There is a sign I pass every day on the way to work that says in bold letters: Health Thyself. The sign, actually an anti-smoking message, is paid for by the medical insurance people and it is, I know, there as a public service.

But the very tone of it, the sort of 11th-Commandment, Thus-Spake-Blue-Cross/Blue-Shield attitude of it, sitting there above the highway, has slowly rubbed raw a small layer of my consciousness.

I have begun to wonder whether the Self-Health movement - of which that sign is more symbol than substance - isn't another variation on our national theme song: Blame the Victim. How many measures, how many beats, how many half notes is it from the order to Health Thyself to the attitude that blames the ill for their illness?

The titles on the bookshelf of my favorite store are a chorus stuck in this monotone: "Stay Out of the Hospital," instructs one. "The Anti-Cancer Diet," offers another. "You Can Stop (Smoking)", cheerleads a third. They tell readers How To design their faces, control their migraines, lose weight, bear children without pain and psyche themselves out of everything from back pain to heart disease.

Perhaps the most typical of them is one that touts "Preventing Cancer: What You Can Do to Cut Your Risks by up to 50 Percent." And another containing "Dr. Frank's No Aging Diet; Eat and Grow Younger."

Now, I am in favor - who is against it" - of proper diet and exercise. I am against - who is in favor of it? - smoking. I assume that a diet high in calories, cholesterol and cognac would eventually do me in. I think that selfconsciousness about health, the desire to take responsibility for the shape of our lungs and calf muscles, is positive, and I agree that we are our own best screening system.

But there is a risk, a risk that as we focus on the aspects of self-health we begin to look at all ilness as self-inflicted and even regard death as a kind of personal folly.

There have been, among my acquaintances, the relatives of my relatives and friends of my friends, three attacks within the past year. One man, I was told, was, well, overweight. "He should have known better." Another woman was, her friends insist, a real "Type A." And the third man, I was assured by the most well-meaning of people, brought it on himself. "He was so out of shape."

Similarly, when people hear reports of cancer, how often do they inadvertently say that the victim should have stayed out of the sun, or off the pill, or away from nitrates?

Now, maybe they are right and maybe they are wrong, but I fear that there are many who seek to know the cause of a disease, not to cure it, but to judge its victims.

It is reassuring to hear that we can cut the risks of cancer by 50 percent. It is lovely to think that we can eat in special ways and grow younger. In a world of amorphous fears, where carcinogens are the new demons, it is very human to try to analyze illness in order to separate ourselves from it, to assure ourselves that we can be immune. There is a natural tendency to try to buy insurance packages - not of Blue Crosses and Blue Shields, but of diets and regimens and cautions.

But there is also something malignant about some of the extremists who make a public virtue of their health. It is the sort of self-righteousness that inspired a letter writer to suggest to me recently that we eliminate lung-cancer research, because "smokers do it to themselves."

There is a judgmental attitude toward ill-health germinating in parts of the country and in parts of our minds that can be spread cruelly. It implies that those who do not. "Health Thyself" not only are courting their own disasters, but also are owed very little in the way of sympathy. It implies that illness is, at root, a punishment for foolishness.

This feeds into the hope, born of fear that if we keep ourselves in shape and watch out, we can not only postpone death but prevent it. The notion that death is, in essence, suicide, and something we can avoid, is the most profound illusion of all.