But many of us are ashamed of who we are or the diseases we have. We feel shame about the physical condition of our bodies.

People who have type 2 diabetes often have an overdeveloped sense of shame. We buy into the conventional wisdom that with our degenerate lifestyle we brought on our diabetes ourselves.

Indeed, a medical dictionary defines a lifestyle disease as one “associated with the way a person or group of people lives. Lifestyle diseases include…type 2 diabetes.”

I don’t doubt that the pounds I gained and the exercise I avoided in the 1980s contributed to the diabetes that I learned in 1994 that I have. I was working 60 or more hours per week in a demanding job as a magazine editor. The publisher of the magazine and culture of this country approved of my lifestyle.

At the time I didn’t feel ashamed being a hard-working person who gave more to my job than to taking care of my body. I didn’t know then what I know now about diet and exercise. And I didn’t know that I had a genetic predisposition to getting diabetes.

“Type 2 diabetes has a stronger genetic basis than type 1,” says the American Diabetes Association. And recently when I got a DNA test for a genetic variation that is a risk factor for diabetes, sure enough I had that genetic predisposition.

Most of us with type 2 diabetes probably have those bad genes. Should we feel ashamed of our genes?

Those of us who have diabetes have bodies that are less than perfect. But that’s no reason to be ashamed of them. In fact, body shame can be counterproductive. It can mask what we can do to control our diabetes.

When we really get to know other people, we find that essentially everyone is flawed. I like to think of all of us as diamonds — flawed diamonds.

Shame at the condition of our bodies remains strong in our culture. But probably not as strong as it once was.

My mother was ashamed that she had epilepsy. She never had a seizure after starting to take Dilantin when I was three years old, and she insisted that my father never tell me about her disease. Since epilepsy is a disease of the mind, our culture felt then that it was particularly shameful. But my father thought that my sister’s children and grandchildren could inherit my mother’s epilepsy, so he eventually told her. It wasn’t until my mother was in her 70s that my sister told me. I think now that it was shameful that I didn’t know earlier, because I would have appreciated my mother a lot better.

Last year when I had an operation to relieve an enlarged prostate — a transurethral resection of the prostate or TURP — it was successful. I had feared two possible consequences of the operation, urinary incontinence and erectile dysfunction. I did temporarily have to wear pads, but that’s not something that I was or am ashamed of.

Erectile dysfunction is a typical result of another condition that people with diabetes are prone to get. Neuropathy, which attacks perhaps half of us, can cause what used to be less gently known as impotence.

A few days ago somebody who reads my articles called me with concerns about neuropathy in his feet. I mentioned that tight blood glucose control, as I had written in an article about erectile dysfunction, could reverse neuropathy.

Since we had never met, he felt free enough of shame that he told me that he also has erectile dysfunction. “But don’t use my name!” he exclaimed.

It is shameful that so many of us can’t talk about such a common physical problem even yet. Our silence too often makes it much more difficult to treat. By talking about our physical problems we can discharge whatever shame that we have about them.

I applaud Dana Jennings, an editor of The New York Times, for starting to bring incontinence and erectile dysfunction out into the open. His article, “Living With Incontinence After Prostate Cancer,” is much wiser than the more typical shameful response to the defects of our bodies.

“It’s important (and difficult) to remember that we are not our incontinence,” he writes. “We are not our impotence. We are not our cancers….It’s just a biomechanical flaw. Same with impotence….I decline to feel diminished by incontinence, to be defined by biological drizzle.”

Bravo, Dana! Likewise, we can’t let diabetes define us. We are people who have diabetes, not diabetics. It’s nothing to be ashamed of, and it’s not something we can cure. But we can start to control our diabetes when we aren’t ashamed that we have it. With that acceptance we take the first step to change.

This article is based on an earlier version of my article published by HealthCentral.