I met a woman in her eighties who talked at length about how healthy, fit, and good-looking she and her husband are. She described regular exercise, summers at the beach, her husband’s consistent swimming, and a long marriage in which roles were stable and predictable. He does the cleaning. She cooks. The structure has been in place for decades. She presented this as evidence of how health is created through personal choices and discipline. Her didactic tone implied that other people — i.e., me — need only to do the same things to achieve similar outcomes.
She looked at me with the assumption that I had overlooked something basic. The message was that health is available if a person makes the right decisions. It was a comparison between her condition and mine, with an implied hierarchy of effort and outcome. She was interpreting me and my life through the lens of her own, and shaming me for not having made the same choices she had, when I didn’t have anywhere near the same options or resources.
She made her assumptions based on my appearance, but she was blind to the fact that my life history includes chronic trauma starting in early development, repeated violations of bodily safety, and long periods of ongoing harm without accountability or justice. It also includes years of fighting to access basic stability while managing the effects of those experiences in a body that has not had consistent conditions for recovery. She could not see the 8 years of fighting for my life under repeated medical and psychiatric harm, the 7” of hernias in a 14” belly that disable me and prevent most of the activities I enjoy, the six structural problems in my feet that make walking a challenge, the quadrilateral Complex Regional Pain Syndrome that reduced mobility, the arthritis, chronic muscle tension, spinal stenosis, or body wide myalgia. Her comparison did take these into account.
From a Relational Neuroscience perspective, that exchange was a predictable mismatch in how life conditions are interpreted. When someone has lived in long-term relational and financial stability, their system organizes around predictability. Daily habits become possible because the environment is steady enough to support them. That becomes invisible to the person who experiences it. It stops being recognized as a contributing factor and starts to look like normal life.
People with the privilege of such stability often attribute their outcomes to personal choices rather than to the conditions that made those choices sustainable or even available. They believe health practices are universally accessible behaviors rather than responses shaped by environment and experience. This creates a gap between explanation and reality.
When that model is applied to someone whose life has been shaped by repeated disruption, it produces distortion. It reduces complex histories into a simple instruction set. It also turns differences in capacity into differences in character. The nervous system receiving that message responds to the absence of recognition of what has been lived. Mine responded with annoyance.
Her comment, “You need to take care of yourself first,” is in the same category. It assumes that awareness is the limiting factor. It ignores that self-care depends on whether the conditions of a person’s life allow for regulation, rest, and consistency. When those conditions have been repeatedly absent or destabilized, the ability to implement self-care is not a matter of knowing what to do, but whether the system has enough stability to sustain it.
She was speaking from a life organized around long-term support, financial stability, shared responsibility, and consistent partnership. That kind of relational structure colored her assumption of what is available to others. Her tone carried her own sense of authority because her internal model of health was reinforced by decades of stable outcomes. She had no concept of the conditions that produce instability in other lives. Her view also neglected to include the possibility that those conditions can be severe, cumulative, and ongoing. Her thinly veiled advice became a projection of one life pattern onto another life pattern that has been shaped by different forces. She overwrote my lived experience with her assumptions.
Self-care is not independent of the conditions that make it possible. When they are present, it can look simple. When they are missing, it becomes a different kind of task entirely, one that cannot be reduced to instruction or intention.
What she offered was not guidance grounded in reality, but a set of conclusions built from a life where stability and support had been consistent enough to disappear from view. Because she did not register my history, losses, or the conditions I have to navigate, her words landed as judgment rather than information. That is where the harm comes in. When someone applies a narrow model of “health” and “choice” onto a life shaped by repeated disruption, it turns misattunement into a form of relational harm. It erases context, assigns blame, and reinforces a hierarchy that was never based on equal conditions. The problem was not that she spoke. It was that she spoke without the authority she presumed she had earned. I’m thankful I could understand the dynamic and therefore reduce its effect on my system.