What do Walt Disney, Joe DiMaggio, George Harrison, Lucille Ball, Johnny Carson, Patrick Swayze and Eddie Van Halen have in common? They all died from a smoking caused illness, and their smoking was not mentioned in any of their obituaries. We tend to turn away from an accurate and direct attribution of the specific harms caused by smoking.
First the facts. Smoking is extraordinarily lethal. It is the only consumer product that is proven to kill at least 60% of the people who use the product as the manufacturer intends. But smoking persists. Many smokers will say things like “I know it’s bad, but that’s not enough to make me stop”. Others minimize the harm, saying things like “Everything causes cancer”, of “I know a person who smoked and lived to be 90”. What gives?
Behavior, decision making, perception of risk and attribution of blame are complicated processes. Human beings are not as rational as we would like to believe.
A clear- eyed weighing of the benefits and the cost is not how we make most decisions. Decisions usually spring first from a perception and an associated impulsive response: an immediate unconscious inclination to seek reward and satisfy ‘want’ or avoid pain and unpleasantries. Often our reasons or rationale for decisions and actions are applied afterwards, to justify or ‘make sense’ of what we’ve done. We certainly have the capacity to delay gratification, and act in our long term best interest, but that takes an application of energy to override unconscious habitual responses. If the habitual responses are strong, like addictive behaviors, more energy is needed to do something different. And if the cost is too high, reasons will shift to explain or justify the behavior.
Similarly, how we assess health risk is not based upon objective data. Instead it varies and will change based upon the personal perception of how susceptible “I” might be, and the effectiveness and cost of taking action to prevent the health risk. People who smoke will underestimate the health risks of smoking compared with non-smokers, and people who are more addicted to smoking usually underestimate the risks compared with people who are less addicted. The assessment of risk will change based upon how difficult it is to stop or avoid smoking. The severity of the addiction overrides our reasoning.
How we attribute blame varies too. We tend to blame and shame ourselves or other people when there seems to be ‘responsibility’ for causing an illness. We tend to feel more compassion and understanding when illness happens by chance or circumstance. Of course we shouldn’t blame or shame as this just adds insult to injury, but that’s a natural tendency.
Eddie Van Halen thought that his oral cancer might have been caused by the metal guitar pick he would sometimes keep in his mouth. Maybe, but unlikely. Cigarettes are probably the culprit. But in memorial, I would rather understand his reasoning, have a compassionate thought for the sad loss of a great guitar player, and blame the industry that created this addictive and deadly product.