Managing Diabetes. Jeffrey A. Bennett
was a key element of that work. These programs point to the economic imperatives of the modern university, which were crystallized during the financial crisis of the late aughts. As Belinda Jack has succinctly argued, “There’s money in medicine and not so much in the humanities.”59 On a more optimistic note, there is also no denying that there has long existed a dynamic relationship among pedagogy, scholarship, and advocacy in the humanistic investigation of health and medicine. After all, what would AIDS look like without activism? Indeed, what would queer theory look like without studies of HIV/AIDS? What would reproductive rights be without feminist critiques of science? How remiss would the designation of “mental health” be if reduced to definitions outlined by the Diagnostic and Statistical Manual of Mental Disorders (DSM) and without the correctives found in art, music, and literature? The humanities elucidate the fixations and deficiencies of clinical perspectives and highlight the generative possibilities of worldmaking among those living with diabetes. The objects of study and methodologies pertinent to the humanities permit a robust examination of the political climates in which knowledge is conceived.60 The power relations that privilege some bodies over others might give prominence to questions of disability, race, gender, and sexuality that are occasionally lost in objective renditions of science, even as they are fundamental to the inquiries being performed.
Management, then, is not best engaged as a purely medical heuristic. Rather, we might treat management as an intrinsically rhetorical construct that is best studied by spotlighting ecologies of context, the negotiation of meaning-making across publics, and the mystifying complications that escort the circulation and reception of ideas about its functions. There is no shortage of scholarship, from the sciences to the humanities, illustrating that knowledge production is not an inherently impartial process but one underwritten by the realm of human affairs.61 Skeptics of scientific objectivity who are suspicious of nominal claims to neutrality have repeatedly dissected normative medical assumptions to discern how culture both enables and restricts interpretive schemas for assessing health expectations.62 The words used to describe “natural” phenomena matter. The contexts in which those words are used matter. The bodies putting those words into discourse matter. Critical heuristics that focus on the intricacies of meaning-making processes can yield valuable insights about health, identity, and power.
As a scholar who is indebted to the fields of cultural studies, feminism, and queer theory, I accord much consideration to the norms that guide the intelligibility of bodies, the stigma that marks people with disease as polluted or impure, and the symbolic possibilities for public activism. The inclination toward social change strikes me as particularly relevant to this project because diabetes is so rarely treated as an object or effect of political power structures. Privileging the voices and experiences of those who live with diabetes can offer matchless rejoinders to public scripts that overlook diabetes’s more unconventional, though no less critical, forms. For example, a posting on the widely utilized tudiabetes.com by a blogger who uses the alias “queer diabetic for universal healthcare” illustrates how meanings not typically foregrounded in the public sphere can subtly shift attitudes in productive fashion. Centralizing an intersection that I have not often come across, she asks: “how exactly are queerness and diabetes connected for you?” Her points are worth relaying in full, reproduced here as they are in the forum. She reports:
-im queer and diabetic. they both exist in me and make me who i am. the simple presence of queer diabetics makes them related.
-i have felt shame and pride at different times about being both queer and diabetic.
-i constantly have to come out as queer and diabetic. the process of coming out always reminds me of my otherness, my deviation from normal, which reminds me of unearned privilege (mine and others) and the subsequent inherent discrimination and oppression created in society. the need to come out also reminds me that (good) health and (hetero)sexuality are constantly presumed. and that is inherently homophobic, diabetaphobic, and ableist.
-im queer and i fight for queer liberation in the streets. but im afraid to get arrested and detained without sugar, insulin, test strips. shouldnt the queer liberation movement be flexible enough to make it safe for me to participate? shouldnt i still be able to be a “hardcore activist” without going into a coma?
-im diabetic and i want a cure, goddammit. would kid-friendly type 1 groups want me to join them in the search and fundraising if they knew about how i have sex? would they be willing to risk their benign-wholesome-white-family/friendly-we-didnt-do-anything-wrong image for my liberation? why not? their fear, my fear must be tied.
-what good is a cure if only rich folks with jobs and health insurance and money can afford it?
-what good is liberation if only some people are allowed to be free?
-what good does it do to “dismantle the police state” if the liberators police and judge our bodies, our medical decisions, our food choices, our worth (based on our ability)?
-i need my meds. i need health insurance. i need love. i need respect & acceptance for my full self.
Management here necessitates health care, medicine, and healthy food choices. But it also demands publics that are sensitive to privilege and marginalization, freedom from fear, mental wellness related to sexual acceptance, and the recognition of one’s personhood. The blogger’s list posits not simply an arduous subject position, but a queer positionality situated by norms of capitalism, white middle-class respectability politics, and the constant prospects of danger (both internal and external) to her body. Her goal is not simply to tell forumites about diabetes, but to illustrate how we might think about management anew through frames emphasizing activism, queerness, and disability free of social stigma. Such testimonials are vital to expanding the umbrella of management rhetorics and reconfiguring how diabetes might be made knowable.
The incorporation of experience, such as the testimonial above, into studies of health and medicine risks dismissal when litigated through a biomedical model that devalues personal narrative.63 Certainly, the experiences of one individual will inevitably fail to match wholly with those of others, especially when intersectional considerations of identity and geography are taken into account. Nonetheless, the anecdotal is a reflection of a wider field of discourse that surfaces among a spectrum of possibilities. Foucault was one of the many philosophers of medicine who was “fascinated by the ways experience as well as intellectual inquiry contributed to understanding, the authorization of role, and forms of subjectivity.”64 Giving presence to the lived realities of some bodies over others risks hasty generalizations and reckless universalizing. And, yet, the same can be said for conglomerations of data, abstract theoretical terms, or scientifically essentialized categories. Still, just as Lauren Berlant and Michael Warner explored the power of counter-publics through a now infamous example of erotic vomiting in a Chicago gay bar, so too can a peculiar exemplar or representative anecdote lend insight into the normative forces of culture.65
Let’s consider the 1989 film Steel Magnolias, which probably influenced public perceptions of type 1 diabetes more than any other popular culture artifact in a generation. When I was hospitalized after being diagnosed, a good friend walked into the ICU where I was recovering and declared, with unbridled bravado, “Drink your juice, Shelby!!!” He was referencing a character in the film, played by Julia Roberts, who lives with an especially perilous form of type 1 diabetes. During a pivotal scene in the movie, Shelby experiences a violent bout of hypoglycemia in the salon, Truvy’s Beauty Spot, where much of the film takes place. Her mother, played by Sally Field, forces Shelby to drink juice to rectify the medical emergency. Shelby resists the sugary drink and shakes uncontrollably during this portion of the film while her mother infantilizes her in front of the other characters. This intense interaction is perhaps the most iconic scene of the production (the spectacle helped to garner Oscar nominations for both Roberts and Field). Although I take some exception to the exaggerated nature of hypoglycemia as it is depicted in the film, it is likely no accident that one of the most common refrains I encounter, part of the “absent archive” of my everyday life, is people believing that juice is the most effective antidote when my blood sugar is low.66 As generative as the film has been to the camp lexicon, it problematically depicts diabetes as an explosive condition, one that is both dangerous and, appropriate to the genre, utterly dramatic.67 As life-threatening as hypoglycemia may be to people