If you’ve been indulging in the guilty pleasure of watching "The Real Housewives of Beverly Hills," you know a major storyline this season is Yolanda Hadid’s ongoing struggle with Lyme disease. From her sickly pallor and face uncharacteristically devoid of makeup to her closet full of pill bottles, this season’s Hadid (formerly Yolanda Foster) is in striking contrast to her perfectly coiffed presence in seasons past.
For her castmates, speculation abounds: How can she sometimes look so healthy? Why is she at one function but can’t make another? Why isn’t she getting better?
Despite earnest claims by her friends that they know she is ill and suffering, the fluctuating nature of her illness and her diagnosis -- neurologic Lyme, an advanced stage of Lyme disease which can cause cognitive symptoms like short-term memory loss and processing problems — leave her friends questioning.
[This is] about what happens when patients, particularly female patients, are not seen as reliable narrators of their illness.
In a conversation about Hadid, castmate Lisa Rinna went so far as to bring up Munchhausen's syndrome, a mental disorder wherein the patient makes up physical symptoms for attention. Watching that scene, I could almost feel the collective shudder of chronic illness sufferers across the country.
I think it's fair to say people don’t watch Bravo's "Real Housewives" franchise expecting large doses of reality. After all, the escapist series is mostly about parties, decadence, behind-the-back whispers and air kisses. But here’s why the conversation we’re seeing play out now actually matters: it reveals a fundamental misunderstanding of what chronic illness actually is, and it taps into ingrained and destructive stereotypes regarding gender, pain and illness. This isn’t about Yolanda Hadid in particular, or even about her Lyme diagnosis. It’s about what happens when patients, particularly female patients, are not seen as reliable narrators of their illness.
While it may confound her Beverly Hills friends, it doesn’t seem strange to me at all that Hadid can look healthy some days and haggard others. By definition, chronic illness is treatable but not curable, and there are nearly 133 million Americans living with chronic illness whose symptoms may wax and wane, sometimes fairly quickly. As someone who has lived with genetic respiratory and autoimmune disorders my entire life, my answer to the “But you don’t look sick?” query is fairly simple: that’s because you don’t see me on my bad days, when I’m too sick to be out and about. Absence of physical symptoms at a given time does not preclude their existence, nor their severity.
When you add gender into the mix, diagnosis and appropriate management of chronic illness is even more problematic. Women are more likely to have pain dismissed as emotional and when we do receive treatment, it is less aggressive than the treatments men receive. Many chronic illnesses are hard to diagnose to begin with, which exacerbates this gender gap further. For example, women are three times more likely than men to develop autoimmune diseases, which are notorious for their complexity and difficulty in diagnosing, and nine times more likely to be diagnosed with fibromyalgia. As many as 50 million American women live with what are called neglected pain disorders, conditions like endometriosis that entirely or disproportionately affect women and lack sufficient research funds, training and physician education.
While we’d like to think the days of perceived hysterical female illness are firmly in the past, that is unfortunately not the case. Consider that in 2013, the newest version of the Diagnostic and Statistical Manual of Mental Disorders, DSM-5, debuted the diagnosis of Somatic Symptom Disorder (SSD). Here, patients with a physical symptom lasting more than six months who also report increased anxiety or thoughts about their physical symptoms or otherwise spend too much time on could meet the criteria.
When Hadid told her friends in this week’s episode that their skepticism was an insult to her integrity, her words rang true for chronic patients everywhere.
Here’s the problem with that so-called diagnosis: most people who live with persistent and often progressive physical symptoms for several months will start to devote more time, thought and energy trying to manage and alleviate them — especially if these prolonged symptoms affect their ability to work, to enjoy social activities and to live productive lives. Having symptoms and experiences further invalidated or doubted by friends, family and physicians compounds all those existing problems.
Certainly, much of Hadid's experience is beyond the realities of most patients with chronic illness who don’t have her enormous financial resources to try numerous therapies or fly across the country for surgeries, and who may face serious economic peril if disease progression means they cannot remain employed. Yet after a lifetime of illness I’ve found that there are some fundamental truths about living with illness that transcend matters of disease-specific symptoms or socioeconomics. When Hadid told her friends in this week’s episode that their skepticism was an insult to her integrity, her words rang true for chronic patients everywhere.
In a culture where women’s pain and illness experiences are all too easily cast aside as psychogenic, such skepticism is more than idle gossip — it’s a slippery slope.