What Will It Take for Wellness To Finally Leave Behind Its Ableist Origins?

By including folks with disabilities and chronic illnesses in the wellness conversation—and evolving wellness to better suit their needs—we’d be creating a version of wellness that better serves everyone.

After being diagnosed with debilitating psoriatic arthritis, Nitika Chopra wholeheartedly embraced wellness culture. She sought healing through holistic methods like acupuncture and “clean eating” and gobbled up self-help texts like The Secret and the works of Deepak Chopra (no relation).

For a time, Chopra embraced the idea being peddled to her by the “thriving” individuals in her wellness circles: that she could become as healthy as they were through perfect thought and action. But despite her best efforts, at just 25 years old, Chopra found herself bedridden and unable to audition for the role of a lifetime. Mantras and affirmations, it was clear, were no match for her autoimmune condition.

It was a turning point for Chopra, who would go on to found Chronicon, a community for folks with chronic illnesses. In deciding to let go of the pressure she’d been putting on herself to self-heal and instead consult a doctor, she also realized that the message she’d been internalizing—that her inability to get well was a personal failure—was harmfully ableist. She came to accept that she was, and would likely remain, chronically ill through no fault of her own, and that she had been gaslit by some segments of wellness culture into feeling otherwise.

This idea that good health is both a personal responsibility and a moral obligation is what’s been called “healthism,” a term attributed to political scientist Robert Crawford, PhD. In 1980, Dr. Crawford wrote an article for the International Journal of Health Services called “Healthism and the Medicalization of Everyday Life,” in which he defines the term as “the preoccupation with personal health as a primary—often the primary—focus for the definition and achievement of well-being; a goal which is to be attained primarily through the modification of life styles, with or without therapeutic help.” Dr. Crawford writes: “For the healthist, solution rests within the individual’s determination to resist culture, advertising, institutional and environmental constraints, disease agents, or, simply, lazy or poor personal habits.”

As Chopra discovered, healthism disproportionately harms individuals with disabilities and chronic illnesses, for whom “perfect health,” as defined by limited cultural standards, may never be a possibility. But this way of thinking didn’t begin in the ‘80s: It’s been integral to modern wellness culture from the beginning.

The past and present of healthism in wellness culture

Americans’ pursuit of health began to resemble a version of wellness culture we recognize today—with a focus on using lifestyle behaviors and alternative healing practices to prevent illness—sometime around the late 19th century, when some Christian sects began to preach healthy living as a virtuous way of life. Even in these early days, the idea that in order to be “good” you had to aspire to perfect health was baked into the American definition of wellness, says Matthew Remski, co-founder of the Conspirituality podcast, which examines the overlap between New-Age spirituality and alt-right beliefs.

Dr. Kellogg also enthusiastically joined the then-burgeoning pseudoscientific eugenics movement. He preached that the adoption of healthy lifestyle habits could result in optimal health, which would then create optimally healthy offspring. Eventually, he believed, a race of superhumans would result. But Dr. Kellogg didn’t believe all people were capable of this achievement, and he thought that those who remained unhealthy—or were neurodivergent, mentally ill, or had any number of other traits—should be sterilized. Many subsequently were: The first forced sterilization law in the world was passed in Indiana in 1907, and eventually 31 other states followed suit with their own laws. Dr. Kellogg framed this weeding out process as “race betterment.”

Another American of the same era, Bernarr Macfadden, also espoused a morality-based wellness ideology. He billed himself as a “teacher of physical culture” and built an empire around his health-related beliefs that included books, spas, and a number of magazines, including one of the world’s first fitness publications, Physical Culture (the slogan of which was, "Weakness is a crime. Don't be a criminal!"). Like Dr. Kellogg, Macfadden believed wellness was within an individual's control and that those who couldn’t become well were inferior, immoral, and should be weeded out of the human race.

While some of these ideas were quite fringe, both men had enthusiastic and prominent followings. The wellness mecca Dr. Kellogg directed, called the Battle Creek Sanitarium, drew luminaries of the day, such as John D. Rockefeller, Jr., Amelia Earhart, and Sojourner Truth.​​ And Macfadden was such a big name that he attempted to run for president, and eventually became one of America’s top publishers. “They were popularizers—early trailblazers who laid the foundation for what later became mainstream,” says Petrzela.

Petrzela says the ideologies put forth by these early wellness pioneers caught on in the United States at that time largely because they aligned with the Protestant work ethic of “working to show your salvation.” In this case, she says, the godly was bodily discipline.

Despite a century’s worth of evolution, today’s wellness culture has not been able to shed its original guiding philosophy: that the pursuit of health is a moral and individual one. Neoliberalism has simply shifted the specific moral imperative for pursuing health away from god (or country, as was the prevailing ideology in other parts of the world) to capital.

It’s no accident that some of the most famous wellness figureheads of today—think Goop guru Gwyneth Paltrow or bio-hacking pioneer Dave Asprey—are hyper-successful individuals who evangelize their wellness behaviors as helping them “do it all.”

“It’s like [essayist] Jia Tolentino says, ‘Always be optimizing,’” says Christy Harrison, MPH, RD, author of The Wellness Trap, of hustle culture. We’re led to believe that, in order to add value to society, we must “always be pushing for greater and greater wellness—fasting more and taking more supplements and doing more cold water baths or whatever—to try to get that extra level of mental sharpness that’ll help you work that extra hour in the day,” she says.

Wellness culture’s focus on individual habits is uniquely ableist

Healthism’s framing of well-being as a series of correct choices perpetuates the idea that if you are ill, it must be because you made incorrect choices.

But data does not support this philosophy. According to Harrison, “When we look at the research on population-level health outcomes, we see that 10 percent of modifiable risk factors are attributable to diet and exercise, 70 percent are attributable to social determinants of health—which are the conditions in which you live, your socioeconomic status, your food security, discrimination you may experience, job security, things like that—and the other 20 percent are individual behaviors like avoiding smoking and safe sexual health practices.” And of course, she adds, genetics play a significant role as well. “A lot of people have genetic conditions they were always going to get no matter what they did,” Harrison says.

When the reality is that not everything can be healed, it’s psychologically harmful to preach not only that it can, but that it’s an individual’s fault if they remain unwell, says Zoe Mckenzie, a physiotherapist and certified trainer who created the platform Actively Autoimmune to provide a supportive exercise plans for people with invisible illnesses. (Her Actively Studio includes a “Bed Pilates,” program, for instance, that can be done fully horizontal.)

“The narrative that health is fully in our control, when a lot of health conditions and disabilities are not, puts a lot of pressure on people and can make them feel a lot of guilt if they aren’t able to become the best, healthiest version that everyone says they should be able to become,” says Mckenzie. “It also implies that we’re not trying hard enough to ‘get better.’”

Such hyper-focus on individual control over well-being also discounts systemic causes of poor health. America’s systems are not well positioned to help anyone in need, but they make life especially difficult for those who are living with disabilities. After all, no amount of wellness practices will help someone who needs and can’t access expensive medical treatments that are necessary to manage their chronic illness or disability. Nor will diet and exercise (let alone sauna treatments and daily affirmations) help to financially support an individual who is unable to work.

According to disability advocate Kelsey Lindell, an astounding 80 percent of disabled individuals are unemployed, but disability benefits are not easy to qualify for. (Note that over half of disabled individuals are over age 65. However, in 2022, the unemployment rate for those with a disability was more than double the rate of those without a disability.) And if you are able to earn a little bit of money—anything over $1,470 a month for most people with a disability, which is not a livable wage in 2023—you become ineligible to receive them. Marriage threatens disability benefits as well—it can result in a reduction of monthly benefits or even a loss of eligibility for benefits—which forces many disabled individuals to remain legally single and miss out on the proven health benefits of formally coupling up. It’s also actually legal in a majority of states to pay disabled people less than minimum wage.

“The reality is that most people who are disabled cannot just do everything they set their mind to because of structural systemic barriers,” says Lindell.

The wellness industry was built to serve those who are already well—and shuts out those who are not

The wellness industry has earned its reputation for being expensive—one $45 spin class, $15 juice, and $60 jar of supplements at a time.

“Finances are a huge barrier to disabled people accessing the wellness world,” says Mckenzie. “Exercise programs, diets, specialist advice, coaches: That is just very out of reach for a lot of people living with disabilities or chronic conditions…Perhaps they're living off benefits, or they're unable to work or, you know, it’s just so expensive to live with a health condition between medications and treatments and health insurance.”

It also takes a significant amount of time and energy to research wellness treatments (and to become an educated patient in general), Mckenzie says, and those are two things that those with chronic conditions or disabilities are not likely to have in excess, either. Therefore, people from these communities are often excluded from wellness, even though they’re the ones who most stand to benefit from its offerings.

This message also reinforces the way American capitalism ties productivity (our old friend!) to personal value—it’s only hyper-productive folks with disabilities who get air time.

Lindell aims to improve disability representation, in the wellness space and beyond, with the launch of a new agency called Misfit Media. “Eighty percent of the representation we see in media, marketing, and entertainment is through the harmful use of stereotypes that disabled people are actively trying to avoid,” Lindell says. “I'm helping brands become more inclusive so they are including disabled people more but also in ways that don't harm us.”

How advocates are working towards a more inclusive future

The current wellness movement, says Mckenzie, assumes that everyone has the same goal of striving to be the best and healthiest version of themselves. “But some people are just trying to survive,” she says.

What it means to live “well” and the goals of wellness need to expand to accommodate this reality. Our singular, idealized image of perfect health (you can picture her: the thin, able-bodied, uber-successful wellness maven who fits in a Peloton ride at 5:00 a.m. before working a full day and then feeding her kids a nutritious dinner and tucking them into bed) must be replaced with individualized definitions of wellness that take into account inevitable, unavoidable, and often incurable health conditions. The wellness goal for some people may be to “slightly improve their quality of life or change their mindset,” says Mckenzie.

“There are different spectrums of wellness,” agrees Chopra. By including folks with disabilities in the wellness conversation and, indeed, evolving wellness to better suit this community’s needs, we’d be creating a version of wellness that better serves everyone.

Take, for instance, the emphasis fitness and wellness culture places on pushing yourself to the limit. When it comes to exercise, we’re led to believe, you need to go hard, or go home. But that approach can actually be harmful for many individuals with disabilities, whose conditions can be exacerbated by physical stress, both Lindell and Mckenzie point out. For many people, rest may be the healthiest wellness behavior in which they could engage, but rarely does the culture emphasize or celebrate it as such. Shifting to a definition of wellness that is more accepting of ease and rest, therefore, would be a boon not only to people with disabilities, but to all overworked and burnt out Americans.

Chopra says she wants to see disability being celebrated within wellness spaces. She likens the chronic illness movement to the body acceptance movement: The same way there has been a shift towards greater inclusion and representation of more body sizes, “I want [those with chronic illnesses] to have our own movement that’s about celebrating us and not about changing us,” she says.