Biomedicalization and the Practice of Culture: Globalization and Type 2 Diabetes in the United States and Japan

By Mari Armstrong-Hough | Go to book overview

CHAPTER TWO
Cavemen Didn’t Get Diabetes
American Narratives about the Origins of Type 2 Diabetes

Sofie Loftis, an athletic blonde in her midthirties, told me she doesn’t look the part. Though a publicist for a professional sports team sponsored by a pharmaceutical company known for its oral and injectable antidiabetics, she avoids mentioning her polycystic ovary syndrome (PCOS)-related type 2 diabetes to strangers. Most people, she has learned, do not take the news gracefully. Surprised, they blurt out objections: “But you’re so fit!” A slim, overachieving endurance athlete who once walked for most of a day with an excruciating knee injury rather than permit a brace to ruin the line of her dress, Sofie’s social identity revolves around extraordinary discipline. She is not the sort of person Americans think is supposed to get diabetes.

This chapter introduces American discourse on the origins of the diabetes epidemic. I argue that this discourse emphasizes universal risk and rests on pervasive perceptions that illness arises when one treats the body in ways that are “unnatural.” Popular accounts portray the road to health as a life disciplined by natural rhythms, in contrast to the stress- and temptation-filled lives that are possible in modern America. Popular understanding of diabetes risk rests largely on what anthropologist Leslie Aiello and biologist Marlene Zuk have memorably labeled “paleofantasy,” the widely accepted but empirically suspect just-so stories of evolutionary history that pervade American popular culture. This powerful narrative on the origins of the type 2 diabetes epidemic emphasizes universality of diabetes risk to all citizens of modernity, alongside the idea that groups associated with certain lifestyles put themselves at higher risk by behaving in evolutionarily unprecedented or unwise ways. Americans strongly associate diabetes with obesity, and this association is burdened with moralistic overtones that overshadow the socioeconomic and genetic patterning of diabetes risk. Even health care providers draw on this narrative, speaking in interviews of “my-fault diabetes,” informally observed correlations between “type  personalities” and diabetes, and the emotional work of fairly treating patients with illness that arose at least in part from their “own” behavior.

In this chapter, I synthesize findings from the various literatures on patient models of type 2 diabetes, analysis of popular discourse in the popu-

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