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Rejecting the “self-discipline” framework

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Sam at Skepchick has an AI up that I think is probably one of the most clear-cut examples I’ve seen in a long time of how framing an issue really suggests the answers. The post is about obesity and nutrition-related diseases like diabetes and heart disease, and he throws out these discussion questions:

Is obesity as big a problem as reported? If so, who should be held responsible for the country’s soaring obesity rates? Food industry? Government officials? Eaters? Which is more of a factor in the obesity trend/epidemic: lacking self-discipline, living in an environment that promotes unhealthy behaviors, video games/Internet? Obesity rates in children have tripled since 1980. How would you reverse this upward trajectory? Would you?

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Emphasis mine. It’s not just that it invokes an unfortunate either/or framework that makes this question a problem. It’s that it introduces the concept of “sin” into a discussion about public health. I realize that Sam surely didn’t intend it that way. It’s telling that Christianity is so pervasive that its ideas even penetrate atheist circles. “Self-discipline” can’t really be extracted meaningfully in this debate from the concept of sin and punishment. Under the sin framework, gluttony is a sin, and the only proper response to sin is punishment. Therefore, if you accept the “self-discipline” framework, there is no problem here. The overeaters are sinners, and their health problems are punishment for their sin. The system works, let’s all go home. Indeed, you see this exact argument being trotted out in comments. 

But if you reject this notion and instead view negative health effects of overeating as a public health problem to be solved, then the question of “self-discipline” becomes silly. Let’s just say for the sake of argument that you accept this assumption, that people don’t have self-discipline and that’s why they overeat. If you’re still interested in solving the problem, the response then becomes, “So what?” There’s no real way to fix that problem with traditional finger-wagging, as thousands of years of scolding has so far proven ineffective. Leaving it be is also unacceptable, because real people are suffering and our health care systems are overextended. When you’re engaging in problem-solving, it’s best to start by looking at things you can control, and leave the discourse of sin and redemption to the wayside. 

Incidentally, the sexual health debate suffers from the same problem. Even if you accept (which I don’t) the premise that abstinence is inherently good, and that’s what people “should” do, I have the same response: So what? You can say “should” until you’re blue in the face, and people are still going to fuck. If you actually want to fix the problems of STD transmission and unintended pregnancy, you have to deal with people how they are, not how they “should” be. Same with food consumption and exercise. I guess people “should” exert often-extraordinary levels of self-discipline, but they don’t, because they’re human. Meet them where they are, not where they “should” be. 

We can’t fix people’s impulse control, but we can fix their environments through collective action. Interestingly, we can fix their environments so that they are better able to exert self-control. Self-control is neither a fixed quality nor completely under (oh irony) our control. Research has shown that pretty much everyone’s self-control diminishes when they’re mentally exerting themselves or stressed out. Simple fixes that separate mental exertion from eating time could do a lot to reduce over-eating. If that’s not possible, reducing temptation is always an option. Self-control is often only as strong as the environment it presents itself in. (Incidentally, I also reject the way that the sin framework around eating treats eating, which should be a source of pleasure. Demonizing eating is not the best approach here.)

What I would like is for public health discourse to simply get over this fetish for “personal responsibility”. It’s a red herring. First of all, it’s not really a static quality you either have or you don’t. Second of all, it’s not something that’s responsive to scolding, which is the only solution people who love to trot out “personal responsibility” will accept. If we actually give a shit about people and their health, then we have to look at what we can do and what we can fix. And that’s the environment. Plus, there’s piles of evidence that show people are incredibly adaptable to environments. If Americans had an environment that was more conducive to exercise and healthy eating, we’d do more of that. The only other possibility is that we’re uniquely gluttonous as a people, and that’s a little hard to really believe. 

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