composition relays the looming desire for sugary food and the self-monitoring it instigates. Another ponders the isolation of disease in the most public of settings. The artist’s visual narratives are themselves an important part of life with diabetes for, as Mol tells us, in “the logic of care exchanging stories is a moral activity in and of itself.”69 Jacobs calls attention to balance, temptation, desire, and discipline. The song of the cicadas could be the soundtrack to her gallery.
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The remainder of this book explores a variety of case studies to provide an overview of diabetes’s public personifications. The archive of this volume purposefully works outside strict biomedical renderings of diabetes that limit the scope of how the condition is made intelligible, surveying artifacts as diverse as everyday speech and public health controversies, to ascertain diabetes’s amorphous persona. The objects of study in the following chapters are part of a public archive, one composed of media representations, political posturing, and seemingly banal communicative exchanges. The content for each chapter is often mined from news reports but is also composed of congressional testimony, law reviews, and interviews with public health officials. This is not to say that medicine is absent in my archive. Any mention of diabetes carries the rhetorical remainder of that history and I often engage medical reports directly. Following the work of scholars like Berlant, I find that such a prosaic archive exhibits an ordinariness that “requires an intensified critical engagement with what had been undramatically explicit.”70 This archive is itself a form of rhetorical stitching, and I am conscious of the ways my own perspective shapes and narrows management’s conceptualization. Like all forms of knowledge creation, my own academic expertise helps to structure the materials being explored here: Two of the chapters are deeply dependent on queer theory and LGBT studies, one on feminist investigations of intersectionality, and all are informed by disability studies in some form.
The chapters are loosely organized around two dialogical pairs that accentuate how diabetes is publicly represented. The first binary situates diabetes as easily managed on the one hand and lethal on the other. The second dyad focuses on the necessity of the individual to overcome the disease, which often stands apart from discourses that call for heightened systemic intervention. These four tropes: effortlessness, fatalism, individual transcendence, and institutional regard, all act as major organizing devices for the next four chapters. I contend in the book’s conclusion that these four heuristics blur in discussions of diabetes technologies, elucidating political and cultural obstacles that necessitate contemplation in the decades ahead. As is often the case with academic segmentation, the individual concepts in each chapter bleed into one another as much as they stand apart. The case studies are isolated for the purposes of analytical clarity, aspiring to detail an assortment of themes and figures that constitute diabetes management and the cultural contexts people navigate to make sense of their lives.
As a critic indebted to rhetorical and cultural studies, I have selected the case studies that follow because each elucidates unique qualities about the constitution of diabetes management. Humanities scholars have long utilized particular situations in order to theorize larger cultural trends and social impulses, recognizing that all knowledge creation is inherently contextual and contingent. In this way, the examples that structure each chapter do not strive to make universal claims about the composition of diabetes management. I do not believe diabetes management can be easily reduced to a single theoretical heuristic, even if such ideas sometimes surface in the analysis. Resisting theoretical coherence is not an attempt to delay questions about diabetes management. Rather, it is an attempt to address how diabetes management is constituted in specific instances. The cases studies provide snapshots of how management is regarded in common parlance more than offering totalizing explanations of diabetes’s public life. Nonetheless, there is little denying that the dyads selected are ubiquitous in discourses about diabetes. The ideas of ease and fatalism, for example, are widespread in media reports, everyday interpersonal exchanges, and medical monitoring. Indeed, the tension between these two discourses sparked unending consternation when I was first diagnosed. It is not an overstatement to say that this discord provided the initial inspiration for this book.
The next chapter uses as its starting point the controversial analogy “HIV is the new diabetes” to explore how diabetes is cast as an easily managed condition. Medical practitioners who view HIV as a chronic condition have embraced the comparison, but those who cling to the notion that HIV is uncontrollable resist the association. Factions that decry the analogy tend to mischaracterize both diseases by ignoring the commonalities among the conditions and exaggerating the consequences of HIV over those that stem from diabetes. I survey scholarship about HIV’s turbulent history to mine the concepts of apocalypse, paranoia, and precarity and scrutinize pockets of resistance to HIV’s arrival as a chronic condition. These heuristics detail how HIV has come to be marked as erratic and onerous, while diabetes is situated as a disease readily controlled by pharmaceuticals or personal restraint. Not content with this conclusion, I then invert the pair to appraise how we might reconceptualize our thinking about both conditions, particularly with regard to notions of shame, self-governance, and race.
Chapter 3 looks to the advocacy of the JDRF (formerly the Juvenile Diabetes Research Foundation) and its incessant drive to cure type 1 diabetes. The organization is generally heralded as one of the most successful patient lobby groups in the United States, having raised more than $1 billion for scientific research. The JDRF’s most lauded and high-profile event is the Children’s Congress, in which dozens of young people with type 1 diabetes descend biennially on Capitol Hill to testify before the US Senate. Unlike chapter 2, which explores the idea that diabetes is easily managed, the JDRF’s rhetoric contends that diabetes is deterministically fatal. JDRF youth activists argue that management may prolong life, but no amount of personal care can stave off diabetes’s lethal arrival. The somber tone adopted by the advocates creates a melancholic projection of the future, something to which they aspire but may never see. Ultimately, I argue that fatalism has a productive place in management discourse by offering a sense of urgency to the condition to marshal institutional resources. Their pleas also resist notions of self-determination and individual responsibility that tend to characterize uninformed impressions of diabetes.
Supreme Court Justice Sonia Sotomayor and her life with type 1 diabetes are the focus of chapter 4. Sotomayor’s confirmation hearings were famously clouded by institutional racism and sexism. She was accused repeatedly of being intemperate, emotional, and illogical in a judicial sphere that prizes circumspection, deliberateness, and collegiality. Perversely, these prejudices also furnished a backdrop wherein her diabetes could be taken to illustrate her personal restraint. The Obama administration highlighted her lifetime of managing type 1 diabetes as proof of personal control and by extension judicial prudence. This strategic invocation of intersectionality, using a disability to rhetorically “contain” race and gender, was remarkably successful. Press coverage originally posited Sotomayor’s diabetes as a reason to withhold confirmation. After the White House released a letter from her doctor affirming that she had “consistent blood sugars better than 98% of diabetics,” however, this narrative was reconfigured and her condition was situated as a personal strength that would benefit the nation. Management is figured here as a transcendent mechanism and Sotomayor as a so-called super crip. Diabetes may be omnipresent, but its effects can be superseded so long as the person living with the condition “takes care of themselves.” Sotomayor’s inspirational story, which took her from a public housing project in the Bronx to the highest court in the land, inadvertently propelled an American Dream narrative that eclipsed structural impediments that complicate diabetes management.
The question of systemic intervention is the focus of chapter 5, which examines institutional efforts to curtail diabetes rates. I look to New York City’s controversial diabetes registry program, which requires all labs serving municipality residents to report A1C scores to the Department of Health and Mental Hygiene (DOHMH).
