Effort Without Improvement

Chronic illness, meritocracy, and the pressure to do more

I don’t write about my health very often. Not because it isn’t central to my life, but because, honestly, I’m still processing it. It isn’t something I’ve reached clarity or closure around. It’s something I’m still thinking through, often in real time.

This piece is about effort, belief, and the difficulty of living inside a culture that insists improvement is always possible.

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When I became ill at age 21, I truly believed that I could health-hack my way out of it. Over time, I stopped drinking fizzy drinks, stopped eating sugar, gluten, dairy and high-histamine foods, walked more, gave up coffee went to bed early, avoided stress, and eventually got sober. I refused to have even a small hand in the shitty ways my body was behaving. All of this effort was a way of making sure my health could never be treated as a personal failure. Every year the list of limitations and expectations grew longer, my health stubbornly became more complicated, and twenty years passed.

That lifelong pursuit of wellness meant that when perimenopause hit, new diagnoses stacked up, and my health rapidly worsened, I was crushed by the realisation that I was never going to get better. It was only at this point that I actually accepted I was chronically ill and had been for decades. Five years on, despite my body’s clear insistence, I still struggle to accept it.

We tend to understand illness as something you either die from, or recover from. Those of us who are chronically ill live in the awkward inbetween space. Not dying, but not getting better either. Not an emergency, not something fully resolved.

This disparity is where most of ableism’s most popular ideas come from. If you’re still not better you must not be trying hard enough. Have you tried x,y,z? You must be better now because you look fine/a significant amount of time has passed. The idea that illness might be something you manage indefinitely, without progress, without reward, is deeply uncomfortable to a culture that has an ingrained belief that effort always produces results.

We’re told that health, like success, is something you earn through discipline, restraint, and the right behaviour. If you work hard enough, comply closely enough, optimise carefully enough, improvement will follow. Chronic illness disrupts that extremely saleable, inspirational narrative. It produces people who do everything right and still don’t get better. In fact, I have never met a group of people who are doing more right than the chronically ill. And society, rather than question the belief, questions the person.

In a meritocratic culture, maintenance has little value. Standing still looks like failure, lying in bed even more so. Staying level looks like stagnation, when for chronically ill people, ‘level’ is a moon shot. Work that doesn’t produce visible improvement is treated as wasted effort, or worse, as a lack of effort.

What’s particularly corrosive about this is that I make more effort than most people I know. I work constantly to manage my health. It is truly a full time job. I am hard-working and disciplined in ways that would be praised in almost any other context.

And yet, because none of this effort makes me better, I, and many other people in the world, experience it as not enough. The absence of improvement erases my labour. My effort only seems to count if it produces visible progress.

Ableism isn’t just cruelty or ignorance. It’s the enforcement arm of meritocracy, which exists to protect the hyper-capitalist belief that ‘more’ always pays off. The existence of chronically ill and disabled people challenges this simply by the fact that they continue to be ill.

It’s still hard to accept that I have to make as much effort as I do to never get better. And despite understanding, intellectually, that I am chronically ill, my brain continues to search for the magic pill. Not out of optimism, but out of habit, and probably some shame.

With decades of evidence to the contrary, I still catch myself thinking that perhaps I just haven’t found the right lever yet. If I research a little more. If I adjust my pacing. If I try that new supplement. If I push a little harder, or restrict a little further, maybe then things will shift. Maybe then improvement will begin.

Part of this is fear. Fear that if I stop striving, I will have no one to blame but myself. But also that other people will read any acceptance as giving up, or laziness, or self-pity. I recognise all of this as internalised ableism, but recognising it doesn’t resolve it. When most of the messages you encounter treat illness as something to overcome, effort as moral virtue, and acceptance as failure, exiting that framework isn’t a simple act of insight. It’s daily resistance, often undertaken without support.

Understanding the system doesn’t always free you from it. For now I am still stuck inside the trap, counting its teeth.