The Silent Killer

The phrase "the silent killer" has been around for quite a while. Originally it referred to high blood pressure: You can't feel it, smell it, hear it, see it, or taste it, but people with high blood pressure are at significantly increased risk of heart attack and stroke.

I think there is a new silent killer on the loose. Like hypertension, it is virtually invisible. Unlike high blood pressure it doesn't kill the individual. It is, however, significantly disabling. And, unlike hypertension, it affects the community as a whole. Odd as it may seem this new disabling condition is disability.

My office is being inundated with a stream of patients who are either on disability (Social Security disability, i.e., permanent public support) or are actively seeking disability. People in their 20's, 30's, 40's, and 50's. I'm not talking about people in wheelchairs or with walkers, I'm talking about people who walk, talk, dress and toilet themselves. People who drive. The sources of disability I have personally encountered include dyslexia, carpal tunnel syndrome, chronic back pain, fibromyalgia, and -- swear to God-- one who said, "I'm not sure. I think I have a learning disability or something."

The reason I consider this a killer is because our current disability system turns otherwise healthy individuals into dependent victims. It has become a refuge for the unemployed and, more and more, it appears to be a refuge for the under-employed: Those individuals who can't find the kind of work they used to have in manufacturing, clerical, or other work that is meaningful and pays the bills. So I hear, "Doc, I'm just thinking of going after my disability. I'm 46, I've got a bad back and neck and I just can't do this anymore. At my old job I was fine but now...." I recently saw a patient in their 30's who was permanently disabled for a seizure disorder although they hadn't had a seizure in over 10 years. The person had recently broken a bone and all they wanted to know is when they could get back to aerobics. The patient stressed to me the need to get back to exercise because they were "addicted to working out." I saw another patient, already on permanent Social Security disability for a bad knee, who was in seeing me for an injury to the hand. It happened while working on the engine of their truck. With rare exception they all seem to manage to pursue their recreations, it's just work: They just can't work.

Entitlement comes in all forms these days but from where I sit growing the ranks of the disabled is one of the greatest disservices we offer. From where I sit the greatest source of contemporary disability is not some epidemic of physical injury or disease. Rather, it's a lack of opportunity coupled with a lack of obligation. Once the disability payments start no one feels any obligation to contribute.

Driving around my small home town and around a major metropolitan area recently I see mountains of public work to be done. Small stuff like litter and trash and general picking up. I see seniors that need rides or assistance with shopping. Kids that need care. There must be hundreds of jobs the new generation of disabled could do, if even for 3 or 4 hours a day. Jobs that need to be done but public budgets can no longer fund.

By and large we are not caring for disability as much as for depression. The value we need to add is not so much to ensure we get something for our public investment as it is restore a sense of dignity and value to the person receiving the aid. It's the only treatment I see that can eradicate this pernicious silent epidemic.