Excuses, excuses....

All disabilities confer selective advantage, even if only via the responses of others who have learned from the situation. “Selective advantage” is a biological term for that which is helpful to the survival of the species.

But for many a disabled person, the chief advantage of being disabled is to himself or herself.

Erving Goffman, sociologist, in Asylums (1975), built upon the work of Talcott Parsons and others to define the “sick role.” Being diagnosed confers the advantage of restrictions on going to work, or freedom from it. In a “total institution” such as he described, like the closed psychiatric unit in a hospital, patients undergo “the mortification of self.”

A rock-bottom aspect of the self in American culture is being able to give a reply concerning a vocation to the query, “What do you do?” In a psychiatric unit, one does nothing of one’s normal adult life, just art therapy, music therapy, and suchlike. These recreational therapies do not bode well for self-esteem, because when the sole activities, they do not allow the patient to contribute to his or her loved ones (unless it happens that the person’s vocation or important avocation is artistic, musical, etc.)

Many disabled people tend to make excuses for themselves, by manufacturing instances of their truly dominant symptom, in order to obtain some benefit. They may manufacture frequency of the symptom, severity of the symptom, or both. This is true of disabled people with or without psychiatric disabilities.

This behavior is very different from the American Psychiatric Association's Diagnostic and Statistical Manual V’s diagnoses of factitious disorder or of malingering. The person whom I am describing, who makes excuses for himself or herself, is genuinely disabled and is not mimicking a medical condition for sympathy (which is factitious syndrome,) or for a financial or legal advantage (which is malingering.)

And, indeed, it may just be true that everyone, disabled or not, tends to “milk sympathy” by exaggerating his or her problems in conversations with family or friends. Since I know that I do this, and since I am disabled, I am inclined however to think that it is a tendency that may be engaged in frequently by people with disabilities.